类风湿性关节炎患者EBV感染情况分析

目的:检测类风湿性关节炎患者血清EBV(Epstein-Barr virus)衣壳抗原IgA抗体(VCA-IgA),分析EBV感染与类风湿性关节炎的相关性.方法:用酶联免疫吸附试验(ELISA)检测92例确诊为类风湿性关节炎患者和80例体检健康者血清VCA-IgA抗体,分析两组人群EBV VCA-IgA阳性率.结果:类风湿性关节炎患者VCA-IgA抗体阳性率为9.8％(9/92);健康对照组阳性率为2.4％ (2/85)(x2=4.038,P＜0.05).结论:类风湿性关节炎患者血清EBV VCA-IgA抗体检出率明显高于健康对照组,提示部分类风湿性关节炎患者发病与EBV感染有关.     

ANCA与SLE临床表现的相关性及其意义

目的:探讨系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)患者抗中性粒细胞胞浆抗体(Anti-neutrophil Cytoplasmic Antibodies,ANCA)与肾炎及其他临床表现和实验室检查的相关性及其意义.方法:采用前瞻性研究收集77例系统性红斑狼疮患者,用间接免疫荧光法(IIF)检测患者血清ANCA、ELISA法检测ANCA抗原,检测其他免疫学指标如抗核抗体、抗dsDNA抗体等.结果:77例SLE患者中ANCA阳性28(36.4%)例,ANCA阳性组浆膜炎、肾损害、神经精神症状、皮肤血管炎、抗dsDNA抗体阳性、抗Sm抗体阳性、补体下降以及血清IgG升高的发生率明显高于阴性组(P＜0.05).52例LN患者中,25例(48.1%)ANCA阳性,其中P-ANCA阳性者22例(88%).3例(12%)为a-ANCA均出现在RPGN,无一例出现c-ANCA.非LN组25例患者中,仅3例(12%)p-ANCA阳性,且均为抗-MPO.正常对照组无一例ANCA阳性.77例SLE患者中,14例(18.2%)为抗-MPO;13例(16.9%)为抗LF,且只见于DPGN、FPGN和RPGN伴有新月体形成者;10例(13%)为抗-CG,但在非狼疮肾炎患者未检测到抗-LF及抗-CG.在各种临床表现中,抗-MPO与肾脏和皮肤表现有关;而抗-LF与肾脏、关节炎及浆膜炎有关;抗-CG可见于各种临床表现.结论:ANCA可作为评价SLE疾病及鉴别血管炎和狼疮肾炎的一个重要指标.     

联合检测PAIg与CD41+淋巴样小巨核对ITP及MDS鉴别诊断的意义

目的:探讨血小板相关抗体(PAIg)及CD41+淋巴样小巨核在特发性血小板减少性紫癜(ITP)中的诊断价值,以及对ITP与骨髓增生异常综合征(MDS)的鉴别诊断价值.方法:研究血小板相关抗体的样本取自两组患者.一组为ITP患者,另一组为MDS患者.在CD41患者检测中,ITP患者组与MDS患者组进行了比较.ELISA方法用来检测血小板相关抗体的表达,包括PAIgA、PAIgM和PAIgG.CD41阳性淋巴样小巨核的检测采用生物素酶连亲和-碱性磷酸酶标法.抗CD41抗体是单克隆抗体.数据统计分析使用卡方检验.结果:血小板相关抗体检测中,ITP组49例患者的PAIg检出阳性率为81.6%,MDS组9例患者PAIg阳性率为33.3%,二者比较有显著差异,结果具有统计学意义.酶联免疫细胞化学检测ITP组和MDS组淋巴样小巨核CD41阳性表达显示,ITP组阳性率为5%(1/20),而MDS组阳性率为58.3%(21/36).结论:血小板相关抗体(PAIg)及CD41+淋巴样小巨核的表达可作为一项有价值的指标帮助诊断和鉴别诊断ITP患者;同时对判断ITP患者的效果及预后,以及提高ITP的诊断率具有重要的价值.并且CD41+淋巴样小巨核可作为ITP与MDS的鉴别诊断依据.     

子宫内膜异位症患者细胞因子的表达与抗体反应

目的:探究细胞因子的表达与抗体反应在子宫内膜异位症(EMS)发生中的作用及其作为诊断指标的可能性。方法:选取子宫内膜异位症患者70例与对照组50例,检测并比较两组患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-6)、单核细胞趋化因子-1(MCP-1)、血管内皮生长因子(VEGF)的表达以及抗子宫内膜抗体(EM-Ab)和转铁蛋白抗体(TRF-Ab)的阳性率。分析以上细胞因子及抗体的表达与子宫内膜异位症临床分期的关系。结果:子宫内膜异位症组TNF-α、IL-6、MCP-1与VEGF均显著高于对照组,差异具有统计学意义(P0.05);子宫内膜异位症组抗子宫内膜抗体阳性率、转铁蛋白抗体阳性率以及两种抗体均为阳性的比例均显著高于对照组,差异具有统计学意义(P0.05);TNF-α、IL-6、MCP-1与VEGF细胞因子与子宫内膜异位症分期呈正相关,分期越高、EMS病情越重则细胞因子表达水平越高(P0.05)。结论:细胞因子的表达与相关抗体反应均参与了子宫内膜异位症的发生及发展,通过检测到相关细胞因子水平的升高与自身抗体转阳可以筛选与诊断子宫内膜异位症,初步判断其临床分期和病情程度。     

Goodpasture综合征13例回顾分析

目的:探讨Goodpasture综合征的临床特征及诊治要点.方法:对13例Goodpasture综合征患者的临床表现、实验室检查、诊断与治疗等资料进行回顾性分析.结果:13例患者中,全部患者(100％)均有咯血,12例(92.3％)有镜下血尿,大多数患者咯血症状先于肾小球肾炎症状出现.10例(83.3％)抗GBM抗体阳性.12例接受完整治疗方案的患者,有效7例,有效率58.3％.无效死亡5例,平均生存期为(91± 100.1)月.结论:Goodpasture综合征是一组病变进展迅速,预后凶险的自身免疫性疾病,显效组在确诊天数上与有效组与死亡组间的差别具有统计学意义(P均＜0.05),改善疾病预后的关键是早发现、早诊断、早治疗.     

糖尿病肾病患者血清细胞外基质的变化及其临床意义

目的:探讨2型糖尿病患者血清细胞外基质(ECM)水平与糖尿病肾病(DN)之间的关系.方法:运用放射免疫法检测78例2型糖尿病患者和25名健康者的血清Ⅳ型胶原(cⅣ)、层粘蛋白(LN)、透明质酸(HA)3种ECM水平.实验分成对照组、非糖尿病肾病组(NDN组)、糖尿病肾病组(DN组)(又分为微量白蛋白尿MA组、临床肾病CDN组).用直线相关分析糖尿病患者血清cⅣ、LN、HA与其它临床指标之间的相关关系.结果:DN组和NDN组的血清cⅣ、LN水平与对照组间差异有显著性意义,DN组的血清cⅣ、LN水平与NDN组间差异有显著性意义(P<0.01).DN患者进一步分组后,CDN组的血清cⅣ、LN水平与MA组间差异有显著性意义(P<0.05 o糖尿病惠者血清cⅣ、LN水平均分别与空腹血糖(FPG)、舒张压和病程呈正相关.结论:2型糖尿病患者血清cⅣ、LN水平高于正常人,而且与DN的发生、发展有密切的关系.     

狼疮性肾炎患者血清TBX21、SCF、Chemerin水平与病情严重程度的相关性分析

目的:研究狼疮性肾炎(LN)患者血清T-框蛋白21(TBX21)、干细胞因子(SCF)、趋化素(Chemerin)水平与病情严重程度的相关性。方法:将2016年2月~2019年12月我院收治的160例LN患者纳入研究,将其按照疾病活动度的不同分成活动期组92例,非活动期组68例。另取同期于我院接受体检的健康志愿者50例作为对照组。比较三组血清尿素氮(BUN)、红细胞沉降率(ESR)、补体C3、C4、TBX21、SCF及Chemerin水平,并作相关性分析。以受试者工作特征(ROC)曲线分析血清TBX21、SCF及Chemerin水平在LN中的诊断能效。结果:活动期组BUN、ESR水平均高于非活动期组,且非活动期组BUN、ESR水平均高于对照组(P<0.05);活动期组补体C3、C4水平均低于非活动期组,且非活动期组补体C3、C4水平均低于对照组(P<0.05)。活动期组血清TBX21、SCF及Chemerin水平均高于非活动期组,且非活动期组血清TBX21、SCF及Chemerin水平均高于对照组(P<0.05)。经Pearson相关性分析可得:LN患者血清TBX21、SCF及Chemerin水平与BUN、ESR水平均呈正相关,与补体C3、C4水平均呈负相关(P<0.05)。经ROC曲线分析可得:血清TBX21、SCF及Chemerin水平联合检测诊断狼疮性肾炎的曲线下面积为0.933、灵敏度为0.95、特异度为0.91均高于上述指标单独检测。结论:LN患者血清TBX21、SCF及Chemerin水平均存在明显高表达,且和患者的病情严重程度相关,临床工作中可能通过联合检测上述三项血清学指标,继而达到辅助诊断LN以及判断患者病情严重程度的目的。     

安徽北部地区恶性肿瘤人群卡波氏肉瘤相关疱疹病毒血清学分析

卡波氏肉瘤相关疱疹病毒是一种新发现的γ疱疹病毒(Kaposi'ssarcoma-associated herpesvirus,KSHV).在中国新疆,KSHV感染率比较高,KSHV在免疫缺陷患者和静脉吸毒者中感染率也比在普通人群中高.为了进一步研究KSHV在安徽北部地区恶性肿瘤人群中的感染率和高风险因素,初步探讨KSHV与肿瘤的发生之间相关性,研究KSHV的高发人群特点,本研究选用KSHV病毒重组蛋白ORF65、ORF 73和K8.1为抗原,利用酶联免疫吸附实验(ELISA)对500份恶性肿瘤患者血清样本及200份健康体检人群血清样本进行KSHV抗体检测,分析KSHV的感染率及危险因素.结果显示500例肿瘤患者KSHV阳性总数170例,总阳性率为34％,200份健康人群KSHV阳性总数22例,总阳性率为11％,肿瘤人群KSHV阳性率明显高于健康人群(P＜0.001).其中肺癌、肝癌、结肠癌、宫颈癌、乳腺癌样本KSHV阳性率分别为36.4％,34.1％,41.7％,28.6％,30.3％,此5组肿瘤组KSHV阳性率也分别高于健康人群,都具有统计学意义(P＜0.001).但5组肿瘤样本之间KS-HV阳性率无明显差异(P＞0.05),且各组肿瘤样本分别与性别、乙肝五项、丙肝之间无统计学意义(P＞0.05).本研究结果提示安徽北部地区恶性肿瘤患者KSHV抗体阳性率显著高于中国普通人群总体KSHV抗体阳性率,证明KSHV在恶性肿瘤人群中呈现较高比例的分布.     

抗中性粒细胞胞浆抗体、抗核抗体联合检测对类风湿关节炎 的诊断价值

目的:探讨抗中性粒细胞胞浆抗体(ANCA)与抗核抗体(ANA)联合检测对类风湿关节炎的临床意义。方法:采用IIF法对82例RA患者(RA组)、74例非RA自身免疫疾病患者(非RA组)和52例健康体检者(正常对照组)的血清ANCA和ANA谱进行了检测分析,并用ELISA法进行抗丝氨酸蛋白酶3(PR3)、抗髓过氧化物酶(MPO)、ANA谱的定量检测。结果:RA组82例患者中,64例ANCA阳性,阳性率为78.08%,其中核周型(PANCA)37例,阳性率为45.1%,胞浆型(CANCA)27例,阳性率为32.9%;非RA组74例患者中有7例ANCA阳性率分别为9.4%;正常对照组50例中没有一例ANCA阳性。利用Elisa法对患者血清进行检测,分别能够特异的检测到PR3、MPO、抗双链DNA抗体(抗ds-DNA抗体)、抗ss-A等抗体、抗SS-A抗体、抗PM-SCL抗体的存在。结论:联合ANCA、ANA检测有助于提高类风湿关节炎的诊断。     

自身免疫性肝病抗体谱和肝功能检测对自身免疫性肝病与药物性肝损伤的鉴别诊断价值

目的探讨自身免疫性肝病(AILD)抗体谱和肝功能检测在AILD与药物性肝损伤(DILI)鉴别诊断中的应用价值。方法选取2016年6月～2018年1月广西医科大学第一附属医院收治的85例AILD患者和70例DILI患者作为研究对象,检测两组患者的AILD相关自身抗体以及肝功能指标。结果 AILD组抗核抗体(ANA)、抗着丝点抗体(ACA)、抗线粒体抗体(AMA)、抗线粒体抗体M2型(AMA-M2)、抗平滑肌抗体(SMA)的阳性率均明显高于DILI组,差异有统计学意义(P0.05)。AILD组抗肝肾微粒体抗体(LKM)、抗肝细胞溶质抗原抗体(LC-1)及抗胃壁细胞抗体(PCA)阳性率与DILI组比较,差异无统计学意义(P0.05)。原发性胆汁性肝硬化(PBC)患者的AMA、AMA-M2阳性率明显高于自身免疫性肝炎(AIH)患者(P0.05)。AILD组与DILI组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)水平均明显高于其正常值上限,同组患者肝功能结果波动范围较大。结论联合检测ANA、ACA、AMA、AMA-M2对AILD与DILI的鉴别有一定价值,可用于AILD的早期筛查。而两组肝功能检测结果均较正常值升高,对鉴别诊断意义不大。     

Fetal microchimerism in kidney biopsies of lupus nephritis patients may be associated with a beneficial effect

IntroductionMicrochimeric male fetal cells (MFCs) have been associated with systemic lupus erythematosus, and published studies have further correlated MFC with lupus nephritis (LN). In the present study, we evaluated the frequency of MFC in the renal tissue of patients with LN.MethodsTwenty-seven renal biopsies were evaluated: Fourteen were from women with clinical and laboratory findings of LN, and thirteen were from controls. Genomic DNA was extracted from kidney biopsies, and the male fetal DNA was quantified using real-time quantitative polymerase chain reactions for the detection of specific Y chromosome sequences.ResultsMFCs were detected in 9 (64%) of 14 of patients with LN, whereas no MFCs were found in the control group (P = 0.0006). No differences in pregnancy history were found between patients with LN and the control group. Significantly higher amounts of MFCs were found in patients with LN with serum creatinine ≤1.5 mg/dl. Furthermore, women with MFCs had significantly better renal function at the time of biopsy (P = 0.03). In contrast, patients with LN without MFCs presented with more severe forms of glomerulonephritis (World Health Organization class IV = 60% and class V = 40%).ConclusionsOur data indicate a high prevalence of MFCs in renal biopsy specimens from women with LN, suggesting a role for MFCs in the etiology of LN. The present report also provides some evidence that MFCs could have a beneficial effect in this disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-015-0615-4) contains supplementary material, which is available to authorized users.     

Clinical and laboratory findings in primary generalized and multiple-myeloma-related amyloidosis.

Thirty-four patients with primary generalized amyloidosis (PGA) and 14 with multiple-myeloma-related amyloidosis (MRA) were studied. The commonest clinical manifestations in PGA were nephrotic syndrome, hepatomegaly and congestive heart failure, and in MRA, low back pain, plasmacytoma and rheumatoid-arthritis-like syndrome. Eight patients with PGA had limited clinical expression of the disease, such as involvement of only kidneys, joints, parotid glands or gastrointestinal tract; in one patient amyloidosis was limited to lymph nodes. Low serum concentrations of total protein and albumin were common. M components were detected in the serum of 91% of patients with PGA and 92% of patients with MRA: 70% of the M components in PGA and 25% of those in MRA had lambda light chains. Bence Jones proteinemia was detected in 56% of the patients with PGA and in 77% of those with MRA. The serum concentration of immunoglobulins was decreased substantially in more than two thirds of the patients with PGA. Proteinuria (greater than 250 mg/24 h) was observed in 78% of patients with PGA and in 93% of patients with MRA. Bence Jones proteinuria was noted in 75 and 77% of patients, respectively. Plasmacytic infiltration of the bone marrow was found in 90% of the patients with PGA. The mean survival time of the patients with PGA was 28 months and of those with MRA, 29 months from the time of diagnosis.     

Co-Positivity for Anti-dsDNA, -Nucleosome and -Histone Antibodies in Lupus Nephritis Is Indicative of High Serum Levels and Severe Nephropathy

ObjectiveTo characterize the significance of correlated autoantibodies in systemic lupus erythematosus (SLE) and its complication lupus nephritis (LN) in a large cohort of patients.MethodsClinical data were statistically analyzed in 1699 SLE patients with or without nephritis who were diagnosed and treated during 2002–2013 in the northeast region of China. Reactivity to a list of 16 autoantibodies was detected by the serum test Euroline ANA profile (IgG). Serum titers of the anti-nucleosome autoantibodies were measured by ELISA assays. Kidney biopsies were examined by pathologists. Immune complex deposition was identified by immunohistochemistry stain.ResultsSimultaneous positivity of anti-dsDNA, -nucleosome and -histone antibodies (3-pos) was prevalent in SLE patients with LN compared to Non-renal SLE patients (41% vs 11%, p< 0.001). Significant correlations were found between any two of the above three anti-nucleosome antibodies in LN patients. In comparison to non-3-pos cohorts, 3-pos patients with LN had significantly higher serum levels of the three antibodies and more active disease; was associated with type IV disease; suffered from more severe renal damages; received more intensive treatment and had worse disease outcome. The serum levels of these three autoantibodies in 3-pos LN patients were significantly decreased when they underwent clinical recovery.ConclusionsSimultaneous reactivity to anti-dsDNA, -nucleosome and -histone antibodies by Euroline ANA profile (IgG) may indicate severe nephropathy in patients with SLE.     

Pattern visual evoked potentials in the early diagnosis of optic neuropathy in the course of Graves' ophthalmopathy

THE AIM OF THE STUDY: To investigate by means of pattern visual evoked potentials (PVEPs) early neuropathic changes in Graves' ophthalmopathy (GO) patients without any clinical symptoms of optic neuropathy in order to evaluate the prevalence of subclinical optic neuropathy in GO patients and to elucidate whether there is a relationship between PVEP (P100 and N75 latency), intraocular pressure (IOP) and exophthalmometry. MATERIAL AND METHODS: Two groups of patients were examined: 15 patients with GO without clinical signs of dysthyroid optic neuropathy (DON) and 12 healthy controls. The correlations between the N75 and P100 latencies, IOP and Hertel exophthalmometry were investigated. RESULTS: The mean PVEP N75 and P100 latencies were significantly delayed in the GO uncomplicated with DON in comparison with controls (LP100- 106.2 +/- 4.4 ms vs. 102.4 +/- 2.7 ms, p < 0.01 and LN75- 79.0 +/- 3.7 ms vs. 73.9 +/- 2.8 ms, p < 0.001). In GO patients we documented a positive correlation between the LN75 latency and exophthalmometric readings (R = 0.51; p < 0.01). The value of LP100 and LN75 was above the normal limit in 5/30 eyes (17%) and in 3/30 eyes (10%) respectively. CONCLUSIONS: The assessment of PVEPs (especially the P100 latency) in GO patients without clinical signs of DON is a useful tool for the early diagnosis of optic nerve involvement.     

狼疮性肾炎患者血清NETs、TWEAK、外周血CD4+T/CD8+T比例与疾病活动度及肾脏预后的关系

摘要 目的：探讨狼疮性肾炎（LN）患者血清中性粒细胞胞外诱捕网（NETs）、肿瘤坏死因子样凋亡微弱诱导剂（TWEAK）、外周血分化簇（CD）4⁺T/CD8⁺T比例与疾病活动度及肾脏预后的关系。方法：选取2021年8月～2022年8月川北医学院附属医院肾内科收治的LN患者137例（LN组）,根据系统性红斑狼疮疾病活动指数（SLEDAI）-2000评分分为轻度活动组（52例）、中度活动组（45例）、重度活动组（40例）。随访1年,根据肾脏相关终点事件发生情况分为预后不良组（43例）和预后良好组（94例）,另选取同期76名体检健康志愿者（对照组）。采用酶联免疫吸附法检测血清NETs、TWEAK水平,流式细胞术检测外周血CD4⁺T/CD8⁺T比例。Spearman相关性分析LN患者血清NETs、TWEAK和外周血CD4⁺T/CD8⁺T与SLEDAI-2000评分的相关性,多因素Logistic回归分析LN患者预后不良的因素,受试者工作特征曲线分析血清NETs、TWEAK和外周血CD4⁺T/CD8⁺T对LN患者预后不良的预测价值。结果：与对照组比较,LN组血清NETs、TWEAK水平升高,外周血CD4⁺T/CD8⁺T降低（P＜0.05）。轻度活动组、中度活动组、重度活动组血清NETs、TWEAK依次升高,外周血CD4⁺T/CD8⁺T依次降低（P＜0.05）。LN患者SLEDAI-2000评分与血清NETs、TWEAK呈正相关,与外周血CD4⁺T/CD8⁺T呈负相关（P＜0.05）。慢性肾脏病分期4期、SLEDAI-2000评分升高、NETs升高、TWEAK升高为LN患者预后不良的独立危险因素,估算肾小球滤过率升高、CD4⁺T/CD8⁺T升高为独立保护因素（P＜0.05）。血清NETs、TWEAK和外周血CD4⁺T/CD8⁺T联合预测LN患者预后不良的曲线下面积为0.943,大于血清NETs、TWEAK和外周血CD4⁺T/CD8⁺T单独预测的0.790、0.788、0.799（P＜0.05）。结论：LN患者血清NETs、TWEAK水平升高,外周血CD4⁺T/CD8⁺T降低,与疾病活动度及肾脏预后不良密切相关,血清NETs、TWEAK联合外周血CD4⁺T/CD8⁺T预测LN患者肾脏预后的价值较高。     

Th 细胞因子IL-17、IFN-γ、IL-4 在狼疮性肾炎中的表达及意义

目的:探讨T辅助细胞(Th)相关细胞因子在狼疮性肾炎发病中的免疫机制作用。方法:64例系统性红斑狼疮患者和28例健康体检者作为对照,采用酶联免疫吸附测定法(ELISA法)检测所有受试者血清IL-17、IFN-γ、IL-4水平,并对其与SLEDAI、SDI、24小时尿蛋白量相关性进行研究。结果:狼疮性肾炎组血清IL-17水平显著高于狼疮无肾炎组和健康对照组(P<0.001),狼疮性肾炎组血清IFN-γ水平显著高于狼疮无肾炎组(P<0.05)和健康对照组(P<0.01),血清IL-4水平在狼疮性肾炎组、狼疮无肾炎组均显著高于健康对照组(P<0.01)。狼疮性肾炎组IFN-γ/IL-4比值显著高于狼疮无肾炎组(P<0.01)和健康对照组(P<0.05);狼疮无肾炎组IFN-γ/IL-4比值显著低于健康对照组(P<0.01)。SLE患者血清IFN-γ表达水平与SLEDAI积分呈正相关(r=0.402,P<0.05),血清IL-17、IL-4表达水平与SLEDAI、SDI、抗ds-DNA抗体、C3、24小时尿蛋白量均无相关性。结论:狼疮性肾炎患者外周血中IL-17、IFN-γ、IL-4等促炎细胞因子均有不同程度升高促起炎症发生及组织损伤,参与了狼疮性肾炎的免疫发病过程。     

血清miR-92a在胰腺癌诊断及预后评估中的临床意义研究

目的:探讨血清miR-92a在胰腺癌诊断和预后分析中的价值,为胰腺癌早诊断以及预后评估提供潜在的分子标志物。方法:回顾性分析我院及重庆医科大学附属第一、第二医院2014年8月~2016年12月收治的30例胰腺癌未转移患者、30例胰腺癌转移患者和30例慢性胰腺炎患者的临床资料,另选择同期在我院进行健康体检的30例健康人作为健康组。收集血清,应用定量PCR法检测各组血清miR-92a的表达水平,利用化学发光法检测各组血清中的糖蛋白抗原19-9(CA-19-9)含量。以ROC分析比较血清miR-92a与CA 19-9在胰腺癌诊断中的特异度、敏感性。结果:胰腺癌未转移组患者和胰腺癌转移组患者血清中miR-92a水平显著高于健康组和慢性胰腺炎组(P0.05),胰腺癌转移组患者血清中miR-92a水平显著高于胰腺癌未转移组患者(P0.05)。胰腺癌未转移组患者和胰腺癌转移组患者血清中CA19-9水平显著高于健康组和慢性胰腺炎组(P0.05)。miR-92a诊断胰腺癌的敏感度高于CA19-9和miR-92a+CA 19-9,而miR-92a+CA 19-9诊断胰腺癌的特异度显著高于miR-92a和CA19-9(P0.05),且有较高的胰腺癌转移预测应用价值。结论:血清miR-92a联合CA 19-9检测能够诊断胰腺癌,具有良好的敏感度和特异度,miR-92a还具有较好的胰腺癌转移预测价值,可作为胰腺癌早期无创筛查方法加以应用。     

手术切除与介入栓塞治疗肝癌术后复发患者的临床对比研究

目的:比较手术切除与介入栓塞治疗肝癌术后复发患者的临床疗效。方法:选择2010年6月到2011年6月本院收治的92例肝癌手术切除术后复发患者,按随机数字表法分为手术切除组和介入栓塞组,各46例。手术切除组患者给予再次切除治疗,介入栓塞组患者给予介入栓塞治疗。记录并比较两组患者治疗后1年、3年及5年的生存率。检测并比较两组患者治疗前后血清肝纤维化指标,包括血清透明质酸(HA)、层黏蛋白(LN)、人Ⅲ型前胶原(HPC-Ⅲ)及IV型胶原(IV-C)水平。检测并比较两组患者治疗前后血清白细胞(WBC)、甲胎蛋白(AFP)及癌胚抗原(CEA)水平。结果:手术切除组患者治疗后1年、3年、5年的生存率均明显高于介入栓塞组,差异均具有统计学意义(P0.05)。治疗后,介入栓塞组血清HA、LN、HPC-Ⅲ及IV-C明显高于治疗前,且均明显高于手术切除组,差异均具有统计学意义(P0.05)。两组患者治疗后血清WBC、AFP及CEA水平均明显低于治疗前,且手术切除组患者血清WBC明显高于介入栓塞组,而血清AFP、CEA水平明显低于介入栓塞组,差异均具有统计学意义(P0.05)。结论:手术切除治疗肝癌术后复发能够明显提高患者生存率,降低肝纤维化程度,改善血清AFP及CEA水平,值得在临床上推广应用。