p53基因突变与肺癌亚临床诊断

１ｐ５３基因与肺癌现代医学遗传学研究显示［１］：肺癌的发生、发展是一个多阶段、多步骤、渐进演化的过程。从早期形态上的不典型增生,到癌变过程的结束,发生了一系列遗传学改变。该过程涉及到众多原癌基因的激活和肿瘤抑癌基因的失活。ｐ５３肿瘤抑制癌基因的突变是...     

螺旋CT多平面重建判断周围型肺癌与叶间胸膜的关系

目的评估螺旋CT多平面重建(MPR)在周围型肺癌侵犯叶间胸膜方面的应用价值。方法47例在肺裂附近的周围型肺癌患者进行螺旋CT检查,在病灶附近进行薄层扫描,而后行MPR重建,主要研究叶间胸膜与肿瘤的关系,重建结果与开胸手术结果相比较。结果螺旋CTMPR均能较清楚的显示水平裂及斜裂,仅有1例患者水平裂显示不清,轴位CT有7例不能正确评价水平裂与肿瘤的关系,与手术结果比较,轴位CT侵犯斜裂的敏感性为74.3%,CTMPR侵犯斜裂的敏感性为100%。结论螺旋CTMPR在评估肺癌有与叶间裂的关系的准确性与敏感性明显高于轴位CT。     

HIF-1α、GLUT-1和MMP-2在非小细胞肺癌中的表达

目的 研究缺氧诱导因子1α(HIF-1α)、葡萄糖转运蛋白1(GLUT-1)和基质金属蛋白酶2(MMP-2)在非小细胞肺癌(NSCLC)组织中的表达及临床意义.方法 应用RT-PCR法和免疫组化检测80例NSCLC组织和26例癌旁正常肺组织中HIF-1α、GLUT-1和MMP-2 mRNA和蛋白表达,并分析其与临床病理特点之间及三者相互关系.结果 NSCLC组织中HIF-1α和GLUT-1、MMP-2 mRNA、蛋白阳性表达率明显高于癌旁正常肺组织(P＜0.01),有淋巴结转移的表达高于无淋巴结转移者,中晚期(Ⅲ～Ⅳ期)肺癌组织中的表达高于早期(Ⅰ～Ⅱ期)(P＜0.05).HIF-1α与GLUT-1、MMP-2 mRNA蛋白表达呈正相关(P＜0.01).结论 HIF-1α、GLUT-1和MMP-2在NSCLC组织中的过表达与肺癌的生长、侵袭转移有密切关系,联合三者的检测有助于判断NSCLC的转移、分期以及评估患者的预后.     

肺曲菌病20例诊治分析

随着临床诊疗技术的发展,抗生素、激素等药物的广泛应用,尤其是肿瘤、器官移植患者显著增多,真菌感染已成为日益严重的临床问题。肺曲菌病这一过去少见的肺部真菌感染性疾病近年来发病率也呈增高趋势。为进一步提高对该病的认识,减少误诊、漏诊,现将本院1996~2004年门诊及住院收治的20例肺曲菌病作一回顾性分析。一、临床资料1.一般资料:20例患者中男11例,女9例,年龄23~67岁。病程15 d~4年,平均1年。多数有基础疾病,其中3例肺结核,2例肺癌,2例急性淋巴细胞性白血病,1例干燥综合征,1例糖尿病,1例因子宫肌瘤行子宫全切术,余无基础疾病。主要临…     

口服青霉素V钾致皮肤过敏1例

病例介绍：患者陈××，女，３８岁，工人。因患上呼吸道感染口服青霉素Ｖ钾０．２５克，服后数分钟即出现双手掌搔痒、发红，１０分钟后出现面部肿胀发紧、面部皮肤发红、发热、全身搔痒并出现红色药疹，即到我院就诊。患者精神紧张，面部发红、肿胀、双手不停的搔痒无呼吸困难，既往无青霉素过敏史，服用青霉素Ｖ钾片时未同时服用其他任何药品，故可排除其他药物过敏。给予立即停用青霉素Ｖ钾药物，地塞米松１０ｍｇ静推，静脉滴人５％，葡萄糖５００ｍｌ加维生素Ｃ２克，病人皮肤搔痒及面部肿胀逐渐好转，皮疹消失。体会：口服青霉素类药…     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.     

骨桥蛋白、核因子-κB p65在非小细胞肺癌中的表达

目的 探讨骨桥蛋白(OPN)和核因子-κB p65(NF-κB p65)在非小细胞肺癌(NSCLC)中的表达及两者与临床病理特征的关系.方法 采用免疫组化检测80例NSCLC和21例正常肺组织中OPN和NF-κB p65的表达,并分析OPN和NF-κB p65的表达与NSCLC临床病理特征及患者生存时间之间的关系.结果 OPN和NF-κB p65在NSCLC中表达阳性率分别为63.75%、61.25%,在正常肺组织中表达阳性率分别为23.81%、9.52%.NSCLC中OPN和NF-κB p65表达显著高于正常组织(P＜0.05).OPN和NF-κB p65的表达率与患者的淋巴结转移、TNM分期有密切关系;OPN表达还与患者组织学类型有关(P＜0.05).OPN和NF-κB p65为负性预后冈子;OPN和NF-κB p65之间呈正相关.结论 OPN和NF-κB p65在肺癌巾高表达,OPN和NF-κB p65阳性表达提示预后不良.     

高龄老年高血压患者动态血压特点

目的探讨高龄老年高血压患者动态血压特点。方法选择我院心血管内科及老年医学科住院的高血压患者265例,按年龄分为高龄老年组(年龄≥80岁)94例、老年组(60～79岁)90例和60岁组81例,行动态血压监测,分析其血压节律、3个时段(24h、昼间及夜间)血压均值及血压变异性的特点。结果高龄老年组和老年组杓型血压发生率、24h舒张压、昼间舒张压、昼间平均压、夜间舒张压明显低于60岁组,反杓型血压发生率、24h脉压、昼间脉压、夜间收缩压、夜间脉压明显高于60岁组(P0.05,P0.01);高龄老年组杓型血压发生率及24h、昼间、夜间舒张压明显低于老年组[13.83%vs 26.66%,(66.17±7.39)mm Hg(1mm Hg=0.133kPa)vs (70.39±10.96)mm Hg,(66.90±7.55)mm Hg vs (70.88±11.68)mm Hg,(64.10±8.14)mm Hg vs (68.27±11.86)mm Hg,P0.05,P0.01],24h、夜间脉压明显高于老年组(P0.05,P0.01),昼间收缩压变异明显高于老年组和60岁组,24h收缩压变异高于60岁组,差异有统计学意义(P0.01);老年组24h平均压明显低于60岁组(P0.05)。结论高龄老年高血压患者动态血压表现出血压节律异常、脉压增大、血压变异性升高等特点。     

肺重复癌——附19例临床分析

肺重复癌是指肺多原发癌加上肺与其它脏器重复癌。本文报道经病理学确诊的肺重复癌１９例，就其发病率、危险因素、好发部位、诊断和治疗、预后进行分析讨论，强调区分多原发癌抑或转移癌的重要性，后者只能姑息治疗，而前者却有根治希望。