联合检测AFP、CEA和CA199对原发性肝癌的诊断价值及护理

目的探讨AFP、CEA、CA199联检对原发性肝癌的诊断价值。方法均采用化学发光法,测定40例原发性肝癌患者和50例健康对照组的血清AFP、CEA、CA199水平。结果原发性肝癌组血清AFP、CEA、CA199水平明显高于健康对照组(P<0.01)。原发性肝癌组血清AFP、CEA、CA199单独检测时的敏感性分别为67.5%、27.5%和50%,联合检测AFP和CEA或CA199可使检测的敏感性提高到85.0%和90.0%,三者联合检测敏感性达95%,对血清AFP阴性的标本,CA199、CEA敏感性分别为53.8%、23.1%。结论AFP、CEA、CA199联检可以大大提高原发性肝癌尤其是AFP阴性的诊断率。同时加强护理尤为重要。     

Chemoembolization for Hepatocellular Carcinoma in Patients with Extrahepatic Spread: Prognostic Determinants and Appropriate Candidates

Purpose

To investigate treatment outcome, prognostic factors for overall survival, and appropriate candidates for transarterial chemoembolization among patients with hepatocellular carcinoma (HCC) and extrahepatic spread (EHS).

肝癌特异性超抗原SEA(D227A)基因表达载体的构建与表达

目的：构建受AFP顺式作用元件调控的超抗原表达载体，将SEA(D227A)特异性的表达于AFP阳性肝癌细胞膜表面。方法：PCR扩增AFP基因启动子、增强子、linker—CD80tm和SEA(D227A)。将上述片断插入逆转录病毒载体pLXSN的多克隆位点，构建AFP基因顺式作用元件调控的肝癌特异性减毒超抗原表达载体(pLXSN SEA(D227A)—linker—CD80tm)。通过脂质体介导，以表达载体转染表达或不表达AFP的肿瘤细胞系，用RT—PCR和间接免疫荧光染色，检测SEA的表达。结果：成功地将AFP基因的启动子、增强子、linker—CD80tm和SEA(D227A)克隆到逆转录病毒载体pLXSN的多克隆位点，酶切鉴定和DNA序列分析无误，RT—PCR和间接免疫荧光法检测证实，SEA(D227A)能在AFP阳性的肝癌细胞膜特异性表达。结论：AFP顺式作用元件修饰的超抗原表达载体的构建，为下一步用其强化肝癌的免疫治疗奠定了基础。     

孕早中期联合产前筛查实验分析

目的联合孕早期B超及孕中期母血清检测,提高对唐氏综合征(Down′s Syndrom e,DS)患儿的筛查率。方法对孕早期(11-14 w)孕妇进行B超胎儿颈项部透明层厚度(nuchal translucency th ickness,NT)的测定,以及孕中期(14-20 6w)孕妇进行甲胎蛋白(AFP)和游离-β-绒毛膜促性腺激素(Free-β-HCG)两项血清生化指标检测,经特殊软件计算,对可能影响检测结果的部分因素,如年龄、体重、孕周等加以分析校正,对结果为高危的孕妇进行遗传咨询,在知情同意的情况下进行B超和羊水或脐血培养产前诊断。并随访追踪每例筛查孕妇直至胎儿出生。结果筛查4376例孕妇,孕早期B超检出NT高危43例,孕中期母血清检测DS高危252例,神经管缺陷(Nervous tube defect,NTD)高危78例。发现21-三体综合征4例,其它染色体异常2例;另外12例为染色体正常的出生缺陷。结论孕早期B超测定NT及孕中期母血清生化标志物AFP和Free-β-HCG联合应用,对胎儿先天缺陷尤其是对DS产前筛查有效可行,经产前诊断及时采取措施,降低了这些缺陷儿的出生。     

溶血及标本放置对血清甲胎蛋白、β绒毛膜促性腺激素测定的影响

目的了解溶血及血标本放置时间对血清甲胎蛋白(AFP)、游离β绒毛膜促性腺激素(free-β-hCG)测定有无影响。方法在溶血前后分别应用酶联免疫吸附方法(ELISA)测定64名孕妇血清AFP及free-β-hCG浓度;于采血后30m in、1h、2h及3h应用酶联免疫吸附方法(ELISA)分别测定22名孕妇血清AFP及free-β-hCG浓度。结果溶血前后测定血清AFP的浓度无显著性差异;但溶血后free-β-hCG的浓度显著高于溶血前;采血后30m in、1h、2h及3h测定血清AFP及free-β-hCG的浓度无显著性差异。结论溶血对free-β-hCG的测定有一定影响,但对于AFP无明显影响;血标本短时间放置对血清AFP及free-β-hCG的测定无明显影响。     

血清、腹水中AFP、CEA及CA125水平对良、恶性腹水的诊断价值

目的 :探讨检测血清、腹水AFP、CEA及CA1 2 5对良、恶性腹水的诊断价值。方法 :放射免疫分析 86例患者血清和腹水AFP、CEA及CA1 2 5的含量。结果 :恶性腹水组血清、腹水AFP、CEA及CA1 2 5水平较之良性腹水组差异非常显著 (p <0 0 1 )。在鉴别结核、肝硬化腹水和恶性腹水时 ,以CA1 2 5≥ 5 0 0U/ml、AFP≥ 30 0ng/ml为临界值[1 ] ,可提高诊断的特异性和准确性。结论 :血清和腹水中AFP、CEA及CA1 2 5水平具有鉴别良、恶性腹水的重要意义。     

Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation

Background/Aims

The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated.

Methods

Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ± 1.3 ng/mL (mean ± SD).

Results

The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive ¹⁸fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).

Conclusions

Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.     

脂质体转染AFP基因构建树突状细胞肝癌瘤苗及体外活性检测

目的：探讨以ＡＦＰ为靶点，构建ＡＦＰ－ＤＣ肝癌瘤苗及其抗肝癌免疫治疗的可能性。方法：应用脂质体将ＡＦＰ基因转染体外培养的未成熟 ＢＭＤＣ，构建 ＡＦＰ－ＤＣ肝癌瘤苗，以流式细胞术、Ｗｅｓｔｅｒｎ ｂｌｏｔ、３Ｈ－ＴｄＲ法和 ＭＴＴ法等检测其免疫活性。结果：ＡＦＰ－ＤＣ瘤苗不仅能产生和分泌ＡＦＰ，而且能上调自身的Ｂ７分子和ＭＨＣ分子，明显刺激Ｔ细胞增殖及提高ＣＴＬ的杀伤作用。结论：提示肝癌相关基因ＡＦＰ可作为抗肝癌基因治疗的切入点。     

Alpha-fetoprotein-producing lung carcinoma: report of three cases

Three cases of alpha-fetoprotein (AFP)-producing lung carcinoma were studied histologically and immunohistochemically. Samples were obtained from two men and one woman who ranged in age from 64 to 71 years. Serum AFP levels for the three samples were 9826, 74.4 and 24.3 ng/mL. One case was classified as stage IIIA and two as stage IIIB. Two cases were diagnosed as large cell neuroendocrine carcinoma, and AFP expression was detected immunohistochemically. One of these samples showed differentiation to a hepatoid carcinoma, while the other was combined with a squamous cell carcinoma. The remaining case was a squamous cell carcinoma, and AFP was detected in only some of the tumor cells. All patients died within 2 years. The Ki-67 labeling indices of the AFP-producing pulmonary carcinomas (30.2 +/- 4.6%) were significantly higher than those of AFP-negative pulmonary carcinomas (P < 0.05). The high proliferative activity, advanced stage at presentation, vascular endothelial growth factor expression and vascular invasion observed in these tumors may explain the poor prognosis of AFP-producing lung carcinomas.     

孕中期产前筛查30159例结果分析

目的探讨孕妇孕中期血清标记物产前筛查胎儿神经管畸形、染色体异常为主的先天缺陷.方法应用时间分辨荧光检测仪检测孕中期血清标记物(AFP、Fβ-HCG).结果 30159例孕妇中检出各类高风险人群共2154例,其中DS高风险有1844例,占筛查总数的6.1%;NTD高风险有266例,占筛查总数的8.8‰;18三体高风险有44例,占筛查总数的1.4‰.确诊异常胎儿86例,其中染色体异常22例,脊柱裂等异常64例.低风险中发现唐氏综合征2例.异常胎儿在人群中检出率为2.8‰,假阳性率为6.8%.结论孕中期应用母血清二联生化指标进行产前筛查,结合产前诊断是减少出生缺陷发生的一种重要有效手段之一.