DNA甲基转移酶在肝癌中的表达及其临床意义

Objective To investigate the expression of DNA methyltransferases (DNMTs) in liver cancer and its clinical significance. Methods The specimens of liver cancer tissues, adjacent tissues, cirrhotic tissues and chronic hepatitis tissues were collected from 50 patients who received radical resection at the First Affiliated Hospital of Sun Yat-Sen University from July 2007 to April 2008. The mRNA and protein expressions of DNMT1,DNMT3a and DNMT3b in liver cancer tissues, adjacent tissues, cirrhotic tissues and chronic hepatitis tissues were detected by real-time quantitative PCR and immunohistochemical staining. The mRNA expression of DNMTs in the liver cancer tissues was compared with those in the adjacent tissues, cirrhotic tissues and chronic hepatitis tissues by using t test and Mann-Whitney U test. The correlation between the protein expression of DNMTs in the liver cancer tissue and the clinicopathological features was analyzed by chi-square test or Fisher exact test, and the tumor-free survival time was analyzed by using Kaplan-Meier method and the difference in tumor-free survival rate between different patients was analyzed by Log-rank test. Results The mRNA expressions of DNMT1, DNMT3a and DNMT3b in the liver cancer tissue were 2.57, 2.29 and 4.86 times higher than those in the adjacent tissues (t = 3.94, 2. 72, 4. 06, P ＜ 0.05 ). The mRNA expressions of DNMT1, DNMT3a and DNMT3b were 2.38,2.14 and 4.66 times higher than those in the cirrhotic tissues, and 6.12, 4.58 and 12.99 times higher than those in the chronic hepatitis tissues. The mRNA expressions of DNMT1, DNMT3a and DNMT3b in the liver cancer tissue were significantly higher than those in the cirrhotic tissues and chronic hepatitis tissues ( U = 587.5,730. 0,562.5; 65.5, 64.5, 71.0, P ＜ 0.05). The protein expression of DNMT1 was correlated with the size, number,TNM stages and vascular invasion of tumors ( x2 = 4.08, 5.95, 4.08, P ＜ 0.05 ). The protein expression of DNMT3a was correlated with the size, number and TNM stages of tumors (x2 = 4.08, 5.95, 4.08, P ＜ 0.05 ).The mean tumor recurrence time of patients with low expressions of DNMT1 and DNMT3a were 9.4 and 8.7 months, which were significantly longer than 5.0 and 3.2 months of those with high expressions of DNMT1 and DNMT3a (x2 =3.89, 9.91, P＜0.05). Conclusions DNMTs play an important role in hepatocarcinogenesis.High expressions of DNMT1 and DNMT3a are correlated with the postoperative recurrence of liver cancer, which are valuable prognostic factors for liver cancer.     

益气活血法治疗冠心病拾遗

冠心病多属中医学的“心悸”,“胸痹”,“真心痛”范畴。临床均有不同程度的心悸,气促,胸闷,胸痛等症状。舌质或暗红,或淡紫,或有淤点,淤斑,脉多弦涩,细弱或结代。观其脉症,本病可概之为本虚标实之证,且以心气亏虚为本,血脉淤阻为标。祖国医学认为“心主血脉”,心气是推动血液循行的动力,心气充沛,鼓动有力,能帅血运行,则血流畅利无淤阻。反之,心气虚弱,无力推动血液正常运行即可发生气血淤滞,血脉痹塞不适,而见胸闷,胸痛,心悸,气促等证。     

DNA甲基转移酶在肝癌中的表达及其临床意义

目的 探讨DNA甲基转移酶(DNMTs)在肝癌中的表达及其临床意义.方法 收集2007年7月至2008年4月中山大学附属第一医院行根治性切除的50例肝癌患者的肝癌组织、癌旁组织、肝硬化组织和慢性肝炎组织.采用RT-PCR和免疫组织化学方法检测肝癌组织及癌旁组织中DNMT1、DNMT3a、DNMT3b mRNA与蛋白表达水平,采用配对t检验和Mann-Whitney U检验比较肝癌组织与癌旁组织,肝硬化组织与慢性肝炎组织DNMTs mRNA表达的差异,x2检验和Fisher确切概率法分析肝癌组织DNMTs蛋白表达与临床病理因素的相关性,Kaplan-Meier法分析患者无瘤生存时间,不同患者无瘤生存时间的比较采用Log-rank检验.结果 肝癌组织中DNMT1、DNMT3a、DNMT3b mRNA的表达水平分别为癌旁组织的2.57、2.29和4.86倍(t=3.94,2.72,4.06,P＜0.05).肝癌组织中DNMT1、DNMT3a、DNMT3b mRNA的表达分别是肝硬化组织和慢性肝炎组织的2.38、2.14、4.66倍和6.12、4.58、12.99倍.DNMT1、DNMT3a、DNMT3b mRNA在肝癌组织的表达显著高于其在肝硬化组织和慢性肝炎组织中的表达(U=587.5、730.0、562.5,65.5、64.5、71.0,P＜0.05).DNMT1蛋白表达与肿瘤大小、数目、有无血管侵犯、TNM分期有关(x2=5.24,4.08,4.08,14.13,P＜0.05);DNMT3a蛋白表达与肿瘤大小、数目、TNM分期有关(x2=4.08,5.95,4.08,P＜0.05).DNMT1和DNMT3a低表达者平均肿瘤复发时间分别为9.4个月和8.7个月,显著长于高表达者的5.0个月和3.2个月,两者比较,差异有统计学意义(x2=3.89,9.91,P＜0.05).结论 DNMTs在肝癌发生、发展中起重要作用;DNMT1与DNMT3a高表达与肿瘤切除术后复发密切相关,可望成为肝癌预后的重要预测因子.

Abstract：

Objective To investigate the expression of DNA methyltransferases (DNMTs) in liver cancer and its clinical significance. Methods The specimens of liver cancer tissues, adjacent tissues, cirrhotic tissues and chronic hepatitis tissues were collected from 50 patients who received radical resection at the First Affiliated Hospital of Sun Yat-Sen University from July 2007 to April 2008. The mRNA and protein expressions of DNMT1,DNMT3a and DNMT3b in liver cancer tissues, adjacent tissues, cirrhotic tissues and chronic hepatitis tissues were detected by real-time quantitative PCR and immunohistochemical staining. The mRNA expression of DNMTs in the liver cancer tissues was compared with those in the adjacent tissues, cirrhotic tissues and chronic hepatitis tissues by using t test and Mann-Whitney U test. The correlation between the protein expression of DNMTs in the liver cancer tissue and the clinicopathological features was analyzed by chi-square test or Fisher exact test, and the tumor-free survival time was analyzed by using Kaplan-Meier method and the difference in tumor-free survival rate between different patients was analyzed by Log-rank test. Results The mRNA expressions of DNMT1, DNMT3a and DNMT3b in the liver cancer tissue were 2.57, 2.29 and 4.86 times higher than those in the adjacent tissues (t = 3.94, 2. 72, 4. 06, P ＜ 0.05 ). The mRNA expressions of DNMT1, DNMT3a and DNMT3b were 2.38,2.14 and 4.66 times higher than those in the cirrhotic tissues, and 6.12, 4.58 and 12.99 times higher than those in the chronic hepatitis tissues. The mRNA expressions of DNMT1, DNMT3a and DNMT3b in the liver cancer tissue were significantly higher than those in the cirrhotic tissues and chronic hepatitis tissues ( U = 587.5,730. 0,562.5; 65.5, 64.5, 71.0, P ＜ 0.05). The protein expression of DNMT1 was correlated with the size, number,TNM stages and vascular invasion of tumors ( x2 = 4.08, 5.95, 4.08, P ＜ 0.05 ). The protein expression of DNMT3a was correlated with the size, number and TNM stages of tumors (x2 = 4.08, 5.95, 4.08, P ＜ 0.05 ).The mean tumor recurrence time of patients with low expressions of DNMT1 and DNMT3a were 9.4 and 8.7 months, which were significantly longer than 5.0 and 3.2 months of those with high expressions of DNMT1 and DNMT3a (x2 =3.89, 9.91, P＜0.05). Conclusions DNMTs play an important role in hepatocarcinogenesis.High expressions of DNMT1 and DNMT3a are correlated with the postoperative recurrence of liver cancer, which are valuable prognostic factors for liver cancer.     

院前低压复苏对严重创伤出血患者肝肾器官功能及凝血功能的影响

目的:对比严重创伤出血患者院前采用适度低压复苏与常压复苏的效果。方法:纳入我院急诊科收治的严重创伤出血患者共107例作为研究对象,抽签法将所纳入的患者分为常压组53例、低压组54例,其中常压组患者在院前接诊止血前行常压复苏[将平均动脉压(Mean Arterial Pressure,MAP)维持在为80 mm Hg左右],低压组患者行低压复苏(将MAP维持在60 mm Hg左右)。对比两种不同压力液体复苏对患者输液量、输血量、凝血功能及肝肾功能的影响。结果:低压组患者的术前输液量、术中输液量及术中输血量均低于常压组(P<0.05);术后12 h低压组患者的肝肾功能指标门冬氨酸转氨酶(Aspartate Aminotransferase,AST)、丙氨酸转氨酶(Alanine Aminotransferase,ALT)、尿素氮(Blood Urea Nitrogen,BUN)及凝血功能指标部分凝血活酶时间(Activated Partial Thromboplastin Time,APTT)及凝血酶原时间(Prothrombin Time,PT)均低于常压组(P<0.05)。结论:院前低压复苏(MAP=60 mm Hg)可减少严重创伤患者的输液输血量,保护肝肾器官及凝血功能。     

脂肪栓塞综合征误诊为脑血管意外2例报告

例1:男性,51岁,因重物砸伤致右胫骨上段裂纹骨折,左胫腓骨中下1/3骨折,在基层医院行左跟骨骨牵引,并多次整复复位,右小腿小夹板固定,伤后8h患者突然神志不清,呼吸急促,转入我院。查体:中度昏迷状,呼吸急促,40分/次,双侧瞳孔缩小约1.5mm,两胸前皮下散在针尖大小出血点,两肺满布湿罗音,肺部X线片呈肺泡间质密度增加,肺门及双下野成斑片团絮状阴影“暴风雪”样改变。诊断:脂肪栓塞综合征。入院后立即给予吸氧,大剂量应用激素,静点低分子右旋糖酐,纠正水电解质紊乱治疗2天后神志恢复,1周愈。 例2:男性,62岁,因车祸致右股骨干骨折,在基层医院给予胫骨结节牵引,并多次整复复位,17h后突然出现意识不清,考虑为脑血管意外而给予相应治疗,72h后病情加重而转入我院。体检:深昏迷,呼吸困难,前胸及颈部散在针尖大小之出血点,肺部X线片呈“暴风雪”佯改变。诊断:脂肪栓塞综合征,立即行人工呼