前列腺移行细胞癌的临床分析(附4例报告)

<正>前列腺移行细胞癌(transitional cell carcinoma,TCC)是临床少见的泌尿系统恶性肿瘤,不易诊治,且转移快、预后差。本院从2005年12月至2010年6月共收治前列腺TCC患者4例,现结合文献就其临床资料进行系统回顾,以利于提高该病的诊治水平。     

前列腺液中B7-H3分子表达对t-PSA灰区内炎性PSA升高的鉴别诊断价值

目的 探讨前列腺液(EPS)中B7-H3分子对血清t-PSA灰区(4～10 ng/ml)内炎性PSA升高患者的鉴别诊断价值.方法 选择2009年12月至2010年4月收治的全部慢性前列腺炎(CP)患者和t-PSA灰区内行前列腺穿刺活检患者共116例,年龄19～80岁,平均40岁.CP 91例,年龄19～49岁,平均31岁.其中慢性细菌性前列腺炎(II型)11例、慢性炎症性非细菌前列腺炎(IIIA型)26例、慢性非炎症性非细菌前列腺炎(IIIB型)54例.t-PSA灰区内接受经直肠超声引导下前列腺穿刺活检患者25例,年龄62～80岁,平均71岁,t-PSA(7.21±2.60)ng/ml.其中穿刺病理结果阳性5例,Gleason评分6分2例、7分2例、8分1例;阴性20例,其中伴炎症细胞浸润11例.采用经直肠按摩法提取EPS.酶联免疫吸附法检测各组EPS B7-H3水平.健康男性对照11例,年龄24～46岁,平均30岁.既往无泌尿系不适症状及手术史.结果 对照组、II型组、IIIA型组、IIIB型组EPS中B7-H3水平依次为(49.81±11.54)、(19.33±13.90)、(17.67±15.76)、(25.14±13.44)ng/ml,穿刺阳性组、阴性不伴炎症组、阴性伴炎症组分别为(26.30±16.32)、(30.23±18.42)、(10.11±5.42)ng/ml.CP各组EPS B7-H3水平均低于对照组,差异有统计学意义(P＜0.01).II型组和IIIA型组间差异无统计学意义(P＞0.05),但均显著低于IIIB型组,差异有统计学意义(P＜0.05).穿刺阴性伴炎症组EPS中B7-H3水平与II型组、IIIA型组比较差异无统计学意义(P＞0.05),但显著低于穿刺阳性组及阴性不伴炎症组,差异有统计学意义(P＜0.05).EPS B7-H3表达检测在t-PSA灰区内诊断炎性PSA升高患者的ROC曲线下面积为0.883(P=0.001),当EPS B7-H3值≤16.24 ng/ml时,诊断敏感性为78.6%,特异性为81.8%.结论 EPS B7-H3表达检测可能成为t-PSA灰区内鉴别诊断炎性PSA升高的新指标,从而减少不必要的前列腺穿刺活检.

Abstract：

Objective To investigate the value of B7-H3 in expressed prostatic secretions (EPS) in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone (4-10 ng/ml). Methods One hundred and sixteen patients from the ages of 19 to 80 years (mean, 40 years) were stu-died. In the group there were 91 chronic prostatitis (CP) patients (mean age 31 years, 19-49 years), including 11 chronic bacterial prostatitis (type II) patients, 26 inflammatory nonbacterial prostatitis (IIIA) patients and 54 noninflammatory nonbacterial prostatitis (IIIB) patients. Transrectal ultrsound guided prostate biopsy was performed on 25 patients (mean age 71 years, 62-80 years) with t-PSA in gray zone (7.21±2.60 ng/ml). Five had positive results, Gleason score was 6 in two cases, 7 in two cases and 8 in one case. Twenty patients had negative results, of whom 11 patients had inflammatory cell infiltration. EPS was collected by transrectal massage, and Enzyme-linked immunosorbent assays (ELISA) were performed for B7-H3 detection. In addition, 11 normal male controls with a mean age of 30 years (24-46 years) were recruited into the study. Volunteers were excluded if they had a history of genitourinary symptoms or surgery.Results The EPS B7-H3 levels of controls, II, IIIA, IIIB groups were 49.81±11.54, 19.33±13.90, 17.67±15.76, 25.14±13.44 ng/ml, respectively. The levels of EPS B7-H3 in positive biopsy, noninflammatory negative biopsy and inflammatory negative biopsy groups were 26.30±16.32, 30.23±18.42, 10.11±5.42 ng/ml, respectively. The highest levels were found in the control group (P<0.01). Compared to the IIIB, B7-H3 levels in II and IIIA groups were significantly lower (P<0.05). There was no significantly difference between II and IIIA groups (P>0.05). The EPS B7-H3 levels in the inflammatory negative biopsy group were statistically lower than in positive biopsy and noninflammatory biopsy groups (P<0.05). But no significant differences were found among inflammatory negative biopsy, II and IIIA groups (P>0.05). Receiver operating curve (AUC=0.883, P=0.001) utilizing EPS B7-H3 levels≤16.24 ng/ml identified patients with inflammatory elevation of PSA with a sensitivity of 78.6% and a specificity of 81.8% from patients with t-PSA in gray zone. Conclusion The EPS B7-H3 detection provides a new way for differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone resulting in a reduction of unnecessary prostate biopsy.     

HPLC-ELSD法测定蛇胆川贝液中牛磺胆酸钠的含量

目的：建立HPLC—ELSD法测定蛇胆川贝液中牛磺胆酸钠的含量。方法：采用Inertsil ODS-3 C18柱（250mm×4．6mm,5μm）,以乙腈（A）-0．003％三乙胺溶液（B）为流动相进行梯度洗脱,流速1．0ml·min^-1,柱温35℃,漂移管温度110℃,气体流速3．5L·min^-1。结果：牛磺胆酸钠在0．102～1．024μg的范围内线性关系良好,r=0．9994,平均回收率为103．69％,RSD为1．04％（n=9）。结论：该方法操作简便,准确性、重复性好,可用于蛇胆川贝液中的牛磺胆酸钠的含量测定。     

青光眼术后虹膜粘连白内障的手术分析

目的分析青光眼术后虹膜粘连的白内障手术。方法对42眼青光眼术后虹膜粘连行虹膜粘连分离、房角分离和超声乳化人工晶状体植入术。结果患者眼压获得良好控制,视力均有不同程度的提高。结论青光眼术后虹膜粘连白内障患者,行虹膜粘连分离、房角分离和白内障超声乳化术人工晶状体植入术后,患眼不仅提高视力,而且眼压亦获得良好的控制。     

剖宫产术后腹壁瘢痕子宫内膜异位症8例临床分析

目的 探讨剖宫产术后腹壁瘢痕子宫内膜异位症的临床表现及特点、治疗和如何预防.方法 回顾性分析1994年1月至2009年12月本院收治的8例剖宫产术后腹壁瘢痕子宫内膜异位症的患者资料.结果 8例患者主要表现为周期性腹壁瘢痕肿块及疼痛,肿块逐渐长大.手术切除病灶术,术后随访.结论 严格掌握剖宫产术的手术指征,降低剖宫产率,注意术中操作,剖宫产术后腹壁瘢痕子宫内膜异位症是可以预防的.     

普连膏联合刺血拔罐治疗银屑病静止期疗效观察

目的:观察普连膏联合放血拔罐治疗银屑病静止期的临床疗效。方法:选取银屑病静止期患者42例,随机分为两组各21例。对照组给予西药地奈德乳膏外用治疗,治疗组给予普连膏外用联合刺血拔罐治疗。通过PASI银屑病面积与严重性评分量表评价皮损情况,DLQI银屑病生活质量指数评价量表评价生活质量;并比较两组临床疗效。结果:治疗组总有效率为95.24%,对照组总有效率为71.43%,两组比较,差异有统计学意义(P﹤0.05);治疗前,两组DLQI评分以及PASI指数比较无显著差异(P﹥0.05);治疗后,治疗组DLQI评分及PASI指数均改善,且优于对照组(P﹤0.05)。结论:采用普连膏联合放血拔罐治疗静止期银屑病患者,临床疗效优于地奈德乳膏外用治疗。     

埃博拉出血热医学观察患者的护理CSCD

埃博拉出血热（Ebola hemorrhagic fever,EHF）是由埃博拉病毒（Ebolavirus）引起的一种急性出血性传染病。人体主要通过接触患者或感染动物的体液、分泌物和排泄物等而感染,临床表现主要为突起发热、出血和多器官损害。EHF病死率高,可达50%～90%。1976年,该病在非洲首次被发现,目前主要在乌干达、刚果、加蓬、苏丹、科特迪瓦、南非、几内亚、利比里亚、塞拉利昂等非洲国家流行。     

泌尿系统产前超声检查在胎儿畸形诊断中的价值

目的：探讨胎儿泌尿系统畸形的超声表现及超声诊断价值。方法：回顾性分析120例产前超声诊断为泌尿系统畸形的胎儿超声图像,并与产后结果进行对照。结果：120例产前超声诊断泌尿系异常的胎儿与产后随访结果基本一致。结论：超声在胎儿泌尿系畸形的诊断及预后评估中起重要的作用。     

Livin及Caspase-3蛋白在肾癌组织中的表达及意义

目的观察Livin及Caspase-3蛋白在肾癌组织中的表达及其临床病理意义。方法采用免疫组化法检测69例肾癌中Livin及Caspase-3蛋白的表达。结果 Livin蛋白在肾癌中的阳性率明显高于肾组织,而Caspase-3则反之。结论 Livin蛋白表达增高与肾癌的临床分期,复发密切相关。检测Livin及Caspase-3有助于提高肾癌侵袭转移能力的评估,并可作为判定肾癌生物学行为的客观指标。