艾迪注射液联合化疗对卵巢癌患者血清HE4，CA125，CA19-9，AFP，CEA水平及T细胞亚群的影响

目的:探讨艾迪注射液联合化疗对卵巢癌患者血清人附睾蛋白4(HE4)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、甲胎蛋白(AFP)、癌胚抗原(CEA)及T细胞亚群的影响。方法:选取我院2014年8月至2016年2月收治的78例卵巢癌患者,按照随机数表法将其分为观察组(n=39)和对照组(n=39),对照组患者给予化疗,观察组患者给予艾迪注射液联合化疗,比较两组患者的临床疗效、治疗前后血清HE4、CA125、CA19-9、AFP、CEA水平及T细胞亚群的变化。结果:治疗后,观察组的总有效率(94.87%)显著高于对照组(76.92%)(P0.05)。治疗后,两组患者血清HE4、CA125、CA19-9、AFP、CEA水平均较治疗前明显下降,且观察组显著低于对照组(P0.05)。治疗后,两组患者CD3~+、CD4~+、CD8~+较治疗前均显著降低,且观察组患者CD3~+、CD4~+、CD8~+低于对照组(P0.05)。结论:艾迪注射液联合化疗对卵巢癌治疗效果显著,能有效降低血清HE4、CA125、CA19-9、AFP、CEA水平并改善患者免疫功能。     

谷氨酰胺对胃大部切除患者血清胃泌素、CA72-4及HIF-1α水平的影响

目的:探究谷氨酰胺对胃大部切除患者术后血清胃泌素、CA72-4及HIF-1α水平影响。方法:收集我院56例胃大部切除术后患者,随机分为实验组和对照组,各28例。对照组给予临床常规营养治疗,实验组在对照组基础上给予丙氨酰谷氨酰胺注射液100 m L/d。治疗结束后,比较两组患者临床疗效血清胃泌素、CA72-4、HIF-1α及VEGF-A水平。结果:对照组患者治疗后临床有效率71.43%低于研究组患者治疗后临床有效率92.86%,具有统计学意义(P0.05);对照组患者复发率35.71%明显高于实验组10.71%,具有统计学意义(P0.05)。治疗后与治疗前相比,患者血清胃泌素、CA72-4、HIF-1α及VEGF-A水平均降低(P0.05);与对照组比较,实验组血清胃泌素、CA72-4、HIF-1α及VEGF-A水平较低(P0.05)。结论:谷氨酰胺能有效提高胃大部切除患者术后的临床疗效,防止复发,推测其机制与降低血清胃泌素、CA72-4、HIF-1α及VEGF-A水平有关。     

胃癌根治术后腹腔热灌注化疗对患者血清CEA、CA19-9水平及免疫功能的影响

目的:探讨胃癌根治术后腹腔灌注化疗对患者血清CEA(血清癌胚抗原,carcinoembryonic antigen)、CA19-9(糖链抗原19-9,carbohydrate antigen19-9)水平及免疫功能的影响。方法:回顾性2015年2月至2017年4月我院收治的胃癌患者临床资料,依据接受治疗方案不同分为全身静脉化疗组(对照组)和全身静脉化疗联合腹腔热灌注化疗组(观察组),每组各41例。检测和比较两组患者化疗前(治疗前)与化疗1个月后(治疗后)血清肿瘤标志物CEA、CA19-9与免疫功能指标水平的变化,治疗后毒副作用发生情况及治疗前后生活质量的改善情况。结果:治疗前,两组间血清CEA、CA19-9、CD3~+、CD4~+、CD8~+、CD4+/CD8~+水平比较差异均无统计学意义(P0.05);观察组治疗后血清CEA、CA19-9及CD8~+水平显著低于对照组,CD3~+、CD4~+、CD4~+/CD8~+水平显著高于对照组,差异有统计学意义(P0.05);两组骨髓抑制、恶心呕吐、腹痛腹泻及肠梗发生率比较差异均不显著无统计学意义(P=0.478,0.668,0.315,0.552);观察组生活质量改善总有效率为85.37%,显著高于对照组(70.73%,P=0.017)。结论:与单纯全身化疗相比,胃癌根治术后腹腔灌注化疗可更有效降低患者血清CEA、CA19-9水平,改善患者免疫功能,提高其生活质量,且安全性较高。     

长春瑞滨联合卡铂化疗治疗晚期肺癌的临床观察

目的:探讨长春瑞滨联合卡铂化疗对晚期肺癌的治疗效果和安全性。方法:选取我院肿瘤科收治的晚期肺癌患者60例,根据不同治疗方案分为实验组与对照组,每组各30例患者。比较两组患者治疗前后的CEA、CA50、CYFRA21-1水平、白细胞计数及T淋巴细胞亚群CD4+、CD8+水平的变化。结果:治疗前,两组患者的CEA、CA50、CYFRA21-1水平、白细胞计数及T淋巴细胞亚群CD4+、CD8+水平比较均无统计学差异(P0.05)。治疗后,实验组的CEA、CA50、CYFRA21-1、CD8+水平均明显低于对照组,而白细胞计数及T淋巴细胞亚群CD4+、CD4+/CD8+水平均显著高于对照组,差异均具有统计学意义(P0.05)。结论:与放疗相比,长春瑞滨联合卡铂化疗能显著提高晚期肺癌的疗效,且不降低患者的细胞免疫。     

新辅助化疗与营养支持对老年结肠癌患者T 细胞，COX-2 及tM2-PK水平的影响

目的：探讨新辅助化疗与营养支持综合治疗对老年结肠癌患者血清肿瘤标记物水平、COX-2 及生活质量影响及临床意义。 方法：选取我科收治的老年结肠癌患者80 例,根据治疗方案不同分为对照组与试验组。对照组常规行结肠癌根治切除术,试验组 应用FOLFOX3 方案。比较两组患者血清肿瘤标记物CEA 及CA19-9 水平、COX-2 水平及CD4+、CD8+及tM2-PK 水平。结果：与 治疗前相比,治疗后试验组和对照组CEA 及CA19-9 水平降低（P<0.05),COX-2、tM2-PK 水平降低（P<0.05),CD4+及CD4+/CD8+ 水平降低（P<0.05),CD8+水平升高（P<0.05)。与对照组比较,试验组COX-2、tM2-PK 水平、CD4+、CD8+水平改善明显优于对照组, 差异具有统计学意义（P<0.05),而CEA 及CA19-9 水平组间比较,差异无统计学意义（P>0.05）。结论：新辅助化疗与营养支持综合 治疗可杀伤老年结肠癌患者全身不可见转移肿瘤细胞,控制病情,临床疗效理想。     

CRP联合CA72-4, CEA, CA19-9检测对胃癌早期诊断的临床价值

目的:探究C反应蛋白(CRP)联合胃癌抗原(CA72-4)、癌胚抗原(CEA)、糖类抗原(CA19-9)检测对胃癌早期诊断的临床价值。方法:选择2014年3月~2016年6月我院收治的胃癌患者(103例)为胃癌组,包括早期胃癌患者30例,中晚期患者73例;同期就诊于我院的良性胃病患者为良性胃病组(61例),另选择20例年龄、性别相匹配的健康体检人群为健康对照组。比较三组人群血清C反应蛋白(CRP)、CA72-4、CEA、CA19-9水平,并探讨其表达与胃癌患者临床病理特征之间的关系。结果:早期胃癌组、良性胃病组患者的血清CRP、肿瘤标志物CA72-4、CEA、CA19-9的表达水平及阳性检测率均显著高于健康对照组(P0.05);早期胃癌组的上述指标显著高于良性胃病组(P0.05)。肿瘤分化程度低、发生转移、临床分期为Ⅲ,Ⅳ期胃癌患者的血清CRP、CA72-4、CEA、CA19-9阳性检测率显著高于肿瘤高分化、未发生转移、临床分期为Ⅰ、Ⅱ期的胃癌患者(p0.05)。血清CRP、CA72-4、CEA、CA19-9联合检测胃癌的敏感度92.23%,特异度为90.85%,联合检测敏感度显著高于CRP(68.93%)、CA72-4(71.84%)、CEA(77.67%)、CA19-9(59.22%)单项检测(p0.05)。结论:血清CRP、CA72-4、CEA、CA19-9水平与胃癌的临床病理特征密切相关,联合检测能显著提高检测灵敏度,有利于胃癌早期诊断。     

多层CT灌注成像参数与胃癌患者病理分化程度和血清CEA、AFP、CA72-4的关系研究

目的:探讨多层CT灌注成像参数与胃癌患者病理分化程度和血清癌胚抗原(CEA)、甲胎蛋白(AFP)、糖抗原72-4(CA72-4)的关系。方法:选取2016年5月到2018年5月期间在我院接受治疗的胃癌患者60例作为胃癌组,根据患者肿瘤细胞不同病理分化程度将患者分成中高分化组(34例)和低分化组(26例),另选取同期于我院进行健康检查的60例健康志愿者作为对照组。比较不同病理分化程度的胃癌患者多层CT灌注成像参数[血流量(BF)、达峰时间(TTP)、Patlak血容量(PBV)、Patlak表面通透性(PPS)],比较胃癌组和对照组血清CEA、AFP、CA72-4水平,分析胃癌患者多层CT灌注成像参数与血清肿瘤标志物的相关性。结果:胃癌组血清CEA、AFP、CA72-4水平明显高于对照组,差异有统计学意义(P0.05)。中高分化组PBV、PPS均明显低于低分化组,TTP明显高于低分化组,差异有统计学意义(P0.05),中高分化组和低分化组的BF比较差异无统计学意义(P0.05)。经Pearson法分析显示,胃癌患者的BF、TTP、PBV与CEA、AFP、CA72-4无明显的相关性(P0.05),PPS与CEA、AFP、CA72-4呈正相关(P0.05)。结论:胃癌患者的多层CT灌注成像参数与患者的病理分化程度有关,且部分参数还与血清肿瘤标志物CEA、AFP、CA72-4呈正相关。     

不同临床类型乙型病毒感染者外周血T 细胞亚群与血清HBV DNA 载量 及HBeAg 滴度相关性分析

目的:探讨慢性乙型肝炎病毒(HBV)感染患者外周血T细胞亚群与血清HBV DNA载量及HbeAg滴度的关系。方法:选取103名HBV感染患者和20名健康者为研究对象。流式细胞术检测外周血T细胞亚群,聚合酶链式反应及酶免疫分析法分别检测血清HBV DNA载量及HbeAg滴度。结果:慢性乙型肝炎患者和慢性HBV携带者外周血CD3+T、CD4+T淋巴细胞亚群百分数低于健康对照组,结果有统计学意义(P<0.05或0.01;而CD8+T细胞亚群则呈现相反趋势,结果亦有统计学意义(P<0.05或0.01)。HBeAg阴性组中,HBVDNA水平与CD8+T细胞亚群百分数呈正相关(r=0.567,P<0.01),与CD4+/CD8+T细胞亚群百分数比值呈负相关(r=-0.601,P<0.01),而与CD3+T、CD4+T细胞亚群百分数无相关性。HBeAg阳性组中,HBV DNA水平及HbeAg滴度与CD3+T、CD4+T、CD8+T细胞百分数及CD4+/CD8+T细胞百分数均无相关性(P>0.05)。结论:不同临床类型的慢性乙型肝炎病毒感染患者外周血T细胞亚群存在不同程度细胞免疫功能降低和细胞免疫调节异常。HbeAg阴性的HBV感染患者,其血清HBV DNA水平与外周血T淋巴细胞免疫存在相关性。     

传染性单核细胞增多症患者外周血T细胞亚群检测及临床意义

目的检测传染性单核细胞增多症(IM)患者及非本病的发热患者外周血T淋巴细胞亚群,探讨EB病毒感染导致的传染性单核细胞增多症的免疫反应机制及与非本病发热患者的鉴别诊断价值,同时通过检测患者血液中的EBV-DNA载量加以确证。方法选取确诊为传染性单核细胞增多症的患者30例(IM组),非传染性单核细胞增多症的发热患者30例(对照组)。应用流式细胞技术检测患者外周血中淋巴细胞亚群,同时应用荧光定量PCR技术检测血清EBV-DNA载量,采用卡方检验及Mann-Whitney检验进行组间差异分析。结果 IM组与对照组患者T淋巴细胞亚群相比,CD8~+T淋巴细胞所占比例显著升高(Z=1.776,P0.001),CD4~+T淋巴细胞所占比例降低(F=4.008,P0.050),同时CD4~+/CD8~+比例明显下降(Z=6.653,P0.001)。IM组EBV-DNA病毒载量显著高于对照组,差异具有统计学意义(P0.050)。结论传染性单核细胞增多症患者外周血T淋巴细胞亚群主要以CD4~+T淋巴细胞及CD8~+T淋巴细胞的变化为主,T淋巴细胞亚群结合血清EBV-DNA病毒载量的联合检测对IM及非本病的发热患者具有鉴别诊断价值。     

原发性舍格伦综合征患者血清炎症因子、外周血淋巴细胞亚群分布与病情严重程度的相关性探究

目的:探讨原发性舍格伦综合征(pSS)患者血清炎症因子、外周血淋巴细胞亚群分布与病情严重程度的相关性。方法:选取2016年1月至2018年8月我院收治的105例pSS患者为研究对象,根据病程将全部患者分为初发组(n=51)、复发组(n=22)与稳定组(n=32),并选取同期来我院体检的50例健康成人作为对照组。比较各组患者的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)与白细胞介素-32(IL-32)水平以及外周血淋巴细胞亚群分布。采用Pearson相关分析探讨pSS患者欧洲抗风湿联盟干燥综合征疾病活动指数(ESSDAI)与其血清炎症因子、外周血淋巴细胞亚群分布的相关性。结果:⑴血清TNF-α、IL-1β水平:初发组、复发组稳定组对照组;血清IL-32水平:初发组、复发组对照组,复发组稳定组。⑵外周血CD4~+/CD8~+比值:初发组、复发组、稳定组对照组;外周血Th1/Th2比值:初发组、复发组对照组;外周血Th17/Treg比值:初发组、复发组、稳定组对照组,且复发组稳定组。四组研究对象的外周血T淋巴细胞、B淋巴细胞、NK细胞的百分比比较差异均无统计学意义(P0.05)。⑶Pearson相关分析显示pSS患者的ESSDAI评分与血清TNF-α、IL-1β、IL-32水平及外周血Th17/Treg比值均呈显著正相关(r=0.271、0.306、0.251、0.198,P0.05)。结论:pSS患者的血清TNF-α、IL-1β与IL-32水平及外周血CD4~+/CD8~+、Th1/Th2、Th17/Treg比值均明显升高,其中血清TNF-α、IL-1β、IL-32水平、外周血Th17/Treg比值与疾病活动度呈明显正相关。     

Prognostic value of serum and tumor tissue CA 72-4 content in gastric cancer

To date no general agreement has been reached regarding the prognostic significance of CEA, CA 19-9 and CA 72-4 as serum markers in gastric cancer, and only scattered information is available on the predictive value of marker expression in tumor tissue. Therefore, a longitudinal study was designed to analyze the presurgical serum and tumor tissue content of CA 72-4, CEA and CA 19-9 in 166 patients at different stages of gastric cancer, and to evaluate the possible correlation with clinicopathological features in respect to prognostic information on relapse-free survival. The results obtained showed that 48.4% of patients with tumor recurrence had positive presurgical CA 72-4 levels compared to approximately 24% of patients who remained free of disease. Furthermore, the median presurgical serum CA 72-4 levels were significantly elevated in relapsing patients. Serosa and lymph node involvement as well as positive presurgical serum CA 72-4 levels had independent prognostic value in predicting recurrence. A significant association between disease-free survival and lymph node involvement, depth of invasion and tumor tissue content of CA 72-4 was also demonstrated. We may therefore conclude that CA 72-4 antigen can be considered the marker of choice in the follow-up of gastric cancer patients and may be used as a prognostic indicator of relapse.     

参芪扶正注射液联合多西他赛对乳腺癌患者外周血象、免疫功能及血清肿瘤标志物的影响

摘要 目的：观察参芪扶正注射液联合多西他赛对乳腺癌患者外周血象、免疫功能及血清肿瘤标志物的影响。方法：选取2018年1月~2019年12月我院收治的64例乳腺癌患者,根据信封抽签法将患者分为对照组（n=32,多西他赛治疗）和研究组（n=32,参芪扶正注射液联合多西他赛治疗）。对比两组疗效,对比两组治疗前、治疗2个疗程后的外周血象、免疫功能及血清肿瘤标志物,记录两组治疗期间不良反应情况。结果：比较两组不良反应无差异（P>0.05）。治疗2个疗程后,对照组的总有效率为43.75%（14/32）,研究组的总有效率为68.75%（22/32）,研究组的总有效率高于对照组（P<0.05）。治疗2个疗程后,两组血红蛋白、血小板、白细胞水平均较治疗前下降,但研究组高于对照组（P<0.05）。两组CD3⁺、CD4⁺/CD8⁺、CD80、CD86水平均较治疗前下降,但研究组高于对照组（P<0.05）。治疗2个疗程后,两组癌胚抗原（CEA）、糖蛋白 125（CA125）、糖蛋白 153（CA153）水平均较治疗前下降,且研究组低于对照组（P<0.05）。结论：参芪扶正注射液联合多西他赛治疗乳腺癌患者,可有效减少肿瘤标志物分泌,抑制肿瘤生长,减轻机体免疫抑制,改善外周血象,且安全可靠。     

加味八珍汤联合mFOLFOX6方案对晚期结直肠癌患者肿瘤标志物、免疫功能和外周血PI3K-Akt信号通路的影响

摘要 目的：探讨加味八珍汤联合mFOLFOX6方案对晚期结直肠癌患者肿瘤标志物、免疫功能和外周血磷脂酰肌醇3酶（PI3K）-丝苏氨酸蛋白激酶（Akt）信号通路的影响。方法：根据随机数字表法将广州中医药大学附属北碚中医院2020年9月至2022年1月期间收治的晚期结直肠癌患者96例分为对照组（48例,mFOLFOX6方案治疗）和研究组（48例,加味八珍汤联合mFOLFOX6方案治疗）。对比两组疗效、中医证候积分、卡式评分（KPS）、肿瘤标志物、免疫功能和外周血PI3K-Akt信号通路相关指标。结果：与对照组相比,研究组的临床总有效率升高（P<0.05）。研究组治疗后的中医证候总积分低于对照组,KPS评分高于对照组（P<0.05）。研究组治疗后的CD4⁺、CD4⁺/CD8⁺、免疫球蛋白（Ig）M、IgA高于对照组,CD8⁺低于对照组（P<0.05）。研究组治疗后的血清癌胚抗原（CEA）、糖类抗原199（CA199）、糖类抗原72-4（CA72-4）低于对照组（P<0.05）。研究组治疗后的外周血PI3K、Akt mRNA表达水平低于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：加味八珍汤联合mFOLFOX6方案治疗晚期结直肠癌的疗效显著,可有效阻止晚期结直肠癌的疾病进展,增强免疫力,降低血清肿瘤标志物水平,其疗效机制可能与调节外周血PI3K-Akt信号通路有关。     

CA 72-4 compared with CEA and CA 19-9 as a marker of some gastrointestinal malignancies

The objective of this study was to compare CA 72-4 with CEA and CA 19-9 in gastrointestinal malignancies. CA 72-4 was assayed by radioimmunoassay and CEA and CA 19-9 with the Abbott IMx analyser. The study included 52 patients with gastrointestinal cancer and 20 controls with benign gastrointestinal diseases. The 52 cases showed marker sensitivities of 39%, 49% and 35% for CA 72-4, CEA and CA 19-9, respectively, and 64% when the markers were combined. Marker expression in serum was highest in colorectal carcinoma followed by gastric and esophageal carcinoma. The sensitivities of the individual markers in colorectal, gastric and esophageal carcinomas, respectively, were: CA 72-4, 56%, 32% and 18%; CEA, 83%, 33% and 18%; CA 19-9, 53%, 25% and 18%. The sensitivity of the three markers in combination was 89%, 50% and 46% in colorectal, gastric and esophageal cancer, respectively. The specificity of CA 72-4, CEA and CA 19-9 was 100%, 72% and 86%, respectively. However, CA 72-4 is not a useful a marker for gastrointestinal cancers because of its poor sensitivity. CEA, which had the best overall sensitivity and a reasonable specificity, was the most useful single marker, especially for colorectal cancer. Whereas the single markers were not useful in gastric and esophageal cancer, the combination of the three may be.     

Identification of novel subdominant epitopes on the carcinoembryonic antigen recognized by CD4+ T cells of lung cancer patients

The carcinoembryonic Ag (CEA) is an attractive target for immunotherapy because of its expression profile and role in tumor progression. To verify the existence of spontaneous anti-CEA CD4+ T cells in lung cancer patients, we first identified CEA sequences forming naturally processed epitopes, and then used the identified epitopes to test their recognition by CD4+ T cells from the patients. We had previously identified CEA(177-189/355-367) as an immunodominant epitope recognized by CD4+ T cells in association with several HLA-DR alleles. In this study, we identified four additional subdominant CEA sequences (CEA(99-111), CEA(425-437), CEA(568-582), and CEA(666-678)), recognized in association with one or more HLA-DR alleles. Peptide-specific CD4+ T cells produced proinflammatory cytokines when challenged with the native protein and CEA-expressing tumor cells, thus demonstrating that the identified CEA sequences contain naturally processed epitopes. However, CEA is expressed in the thymus and belongs to the CD66 family that comprises highly homologous molecules expressed on hemopoietic cells, raising concerns about tolerance interfering with the in vivo development of anti-CEA immunity. We thus tested the spontaneous reactivity to the identified epitopes of peripheral blood CD4+ T lymphocytes from eight early-stage lung cancer patients bearing CEA-positive tumors. We found GM-CSF- and IFN-gamma-producing CD4+ T cells in two patients. Our data indicate that CD4+ immune responses against CEA develop in neoplastic patients, suggesting that tolerance toward CEA or cross-reactive CD66 homologous molecules might be either not absolute or be overcome in the neoplastic disease.     

CEA determination in the follow-up of extracolorectal neoplasms.

CEA was initially described as a tumor and organ specific colorectal antigen, but later found by more sensitive methods in other tumors (stomach, pancreas, lung, breast) and in minor amounts in inflammatory, normal adult and fetal organs of the gastrointestinal tract. The main clinical application of CEA concerns its pretherapeutic and serial determination as circulating antigen in serum and other body fluids by means of CEA-specific, commercially available test kits. By clinical studies a significant correlation has been proven between the pretherapeutic serum CEA level and tumor stages and prognosis. Moreover, serial CEA level changes have been shown a valuable monitor following operation or during radio/chemotherapy anticipating and reflecting the clinical course of disease. In combination with newly established tumor markers, the main clinical indication for CEA determination in addition to colorectal cancer concerns monitoring of patients with stomach (+CA 72-4), lung (+NSE/SCC) and breast cancer (+CA 15-3/MCA).