鼻咽癌中国1992、2008分期和国际抗癌联盟2010分期标准的比较研究

目的 比较鼻咽癌中国1992、2008分期和国际抗癌联盟(UICC)2010分期标准之间的一致性,评价它们在预测鼻咽癌放疗疗效中的价值.方法 回顾分析2000-2005年间347例无远处转移的初治鼻咽癌患者临床资料,对每例患者分别用中国1992、2008和UICC2010分期标准进行T、N和临床分期.采用Kappa法分析3种分期标准间各期病例数分布的一致性.采用Kaplan-Meier法分别计算3种分期标准的5年总生存率、局部无复发和无远处转移生存率,并用Logrank检验其差异.结果 中国2008分期和UICC 2010分期标准之间的临床分期、T和N分期的病例构成比例的一致性均优于它们各自与1992分期之间的比较,Kappa值分别为0.700、0.881和0.722.3种分期标准下各临床分期的总生存曲线比较只发现Ⅲ与Ⅳ期间的不同,其中2008分期和UICC2010分期标准下Ⅲ与Ⅳ期间的不同(χ2=4.48,P=0.034和χ2=8.88,P=0.003),而1992分期则相似(χ2=0.40,P=0.526).3种分期标准的局部无复发生存率各T1与T2和T2与T3及T3与T4期间的比较均相似(χ2=1.85、0.53、0.50,P=0.174、0.467、0.479和χ2=1.25、2.10、1.99,P=0.264、0.148、0.159及χ2=0.77、0.60、0.87,P=0.381、0.441、0.350).在3种分期标准的各期无远处转移生存率中,1992分期标准的N0与N1、N1与N2、N2与N3间均相似(χ2=3.71、3.11、2.01,P=0.054、0.078、0.156),2008分期标准的N1与N2、N2与N3间不同(χ2=10.49、5.06,P=0.001、0.024);UICC 2010分期标准中仅N1与N2间不同(χ2=7.73,P=0.005).结论 中国2008分期和UICC2010分期标准对鼻咽癌放疗疗效的预测价值相近,且均优于1992分期.

Abstract：

Objective To compare the agreement among Chinese 1992, 2008 and UICC 2010 staging systems of nasopharyngeal carcinoma (NPC) and evaluate their predictive value of radiotherapeutic prognosis.Methods 347 NPC patients without distant metastasis treated in our hospital from 2000 to 2005 were retrospectively analyzed.Every patient was categorized into T, N, and clinical stage by Chinese 1992, 2008 and UICC 2010 staging systems, respectively.Kappa value was used to evaluate the agreement among three systems.Kaplan-Meier method was used to analyze the 5-year overall survival (OS), local-free survival (LFS) and distant metastasis-free survival (DMFS), the difference between subgroup was tested by Logrank.Results The agreement of clinical stage, T and N stage between Chinese 2008 and UICC 2010 staging system was better than that of them compared to 1992 staging system, Kappa value were 0.700、0.881 and 0.722.The agreement of T stage was better than N and clinical stage among these three staging system.The difference of OS between stageⅢ and stage Ⅳ was significant in Chinese 2008 and UICC 2010 staging system (χ2=4.48,P=0.034;χ2=8.88,P=0.003), and with no different in 1992 staging system (χ2=0.40,P=0.526).There was no significant difference of LFS between T1 and T2,T2 and T3,T3 and T4 in all staging systems (χ2=1.85,0.53,0.50,P=0.174,0.467,0.479;χ2=1.25,2.10,1.99,P=0.264,0.148,0.159;χ2=0.77,0.60,0.87, P=0.381,0.441,0.350).There were no significant differencesin 1992 staging system, while there was significant differences of DMFS between N1 and N2, N2 and N3 in 2008 stage system, N1 and N2 in UICC 2010 stage system.Conclusions The predictive value of Chinese 2008 and UICC 2010 staging system for prognosis were similar, and were better than that of 1992 staging system in NPC.     

竹红菌甲素敏化E．coli菌体蛋白光氧化反应及机制

本工作利用ＳＤＳ聚丙烯酰胺胶电泳技术分析了甲素对Ｅ．ｃｏｌｉ菌体蛋白光氧化的敏化作用。实验结果表明，甲素结合光照可引起菌体蛋白降解及交联。甲素敏化菌体蛋白光氧化反应可放单线态氧淬灭剂──ＮａＮ３抑制，但不被各种氧自由基、羟自由基抑制剂所阻断，提示甲素敏化的菌体蛋白光氧化反应属Ⅱ型机制。     

一例17-α羟化酶缺陷症患者临床和CYP17A1基因突变分析

目的 分析1例17-α羟化酶缺陷症患者的临床和CYP17A1基因突变特点.方法 以1例17-α羟化酶缺陷症患者为研究对象,观察其临床表现和辅助检查结果,并对患者及其父母进行CYP17A1基因检测.结果 患者就诊时血压高于正常值,第二性征发育不良;血钾低于正常值.CYP17A1基因检测显示,患者第8外显子9个碱基（TCGACTCTT）缺失,导致第487～489位氨基酸缺失,其母为该部位氨基酸杂合缺失,其父未有异常发现.结论 高血压伴低血钾患者如同时存在性发育不良,应考虑17-α羟化酶缺陷症的可能,CYP17A1基因检测有助于早期诊断.     

腺性膀胱炎中肿瘤相关指标的改变和临床分型的探讨

目的探讨腺性膀胱炎的良恶性及癌变可能性,并探讨临床分型的合理性。方法根据膀胱镜下表现将腺性膀胱炎分为低危型及高危型。25例腺性膀胱炎新鲜组织,其中低危型12例,高危型13例,用流式细胞术检测其DNA含量;38例腺性膀胱炎蜡块组织,其中低危型20例,高危型18例,用免疫组织化学的方法研究增殖细胞核抗原(PCNA)、突变型p53、p21ras、bcl2及Rb等的表达。结果正常二倍体DNA指数为1.00±0.03,低危型腺性膀胱炎组为1.01±0.05,高危型组为1.05±0.07,低危型组和高危型组之间的差异无统计学意义(t=1.639,P=0.115);PCNA及p53在低危型组均表达阴性,在高危型组分别表达5例(27.8%)及4例(22.2%),两组之间的差异有统计学意义(P值分别为0.017、0.041);p21ras、bcl2及Rb在低危型组和高危型组的表达差异无统计学意义。结论高危型腺性膀胱炎和低危型腺性膀胱炎同为良性病变。高危型有发生恶变的可能性,因此将腺性膀胱炎分为高危型及低危型具有合理性。p53基因可能在高危型腺性膀胱炎的恶变过程中有重要作用。     

射频消融治疗家族性预激综合征

报告两例预激综合征患者系一家中两姐妹，均有严重发作性室上性心动过速，药物不能有效控制，行心腔内电生理检查诊断为右后间隔旁道，其姐姐仅有逆传，而其妹妹既有前传，又有逆传，但以逆传为主，在Ｘ线透视下，用射频消融（功率３０Ｗ，阻抗９６～１０５），１０ｓ内均成功阻断旁道的逆传及前传，经静脉点滴异丙肾上腺素及程序刺激不能诱发，随访３～６个月无心动过速发作。     

鼻咽癌放疗性角膜损伤的跟踪研究

目的:探讨鼻咽癌(NPC)放射治疗眼部并发症。方法:对 213 例 NPC 初程放疗患者进行跟踪观察。放疗前、放疗中及放疗后作视功能(包括远视力、裂隙灯活体显微镜、眼底、自动电脑视野及视诱发电位)检查和角膜荧光素染色。结果:发生角膜损伤 19 例,占 8.9 %(19/213)。I～Ⅱ期6 例,Ⅲ期 8 例,Ⅳ期 5 例。全部发病患者均无角膜刺激症状,放疗后 10mo 内,角膜病变消退,但知觉仍较对侧眼明显减退;20mo 后尚未恢复正常。未发现晶状体混浊的患者。结论:NPC 放疗性角膜损伤与鼻咽癌临床分期及照射剂量无密切关系(P>0.05),可能主要与角膜感觉神经损伤导致眼表疾病密切相关;不排除患者不同个体对辐射的敏感差异性。     

Purified protein derivative skin testing on HIV/AIDS patients and logistic regression analysis of its risk factors

Objective: To understand the reactivity of purified protein derivative skin test(PPD test) in HIV-infected persons and to determine the influential factors associated with PPD. Methods: 174 HIV/AIDS patients registered in the local center for disease control and prevention(CDC) participated this study from April to June in 2006. Questionnaire, CD4 count and thoracic roentgenogram were performed for all participants. Results: In this study, response rate of questionnaires was 83.65%. The majority of these participants had a different degree of immunodeficiency that accounted for 93.64%. Female patients had a higher CD4 count than that of males. The total positive rate of PPD was 38.15%. Analysis of single factor in our study indicated that CD4 count, previous tuberculosis history, tuberculosis contact history and thoracic roentgenogram manifestation of patients were related to their PPD diameters. Further analysis of multiple factors also supports the previous conclusion that CD4 count and previous tuberculosis history of patients were risk factors in the PPD test. Conclusion: The PPD test of HIV/AIDS patients could be affected by several factors. For persons infected with HIV, the confirmation of latent tuberculosis infection (LTBI) should be considered the combination effect of previous MTB infection and body cellular immune function.