抗血管内皮细胞单克隆抗体的制备及免疫组化鉴定

本文报道用临床手术切除的肝癌标本制备细胞悬液直接免疫BALB/c小鼠与Sp2/0骨髓瘤细胞融合,在筛选过程中获得一株抗血管内皮细胞的单克隆抗体。该细胞株稳定地在体外连续培养四个月。抗体能直接用于常规福尔马林固定的石蜡包埋的切片染色,不需胰酶消化。经A.B.C法免疫组化染色证明,对全身各脏器血管内皮细胞定位以及30例各种类型血管瘤的内皮细胞染色均呈阳性反应。对起源于内皮细胞的5例血管内皮细胞肉瘤定位4例阳性,1例为阴性。而对血管外皮细胞肉瘤却大部份呈阴性反应。与内皮细胞以外的组织无交叉反应。提示此抗体能识别的抗原可能是Ⅷ因子相关抗原,它对起源于血管的软组织肿瘤的鉴别诊断及免疫组化定位有一定的应用价值。     

胰腺肿瘤伴血糖异常对肿瘤标志物的影响

目的 探讨血糖异常对胰腺肿瘤标志物在胰腺疾病诊断中的影响作用及其临床应用价值.方法 以59例胰腺恶性肿瘤为研究对象,其中包括46例胰腺癌、13例胰腺其他恶性肿瘤,以27例良性疾病患者为对照,采集肿瘤患者术前静脉血,常规离心分离血清进行检测.利用美国雅培公司酶免发光分析仪器及配套试剂进行检测,诊断标准以CA199＞37 kU/L、CA 125＞35 kU/L、癌胚抗原(CEA)＞10 μg/L为阳性.结果 (1)单项检测指标以CA199诊断准确性最高,两两联合检测以CA199+CEA准确性最高,优于单项检测和三者联合,且经x2检验差异具有统计学意义(x2=26.131,P＜0.05).三者联合诊断胰腺肿瘤,只会增加医疗费用,并不能提高诊断的准确性.(2)胰腺肿瘤组各指标平均秩次均高于胰腺良性疾病组,2组之间非参数检验结果如下:CA199(Z=4.682,P=0.000)、CA125(Z=1.866,P=0.062)、CEA(Z=2.573,P=0.010);提示对于鉴别胰腺良恶性疾病,CA199、CEA等指标差异有统计学意义(Z=3.232,P＜0.05;Z=2.573,P=0.010).(3)胰腺肿瘤患者中,血糖异常组与血糖正常组相比,非参数检验结果为CA199(Z=2.265,P=0.024)、CA125(Z=0.736,P=0.462)、CEA(Z=1.536,P=0.125),血糖异常只对CA199影响,差异有统计学意义(Z=2.265,P＜0.05).而在胰腺良性疾病组患者中,差异均无统计学意义(分别为Z=4.214,P＞0.05;Z=3.224,P＞0.05;Z=3.154,P＞0.05).结论 对于胰腺肿瘤的诊断,三种肿瘤指标联合诊断,并不能提高诊断的准确性,只会增加医疗费用;以CA199+CEA联合检测准确性最高;单项检测指标以CA199诊断准确性最高.CA199在对伴有血糖异常的胰腺良恶性疾病的鉴别时,须考虑血糖的影响作用,通过ROC曲线设置不同的CA199调定点,有望达到更优的诊断效能.

Abstract：

Objective To investigate the effect of pathoglycemia on the tumor biomarker expression in pancreatic tumor and assess its influence on the diagnostic value of these biomarkers.Methods We recruited 59 patients with malignant pancreatic tumor in total into this study,including 46 cases with pancreatic carcinoma and 13 cases with other pancreatic malignancies.Twenty-seven patients with benign pancreatic diseases were selected as control.All subjects were extracted venous blood and serum samples were separated by centrifugation.Serum levels of CA199,CA125 and CEA were measured by chemiluminescent microparticle immunoassay(CMIA).The positive expression criteria were designated as ＞37 kU/L for CA199;＞35 kU/L for CA125;＞10 μg/L for CEA.Results (1) CA199 showed the highest diagnostic accuracy when the tumor biomarker was used alone.CA199 plus CEA showed the highest diagnostic accuracy when the biomarkers were used pairwisely,even better than three biomarkers used in combination(x2=26.131,P＜0.05).(2)The average rank of all tumor biomarkers were higher in all malignant pancreatic tumor than benign pancreatic diseases,and some of the differences reached statistically significance(CA199,Z=4.682,P=0.000;CA125,Z=1.866,P=0.062;CEA,Z=2.573,P=0.010).(3)When the malignant pancreatic tumor group were further divided into two groups according to their blood sugar level,we found that CA199 were significantly higher in pathoglycemia group than euglycemia group(Z=2.265,P=0.024),while no significant differences were observed in patients with benign pancreatic diseases when compared between patients with different blood sugar levels(Z=4.214,3.224,3.154,Ps＞0.05).Conclusion The combination use of three tumor biomarkers showed no improvements in the diagnosis of pancreatic neoplasm,but with disadvantage of elevated medical expense.CA199 showed the highest diagnostic accuracy when used alone.CA199 plus CEA showed the highest diagnostic accuracy when the biomarkers were used pairwisely.The blood sugar level should be considered when using CA199 in the differential diagnosis of pancreatic neoplasm from benign pancreatic lesions;a new set-point of CA199 should be set by studying the ROC curve and other statistic index to improve the overall accuracy.     

普外科手术引发切口感染的有关因素及防控措施

目的:针对普外科手术中引发切口感染的有关因素及处置措施进行探讨。方法:收集320例普外科手术患者作为研究对象,将合并切口感染患者作为观察组,没有发生感染患者作为对照组;对比两组患者性别、年龄、全身状况、合并疾病等存在的差异。结果:320例患者中有25例发生合并切口感染,观察组急诊手术多,年龄大,糖尿病多,合并营养不良,手术及住院时间长(P<0.05),这些因素都与切口感染有关。结论:普外科手术中多因素作用可引发切口感染的结果。     

血尿酸水平与冠心病的相关性

目前常见冠心病危险因素除吸烟、高血压、高血脂、糖尿病之外,一些新的冠心病危险因素已引起临床重视,如同型半胱胺酸血症和脂蛋白(α)等.本文通过对我院2002年～2003年的150例住院病例的临床分析,探讨了高尿酸血症与冠心病的关系.     

Tau基因表达与紫杉醇治疗胃癌敏感性的研究

目的:探讨胃癌细胞的Tau基因表达丰度与紫杉醇治疗敏感性间的关系,并分析其可能的耐药机制。方法:通过实时定量PCR筛选出Tau基因高表达和低表达的胃癌细胞株各一,然后观察两细胞株对紫杉醇的反应;并应用细胞增殖实验(CCK8方法)、流式细胞技术(AnnexinⅤ标记)检测紫杉醇在体外对胃癌细胞增殖、凋亡和周期的影响。对于Tau基因高表达的胃癌细胞,通过小干扰RNA(small interfering RNA,siRNA)等技术,观察其敲低Tau基因表达后,对紫杉醇的敏感性有无变化。结果:体外增殖实验显示,紫杉醇对Tau表达低的胃癌细胞的增殖生长抑制作用更为明显(P0.05)。而体外凋亡实验显示,紫杉醇更能促进Tau基因低表达胃癌细胞的凋亡(P0.05),在整个细胞周期中以G2/M期为主。而应用siRNA技术将Tau基因高表达的胃癌细胞降为低基因表达后,紫杉醇对其增殖的抑制作用明显增高(P0.05),更能促进转染后细胞的凋亡(P0.05);且对整个细胞周期,以作用于G2/M期为主。结论:紫杉醇对Tau基因表达低的胃癌细胞具有更强的增殖抑制作用,且更能促进其凋亡。而对干扰后的胃癌细胞,紫杉醇具有更强的抑制增殖作用,且更能促进其凋亡。     

MSCT血管成像技术在主动脉缩窄诊断中的临床价值

目的:评价MSCT血管成像(MSCTA)技术在主动脉缩窄伴心脏畸形诊断中的应用价值。方法:11例主动脉缩窄患者行MSCT平扫和增强扫描,将获得的原始数据进行多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)及仿真内境(VE)等后处理。所有患者术前均行超声心动图检查,对照手术结果及超声心动图,分析MSCTA在诊断主动脉缩窄伴心内畸形中的优缺点。结果:11例患者心内心外畸形共35处,MSCTA共诊断26处(诊断符合率74.3%),其中心外畸形19处(诊断符合率95%),漏诊1处动脉导管未闭,诊断心内畸形7处(诊断符合率46.7%),漏诊2例房间隔缺损和6例瓣膜病变共8处畸形;超声心动图共诊断畸形29处(诊断符合率82.9%),其中诊断心外畸形14处(诊断符合率70%),漏诊主动脉缩窄5例和肺静脉瘤样扩张1例,诊断全部心内畸形(诊断符合率100%)。结论:MSCTA能直观地显示主动脉缩窄的特异征象,明确病变的部位、类型、侧枝血管情况,对于诊断、选择治疗方法、观察术后疗效及随访具有较高的临床应用价值。MSCTA和超声心动图的联合应用是诊断心内心外复杂畸形的最佳方法。     

肾上腺皮质嗜酸细胞肿瘤的CT、MRI诊断

肾上腺皮质嗜酸细胞肿瘤是一种非常少见的病变,国内外报道较少。我院2002年1月～2011年5月期间共收治5例,结合文献对本病的CT与MRI表现、临床和病理特点进行总结,现报告如下。     

Chance骨折1例

患者，男，38岁、干部，坐车时国旅行包滑下，砸伤背部致呼吸困难，腰部剧痛，小能站立，1h为主诉。骨科。查：胸腰部轻肿，压痛，活动受限，L1棘突略向后大．双下肢肌力III级。左大腿外侧感觉障碍。急诊X钱摄腰椎，正侧斜位片示：L1推板模行分离骨折，村拆线向后延伸至椎体，椎体前线压缩，民缩率近50％，Beck指数0．57:1，P12，右侧横大讨折，L1左侧横大，棘突，椎体峡部骨折，L2横交骨折。论断：L1Chance骨折，T12，L1L2横突骨折，L1椎体峡部骨折。治疗：卧硬板床，腰部悬吊牵引，次R双下肢肌力恢复正常，21d畸形复原、左大腿外侧…