多西他赛联合贝伐单抗治疗激素难治性前列腺癌临床疗效

目的研究多西他赛联合贝伐单抗对激素难治性前列腺癌(hormone refractory prostate cancer,HRPC)的临床疗效。方法选取2011年4月—2013年4月在我院就诊的HRPC 74例,最小随机化法分为化疗组和联合治疗组,每组37例;化疗组采用多西他赛联合泼尼松治疗方案,联合治疗组在化疗组用药基础上加用贝伐单抗（5 mg/kg）。观察无病生存时间、总生存时间、血清前列腺特异性抗原(prostate specific antigen,PSA)、前列腺体积、最大尿流率、生活质量。结果治疗后,联合治疗组中位无病生存时间10个月、中位总生存时间22个月高于化疗组的7个月和17个月(P<005),联合治疗组PSA值低于化疗组,联合治疗组游离PSA/总PSA高于化疗组（P<005）,2组比较前列腺体积、最大尿流率变化及生活质量评分差异均无统计学意义（P>005）,联合治疗组不良反应发生率6486%高于化疗组的4865%（P<005）。结论联合应用贝伐单抗可以延长患者生存时间,但其他疗效仍需进一步研究。随着HRPC转化医学研究的深入,免疫治疗、靶向治疗、个体化治疗及药物联合应用必将成为HRPC研究热点。     

米非司酮联合利凡诺用于中期引产的效果及对孕妇血清激素水平的影响

目的:探讨米非司酮联合利凡诺用于中期引产的疗效及对孕妇血清激素水平的影响.方法:将来我院要求进行终止妊娠的中期妊娠孕妇随机分成两组,对照组和观察组各52例,对照组采用单独使用利凡诺引产,观察组则采用利凡诺联合米非司酮引产.比较两种引产方法对孕妇血清激素水平和血流动力学指标影响的差异,统计两种方法的疗效差异.结果:术前两组间各项激素水平均无统计学差异(P＞0.05);注射利凡诺24 h后,观察组泌乳素、雌二醇、孕酮及VEGF水平显著低于对照组,而IG-FBP-1则高于对照组,差异具有统计学意义(P＜0.05).除术中观察组血氧饱和度高于对照组,差异具有统计学意义(P＜0.05),其余血流动力学指标组间差异均无统计学意义,但观察组的波动较小.观察组宫缩发动时间和总产程显著低于对照组,产后2h出血量少于对照组,差异具有统计学意义(P＜0.05).观察组术中疼痛情况明显轻于对照组.结论:米非司酮联合利凡诺用于中期引产,对血清激素的影响大于利凡诺单用,而且对患者生命体征影响较小,引产效果更优.     

黑升麻类药物莉芙敏治疗更年期症状临床疗效观察

目的:研究黑升麻(black cohosh)异丙醇提取物莉芙敏治疗更年期症状的有效性。方法:以随机、双盲对照方法,入组40～55岁围绝经期妇女89例,其中12例中断治疗,77例入组。莉芙敏组45例,口服莉芙敏片28mg,每天2次,连续用药12周;安慰剂组32例。以Kupperman绝经期指数(KM I)总分为主要疗效指标,在治疗前、治疗第4、12周时进行观察、以肝功(谷草转氨酶及谷丙转氨酶)、血脂4项(总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯)、血清中促卵泡生成素(FSH)、雌二醇(E2)、子宫内膜厚度、阴道脱落细胞成熟值评分(VM I),进行用药前后比较。结果:(1)用药前两组各指标之间无统计学差异(P>0.05);(2)治疗4周时,莉芙敏组KM I评分为12.46±6.96,安慰剂组为19.63±11.09;治疗12周时,莉芙敏组KM I评分为6.37±4.16,安慰剂组为17.41±11.61,两组差异有统计学意义(P<0.005)。莉芙敏组KM I评分和潮热次数明显低于安慰剂组;(3)高密度脂蛋白(HDL)安慰剂组从基线水平60.20±16.37降至第12周56.63±12.67,莉芙敏组由58.32±11.64上升至59.74±10.54,差异有统计学意义(P=0.04)。GOT及GPT、FSH、E2在12周的莉芙敏治疗后无显著变化;(4)莉芙敏组与安慰剂组在治疗前后12周,对子宫内膜厚度均无影响。结论:在不能给予或拒绝激素替代疗法的更年期妇女中,莉芙敏(56mg/d)能够有效、安全改善妇女的围绝经期症状。     

青壮年男性获得性性腺功能减退症诊疗现状

青壮年男性获得性性腺功能减退症是指性与生育能力发育正常的青壮年男性因各种病因所致的性腺功能减退。诊断该病时需查找病因,睾酮替代治疗是除病因治疗外非常重要的治疗手段,需严格掌握其禁忌证及不良反应并在治疗中严密监测随访。对于有生育需求的患者可以使用促性腺激素或促性腺激素释放激素等治疗。     

The Influence of Hormone Therapy on secondary diabetes mellitus in Breast Cancer: A Meta-analysis

BackgroundGrowing evidences have implied that patients with primary breast cancer (BC) were at increased risks of developing diabetes mellitus (DM). However, as a major adjuvant treatment, the influence of hormone therapy (HT) on secondary DM in primary BC remains controversial; we conducted a meta-analysis of existing studies to evaluate the association of hormone therapy and secondary DM.MethodsWe searched online databases (PubMed, EMBASE, the Cochrane library, Scopus, and Google Scholar) for studies exploring the influence of hormone therapy on secondary DM in BC. The summarized effect sizes (ES) and 95% confidence interval (95% CI) are calculated by STATA software utilizing fixed-effect or random-effect models, depending on the heterogeneity of the eligible studies.ResultsUltimately, 7 retrospective publications including a total of 44,524 primary BC patients are eligible in present meta-analysis. HT use significantly increased the risk of developing DM in primary BC patients, whenever compared with NON–HT BC patients (pooled adjusted HR 1.30, 95% CI: 1.19-1.43) or NORMAL participants (HR 1.19, 95% CI: 1.14-1.25). As to specific HT medications, our sub-analysis demonstrates the risk for DM in tamoxifen (TAM) users elevates by 30% than NON–TAM use BC patients (pooled HR 1.30, 95% CI: 1.20-1.40) and by 18% than NORMAL participants (pooled HR 1.18, 95% CI: 1.12-1.24). However, for aromatase inhibitors (AIs) users, the risks for DM do not elevate significantly. Funnel plots and Egger's tests are used to evaluate publication bias and no apparent bias is detected in all analysis.ConclusionThe present study is the first meta-analysis which thoroughly reveals that adjuvant HT is a risk factor of secondary DM in primary female BC patients. As to specific HT medications, TAM use significantly enhances the incidence of secondary DM, while AIs use does not influence the DM incidence significantly. Our results can help clinicians to tailor more appropriate strategies for the therapy and follow-up of primary BC patients.     

危重症患儿应激性高血糖相关及伴随指标与预后分析

目的分析危重症患儿可能导致应激性血糖升高及相关激素水平的变化,以及伴随的细胞因子和血脂水平的改变,为危重症患儿的治疗提供依据。方法以2007年1月至2008年4月广州市妇女儿童医疗中心PICU收治的〈14岁危重症患儿为危重症组,以入住PICU时的2次静脉血糖均≤6.1 mmol.L-1为正常血糖亚组,均〉6.1 mmol.L-1为高血糖亚组;以同期健康查体的健康儿童为对照组。观察期间危重症组血糖〈4.0 mmo.lL-1或2次血糖〉10.0 mmo.lL-1的患儿退出观察。以入住PICU当日（0 d）、3 d和5 d为观察时点,测定血糖、皮质醇、生长激素（GH）、胰岛素、胰岛素样生长因子-（IGF-1）、超敏C反-应蛋白（Hs-CRP）、IL-1、IL-6及血脂水平。结果正常血糖亚组10例,高血糖亚组53例,对照组15例进入分析。①高血糖亚组入住PICU 0 d的血糖水平最高,之后呈下降趋势。②高血糖亚组各观察时点皮质醇、胰岛素水平显著高于正常血糖亚组和对照组;GH和IGF-1水平与正常血糖亚组和对照组差异无统计学意义。③高血糖亚组和正常血糖亚组0 d、3 d和5 d Hs-CRP水平呈升高趋势,两亚组差异有统计学意义;0 d高血糖亚组IL-6、三酰甘油水平显著高于正常血糖亚组和对照组;3 d和5 d高密度脂蛋白水平显著低于正常血糖亚组。④高血糖亚组死亡8/53例（15.1%）,死亡患儿0 d血糖、皮质醇和胰岛素水平均高于存活患儿。结论应激性高血糖的发生与皮质醇和胰岛素水平有关;可伴随细胞因子和脂质代谢的异常。血糖、皮质醇和胰岛素水平较高可能提示预后不良。     

Hormone replacement therapy in the geriatric patient: current state of the evidence and questions for the future. Estrogen, progesterone, testosterone, and thyroid hormone augmentation in geriatric clinical practice: part 1

This article presents an up-to-date review of the literature on hormone augmentation in the elderly to help primary care physicians better evaluate and utilize hormone replacement and optimization strategies to benefit their patients. The scientific literature suggests that hormone supplementation with estrogen, progesterone, testosterone, growth hormone, and thyroid hormone has the potential to improve quality of life and to prevent, or reverse, the many symptoms and conditions associated with aging, including fatigue, depression, weight gain,frailty, osteoporosis, loss of libido, and heart disease. Possible long-term side effects are also considered.     

Serum kisspeptin levels in Korean girls with central precocious puberty

Central precocious puberty (CPP) is caused by premature activation of hypothalamic gonadotropin-releasing hormone (GnRH) secretion. Kisspeptin and G-protein coupled receptor-54 system is the essential gatekeeper of the reproductive system, playing a key role in the activation of the gonadotropic axis at puberty. We aimed to determine whether serum kisspeptin may function as a marker for CPP by investigating serum kisspeptin levels in Korean girls with CPP and their prepubertal controls. Serum kisspeptin levels of Korean girls with CPP (n = 30) and age-matched healthy prepubertal controls (n = 30) were measured with a competitive enzyme immunoassay. Serum kisspeptin levels were significantly higher in CPP group than in control group (4.61 ± 1.78 vs 2.15 ± 1.52 pM/L, P < 0.001). Serum kisspeptin was positively correlated with peak luteinizing hormone (LH), peak/basal LH ratio and peak LH/follicular-stimulating hormone (FSH) ratio during GnRH stimulation test. CPP is supposed to be triggered by premature increase of kisspeptin. Serum kisspeptin may be used as a marker of CPP. Further studies on KISS1 gene polymorphisms leading to higher risk of premature increase of kisspeptin and upstream regulator of kisspeptin are also needed.     

危重症患儿应激性高血糖相关及伴随指标与预后分析

目的 分析危重症患儿可能导致应激性血糖升高及相关激素水平的变化,以及伴随的细胞因子和血脂水平的改变,为危重症患儿的治疗提供依据.方法 以2007年1月至2008年4月广州市妇女儿童医疗中心PICU收治的<14岁危重症患儿为危重症组,以入住PICU时的2次静脉血糖均≤6.1 mmol·L-1为正常血糖亚组,均>6.1 m...     

早期激素性股骨头缺血坏死CT灌注、三维重建及病理相关性的实验研究

目的:分析激素性股骨头缺血坏死(ANFH)模型不同时期的股骨头CT灌注及三维重建情况,并与病理学结果相对照。方法:30只健康日本大耳白兔,分别于给药后2周、4周、6周、8周及10周以相同方法行CT三维重建及灌注扫描,绘出股骨头的时间—密度曲线,分析股骨头不同阶段3D图像及BF、BV及MTT灌注值。处死后取材采用HE染色光镜下观察不同给药时间股骨头内空骨陷窝数及微血管数。结果:在给药后6周,MPR上出现点状或小条状骨质增生硬化及囊变,8周、10周出现节裂现象及股骨头塌陷。在给药后2周、4周,BF、BV开始下降;6周、8周,BF、BV明显下降,10周,BF、BV不降反升。给药各时间段MTT变化不明显。股骨头内空骨陷窝数及微血管数出现先下降后上升的表现。结论:三维CT对早期股骨头缺血坏死的诊断价值不大,而CT灌注能够较全面反映早期激素性ANFH的病理变化。