乳腺癌腋窝淋巴结转移患者应用多普勒超声与CT的诊断价值比较

摘要 目的：探讨乳腺癌腋窝淋巴结转移患者应用多普勒超声与CT的诊断价值比较。方法：回顾性分析2017年3月至2019年3月我院接诊的60例经过手术病理证实的乳腺癌患者。比较多普勒超声与128排螺旋CT在乳腺癌腋窝淋巴结转移中的检出率、声像特征比较及两组灵敏度、特异度、准确度。结果：在术后经过病理证实的60例乳腺癌手术患者中,有38例为腋窝淋巴结转移,有22例未腋窝淋巴结转移,在多普勒超声诊断结果对乳腺癌腋窝淋巴结转移诊断中,36例得到确诊,在128排螺旋CT诊断中,30例得到确诊;多普勒超声皮质向心性生长、淋巴结内钙化灶、淋巴结横直径比值及淋巴结边界模糊检出率均显著高于128排螺旋CT检出率,差异显著（P＜0.05）;将病理结果作为金标准。多普勒超声灵敏度、特异度、准确度均比128排螺旋CT结果高,两组方式比较具有显著差异（P＜0.05）。结论：多普勒超声在乳腺癌腋窝淋巴结转移中诊断价值高,可帮助临床提供正确诊断,以选择合适的治疗方案。     

VEGF-C和VEGF-D在胃癌组织中的表达与微血管生成的关系及临床意义

目的:观察胃癌患者血管内皮生长因子C和D(vascular endothelial growth factor-C and-D,VEGF-C,VEGF-D)在胃癌组织中的表达以及其与肿瘤微血管生成的关系.方法:采用免疫组化S-P法检测30例胃癌组织和30例正常胃组织中VEGF-C和VEGF-D蛋白的表达,检测微血管密度(microvessel density,MVD).结果:胃癌组织VEGF-C和VEGF-D表达明显高于正常胃组织(p<0.01),其中淋巴结转移组VEGF-C、VEGF-D的表达与淋巴结未转移组间差异显著(p<0.05).胃癌组织MVD值明显高于正常胃组织(p<0.01),淋巴结转移组MVD值明显高于未转移组(p<0.01).MVD与VEGF-C的蛋白在胃癌组织中的表达高度相关(r=0.735,p<0.05),与VEGF-D的蛋白在胃癌组织中的表达成正相关(r=0.623,p<0.05).结论:VEGF-C和VEGF-D的高表达与肿瘤微血管生成及淋巴道转移密切相关,可作为评估胃癌患者预后的重要参考指标.     

VEGF在口腔鳞状细胞癌中的表达及其临床意义

目的:研究血管内皮生长因子(Vascular endothelial growth factor,VEGF)在口腔鳞状细胞癌中的表达及其临床意义.方法:免疫组化EnVisionTM法检测VEGF在57例手术治疗的原发性OSCC(口腔鳞状细胞癌)中的表迭.结果:①VEGF在OSCC中的阳性表达率为40.35%.②VEGF在不同发病部位组的表达:牙龈癌>舌癌>颊癌>唇癌,组间无统计学差异(P>0.05).③VEOF在不同病理分级组、不同预后组、不同年龄组、不同性别组的表达无显著性差异(P>0.05);淋巴结转移组的表达显著高于无转移组(P<0.05).结论:虽然VEGF的高表达可能在淋巴结转移中起一定的作用,但还不能作为预测口腔鳞状细胞癌临床生物学行为及预后的可靠指标.     

乳腺癌腋窝淋巴结清扫术后上肢淋巴水肿的危险因素分析

研究背景：乳腺癌是女性常见的恶性肿瘤之一,同时也是治愈率最高的癌症,文献报道早期乳腺癌术后5年生存率达85．16％。上肢淋巴水肿是腋窝淋巴结清扫术后常见并发症,术后10—35％患者出现上肢水肿,就上肢淋巴水肿的风险因素,国内外做了许多研究,但结果不一,分歧较大。方法：抽取60例腋窝淋巴结清扫术后患者,调查统计可能与腋窝淋巴结清扫术后上肢淋巴水肿相关的8个因素（变量）：年龄、临床分期、是否放疗、是否出现延迟愈合／感染／积液等术后其它并发症、术后上肢功能锻炼、是否是优势侧,平时是否参加体育锻炼,是否有高血压等合并症。数据采用SPSS13．0分析软件以logistic回归方法进行分析。结果：四项关联因素分别为：1、是否放疗（OR=8．966）2、延迟愈合／感染／积液等其它术后并发症（0R=8．493）3、术后上肢功能锻炼（OR=0．194）4、高血压（0R=5．609）。结论：放疗、其它术后并发症、高血压为腋窝淋巴结清扫术后上肢淋巴水肿的风险因素,而术后上肢功能锻炼为术后水肿的保护因素。     

Dynamics of CD4^＋CD25^＋ T Cells in Spleens and Mesenteric Lymph Nodes of Mice Infected with Schistosomajaponicum

CD4~ CD25~ T cells play a major role in modulating immune response,but few reports havebeen published about schistosomiasis.Here,we investigated the changes in CD4~ CD25~ T cell populations inspleens and mesenteric lymph nodes of mice infected with Schistosoma japonicum.The proportions ofCD4~ CD25~ T cells in total CD4~ T cells were analyzed by flow cytometry.CD25 and Foxp3 expression wasmeasured by real-time quantitative polymerase chain reaction.The suppressive activities of CD4~ CD25~ Tcells were detected by in vitro proliferation of splenocytes.Evidence showed that the percentage of CD4~ CD25~ T cells was the same as controls 3 weeks post-infection.At the acute stage of infection,the percentagedecreased significantly.However,at the chronic stage of infection,it rebounded to normal levels or evenhigher.The expression of the CD25 and Foxp3 showed gradual increase along with the infection progress.Invitro experiment also showed the strong suppressive effect of CD4~ CD25~ T cells,isolated during the chronicstage,on proliferation of the CD25~-splenocytes.This is the first time that the dynamics of CD4~ CD25~ T cellpopulations was demonstrated in mice infected with schistosomiasis.In conclusion,our data indicated thatCD4~ CD25~ cells might be involved in the immune modulation during S.japonicum infection,which en-hances current knowledge of the mechanisms of the immuno-downregulation and re-infection inschistosomiasis.     

激光捕获显微切割技术纯化的鼻咽癌和正常鼻咽上皮细胞的比较蛋白质组学研究

为筛选鼻咽癌(nasopharyngeal carcinoma, NPC)的分子标志物,采用激光捕获显微切割技术(laser capture microdissection, LCM)分别从NPC组织和正常鼻咽上皮组织(normal nasopharyngal epithelial tissue, NNET)中切割纯化NPC细胞和正常鼻咽上皮细胞(normal nasopharyngal epithelial cells, NNEC),应用二维凝胶电泳(two-dimensional electrophoresis, 2-DE)分离LCM纯化细胞的蛋白质,图像分析识别差异表达的蛋白质点,基质辅助激光解吸电离飞行时间质谱(MALDI-TOF-MS)和电喷雾电离串联质谱(ESI-Q-TOF-MS)鉴定差异蛋白质点,Western blot检测差异蛋白cytokeratin 8 (CK8)在LCM纯化的NPC细胞和NNEC以及具有不同分化程度或转移潜能的4株NPC细胞中的表达,免疫组织化学检测CK8在63例NPC、28例NNET及20例颈淋巴结转移NPC组织中的表达水平.建立了LCM纯化的NPC细胞和NNEC的2-DE图谱,质谱鉴定了29个差异蛋白质,其中15个蛋白质只在NPC表达或表达明显增高,14个蛋白质在NPC中表达下调或缺失;Western blot结果显示,CK8的表达水平在NPC中较NNET明显下调,并与NPC细胞株的分化程度和转移潜能有关;免疫组织化学结果显示,CK8在NPC组织中的表达较NNET明显下调,在颈淋巴结转移NPC中的表达较原发NPC明显上调.研究结果提示,CK8与NPC分化及淋巴结转移相关,有望成为预测NPC转移和区别NPC分化程度的分子标志物.     

中国人前列腺癌VEGF—C mRNA、VEGFR-3和CD31表达与肿瘤转移的关系

The expressions of VEGF-C mRNA, VEGFR-3 and CD31 were studied in order to investigate the correlation between them and neoangiogenesis, hyperplasia of micro-lymphatics and tumor metastases. 34 cases of prostate cancer tissue and 12 cases of adjacent nontumorous tissue specimens were tested. They were marked by VEGFR-3 and CD31 with immunohistochemistic staining and analyzed with image, the micro-lymphatics count (MLC) and microvessel density (MVD) were counted using Weidner's highest vessel density count method; the expression of VEGF-C mRNA was inspected in situ hybridization. The expression of VEGF-C mRNA was 44.12% positive in 34 cases of prostate cancer, the MLC (8.26 +/- 2.73)mm2 and MVD (74.82 +/- 11.76)mm2 in prostate cancer were significantly higher than those in adjacent nontumorous tissue (MLC, 4.82 +/- 3.48/mm2; MVD, 32.86 +/- 5.41/mm2). In addition, there was a correlation between the expression of VEGF-C mRNA and micro-lymphatics metastases and there was a positive correlation between the expression of VEGFR-3 and CD31. The expressions of VEGF-C mRNA , MLC, MVD in stage III and IV and those who have lymph metastasis were higher than those in stage I and II and those who have no lymph metastasis; the expressions of VEGFR-3 and CD31 in VEGF-C mRNA positive groups were significantly higher than those in negative groups. The difference of histopathologic grading in prostate cancer had no statistical significance. VEGF-C could accelerate the hyperplasia of micro-lymphatics and neoangiogenesis induced by tumor and play an important role in tumor lymph metastases. There was a close correlation between the expressions of VEGFR-3, CD31 and tumor metastases. The increase of MLC and MVD on prostate cancer indicated the hyperplasia of new micro-lymphatics and neoangiogenesis in the tumor tissue, which could also be a signal to determine the tumor metastases in clinic.     

隐匿性乳腺癌的诊断和治疗方式分析

目的:探讨隐匿性乳腺癌的术前诊断方法和最佳治疗方式。方法:回顾性分析我院2005年1月-2016年5月收治的26例隐匿性乳腺癌患者的临床资料,包括治疗方法和预后情况。结果:26例女性患者,在患侧腋窝淋巴结清扫的基础上,14例行患侧乳房切除术+术后放疗,5例仅行患侧乳房切除术,4例行患侧乳腺外上象限局部切除术+术后放疗,3例患者仅行患侧乳房象限切除术。23例患者行术后化疗,根据激素受体情况决定内分泌治疗及靶向治疗。乳房切除与未切除患者术后局部无复发率(P=0.005)及总生存率(P=0.006)比较差别均有明显统计学意义。术后放疗组与未放疗组局部无复发率比较差异有明显统计学意义(p=0.02),而总生存率比较差异无明显统计学意义(P=0.11)。结论:隐匿性乳腺癌患者术前需完善乳腺彩超、钼靶及MRI等检查,也可选择乳腺核素显像。在患侧腋窝淋巴结清扫的基础上,患侧全乳切除+局部放疗是更加合适的治疗方式。     

宫颈癌组织中c-met的表达与宫颈癌患者淋巴结转移及复发的关系

目的:探讨宫颈癌患者组织中c-met表达与宫颈癌淋巴结转移和复发的关系。方法:选取我院2005年6月至2010年6月间经病理确诊的患者120例。采用SP法检测c-met蛋白在宫颈癌组织中的表达,采用Pearson和Spearman相关性探讨c-met表达与宫颈癌患者临床特征的关系,采用COX回归模型探讨c-met表达与子宫颈癌转移与复发的的关系。结果:120例子宫颈癌患者中转移、复发或死亡者35例,相关性分析提示c-met蛋白水平与宫颈癌患者CA-125值、肿瘤的N分期、肿瘤侵犯深度成正相关,多因素分析提示:肿瘤分化程度(P=0.013)、c-met水平(P=0.02)、肿瘤侵犯深度(P=0.04)是宫颈癌患者转移或复发的独立危险因素。结论:宫颈癌组织中c-met表达阳性是宫颈癌患者转移、复发的独立危险因素。     

甲状腺微小乳头状癌发生隐匿性颈部淋巴结转移的危险因素分析

目的:分析甲状腺微小乳头状癌(PTMC)发生隐匿性颈部淋巴结转移的危险因素。方法:收集2013-2017年于青岛大学附属医院确诊的PTMC患者共1524例,按其术前、术后是否有颈部淋巴结转移分为显性淋巴结转移、隐匿性淋巴结转移及无淋巴结转移三组,比较各组之间的临床病理特征,包括性别(男性)、年龄、肿瘤大小、双叶、多灶、侵犯包膜、合并桥本病、术前TSH水平等是否具有差异性。结果:单因素分析结果显示:与无淋巴结转移患者相比,隐匿性淋巴结转移组男性患者比例、年龄、肿瘤大小、肿瘤累及双叶、多灶比例均有统计学差异(P0.05),其中隐匿性淋巴结转移组中的发病年龄较低(P0.05),合并桥本病的比率无显著差异(P0.05);与显性淋巴结转移相比,隐匿性淋巴结转移肿瘤大小、合并多灶及合并病理桥本病的转移率较后者低(P0.05)。多因素分析表明以无淋巴结转移的患者为对照组,男性患者、年龄、大小、多灶为隐匿性淋巴结转移的危险因素(OR值分别为0.525,1.033,0.169,0.562);与隐匿性淋巴结转移相比,合并桥本病的患者发生显性颈部淋巴结转移的风险更高,而发病年龄较前者大(OR值分别为0.370,0.979)。结论:男性、肿瘤累及双叶、多灶者为PTMC早期淋巴结转移的危险因素,合并桥本病者发生显性颈部淋巴结转移的风险更高;但没有发现桥本病与隐匿性颈部淋巴结转移存在相关性。