结直肠癌早期诊断的研究进展

结直肠癌(colorectal cancer,CRC)的早期诊断对减少肿瘤发病率和死亡率具有极其重要的意义。随着分子生物、内镜影像技术以及激光技术的发展,各种诊断方法不断改进,新诊断方法和技术不断涌现,对结直肠癌的早期诊断、定位和分期提高到了一个新的认知水平。本文简述了结直肠组织的层微结构和癌变进程,介绍了目前临床诊断的主要方法,展望了其发展方向。论文在重点评述非线性光谱技术,包括双光子激发荧光、二次谐波以及拉曼光谱在CRC诊断研究的基础上,提出联合多光子显微成像与拉曼光谱技术进一步开展结直肠癌早期无损诊断研究。     

白介素17 与结直肠癌

结直肠癌是世界范围内的高发癌症,其发病机理尚不明确。大量研究数据表明,基因突变、表观遗传学的改变、饮食习惯以及生活方式等均是结直肠癌发生发展的高危因素。目前,普遍认为慢性炎症在肿瘤的发生发展中起重要作用。白介素17主要由T细胞的亚型Th17细胞分泌产生,能够促进肿瘤相关性炎症,使肿瘤细胞逃避免疫监控。已在胃癌、宫颈癌、食管癌、非小细胞肺癌、肝细胞肝癌、卵巢癌、黑色素瘤、淋巴瘤、乳腺癌、前列腺癌、结直肠癌等多种恶性肿瘤中发现白介素17呈高表达。现有研究表明,白介素17与肠炎和结直肠癌的发生发展密切相关。尽管尚存在争议,多数学者认为白介素17在结直肠癌的发生发展中起促进作用。本文将近年来关于IL-17在结直肠癌的发生发展中的作用以及其与结直肠癌的预后的研究成果进行总结。     

肿瘤标志物在结直肠癌诊疗应用中的研究进展

结直肠癌(colorectal cancer, CRC)是世界第三大常见恶性肿瘤,也是全球癌症相关死亡的主要原因之一。近年来,随着各种新兴组学测序技术和人工智能的发展,肿瘤标志物在临床肿瘤学中的应用研究不断拓宽。以DNA甲基化、非编码RNA、循环肿瘤细胞、肠道菌群及代谢物为主的新型标志物逐渐成为肿瘤诊疗研究中的重点方向,在CRC的早筛早诊、病情监测及预后评估等方面起着重要的指导作用。该文就近年来临床常用肿瘤标志物和新型肿瘤标志物在CRC诊疗中的应用及进展进行了综述,并对检验大数据和人工智能在肿瘤临床诊疗中的潜在应用前景进行了讨论,以期为CRC的诊疗应用研究提供借鉴。     

结直肠癌与肠道菌群

肠道是集消化、吸收、内分泌、免疫、屏障等功能为一体的重要器官,肠道菌群的结构和功能与人体的健康、疾病的发生发展及机体的快速康复息息相关。结直肠癌变是个逐步发生发展的过程,从局部炎性反应、腺瘤、癌前病变到恶化的过程可达数年甚至数十年之久。结肠癌早期临床症状不明显且潜伏期较长,容易造成漏诊和误诊,贻误最佳治疗时机。近年来,国内外多项研究显示大肠埃希菌、粪肠球菌、脆弱拟杆菌、解没食子酸链球菌、具核梭杆菌等细菌与结直肠癌的发生发展关系密切,这为我们从另外一个角度来进行结直肠癌早期诊断提供了新思路和新途径。     

预警症状对结直肠癌的诊断效能研究

目的:明确预警症状(腹部包块、便秘、排便习惯改变、腹泻、肛周异物感、长期腹痛、便血或肛门出血)对结直肠癌的诊断效能。方法:收集我院2016年1月至2016年12月的结肠镜检查数据,计算各个预警症状的诊断敏感度、特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比。结果:预警症状总的诊断敏感度和特异度分别是6.63%和94.33%。所有的预警症状诊断敏感度最高的是便血,敏感度为19.28%,最低的是腹泻,敏感度为2.41%。相对而言,便血和长期腹痛的准确度较高,分别达到了19.28%和11.45%。除了长期腹痛之外,其他所有的预警症状的诊断特异度都达到了90%以上。结论:超过一半的结直肠癌患者没有出现预警症状,用预警症状来诊断结直肠癌具有较低的敏感度和较高的特异度,需要更多的研究来证明预警症状的临床意义。     

IGF-Ⅱ、IGF-lR、IGFBP-3在结直肠癌中的表达及诊断价值研究

目的:探讨结直肠癌中IGF-Ⅱ、IGF-l R以及IGFBP-3等的阳性表达及诊断价值。方法:收集我院45例结直肠癌、33例炎性息肉、40例腺瘤以及35例正常肠粘膜组织予以免疫组织化学SP法进行IGF-Ⅱ、IGF-l R以及IGFBP-3检测,并统计结直肠腺瘤不同组织类型和结直肠癌不同Dukes分期的阳性表达差异。结果:结直肠癌组织中IGF-Ⅱ、IGF-l R以及IGFBP-3表达均呈高阳性率,并且显著高于其他3组(P0.05)。结直肠腺瘤管状、混合型、绒毛状等不同组织类型IGF-Ⅱ、IGF-l R以及IGFBP-3表达阳性率呈逐渐增高趋势,绒毛状腺瘤显著高于其他两型(P0.05)。45例结直肠癌中,Dukes分期A、B两期显著低于C期和D期,比较差异具有显著性(P0.05)。结论:IGF-Ⅱ、IGF-l R以及IGFBP-3可能在结直肠腺瘤发生、发展及进展为结直肠癌的过程中起一定作用,对结直肠癌早期诊断具有一定价值。     

肠道微生物与结直肠癌

结直肠癌(colorectal cancer, CRC)是最常见的恶性肿瘤之一,严重威胁着人类健康。肠道微生态作为人体内最复杂、最庞大的微生态系统,与CRC密切相关。CRC患者的肠道微生物群落多样性构成能调节CRC疾病的发生与发展。本综述旨在讨论CRC肠道微生物群的构成、微生物群相关致癌机制、微生物群作为CRC生物标志物的潜力,为临床应用肠道菌群治疗CRC提供新策略与新思路。     

IGF-Ⅱ、IGF-1R、IGFBP-3在结直肠癌中的表达及诊断价值研究

目的：探讨结直肠癌中IGF-Ⅱ、IGF-1R以及IGFBP-3等的阳性表达及诊断价值。方法：收集我院45例结直肠癌、33例炎性息肉、40例腺瘤以及35例正常肠粘膜组织予以免疫组织化学SP法进行IGF—Ⅱ、IGF—1R以及IGFBP-3检测,并统计结直肠腺瘤不同组织类型和结直肠癌不同Dukes分期的阳性表达差异。结果：结直肠癌组织中IGF—Ⅱ、IGF—1R以及IGFBP-3表达均呈高阳性率,并且显著高于其他3组（P〈0．05）。结直肠腺瘤管状、混合型、绒毛状等不同组织类型IGF-Ⅱ、IGF—1R以及IGFBP-3表达阳性率呈逐渐增高趋势,绒毛状腺瘤显著高于其他两型（P〈0．05）。45例结直肠癌中,Dukes分期A、B两期显著低于C期和D期,比较差异具有显著性（P〈0．05）。结论：IGF—Ⅱ、IGF-1R以及IGFBP-3可能在结直肠腺瘤发生、发展及进展为结直肠癌的过程中起一定作用,对结直肠癌早期诊断具有一定价值。     

肠道微生态在结直肠癌诊断中的研究进展

近年来,肠道微生态学已经成为众学者的研究热点,肠道微生态平衡影响人体健康,尤其与结直肠癌（colorectal cancer,CRC）关系密切。许多CRC患者在早期并无明显症状,在进入中晚期时才被确诊,因错过早期治疗的机会而导致治疗效果欠佳,目前亟需更新更优的CRC早期诊断方法。基于肠道微生态与CRC的密切关系,肠道微生态已成为CRC新诊断方法的主要选择之一,主要研究方向是肠道中的细菌、病毒及其代谢产物的种类与数量的检测。本文就近年来关于肠道微生态对CRC诊断作用的相关热点问题进行概述,并展望肠道微生态在CRC诊断作用研究的主要方向及预期进展,旨在为通过肠道微生态诊断CRC提供理论依据。

     

基因突变在结直肠癌诊疗及预后中的研究进展

结直肠癌是常见的恶性肿瘤之一,其发病率居全球恶性肿瘤发病率的第三位,死亡率呈逐年上升趋势。中国已成为全球结直肠癌每年新发病例数和死亡病例数最多的国家。对结直肠癌基因突变状态的识别以及对结直肠癌发生发展过程进行精确分类,可实现对患者进行个性化精准治疗的目的,而精准治疗的实现有赖于基因测序技术。目前,二代测序技术(Next generation sequencing,NGS)结合基因捕获技术,集中对研究者感兴趣的候选基因或外显子进行平行测序,极大拓展了对肿瘤特征基因的认识,为发展新的治疗手段和治疗策略奠定了基础。整合癌症基因组数据库IntOgen已明确72个结直肠癌驱动突变基因,包括“TP53”、“KRAS”、“PIK3CA”等;癌基因数据库Cancer Gene Census目前收录的结直肠癌突变基因有59个,包括原癌基因“BRAF”、抑癌基因“SMAD4”等;在线人类孟德尔遗传OMIM数据库已收录55个与结直肠癌相关的体细胞突变基因,包括“SRC”、“APC”等。本文通过26篇国内外文献,对结直肠癌基因突变检测的共识基因进行综述,并总结了与结直肠癌患者临床诊断、分型、预后、治疗等临床病理特征相关的突变基因标志物。     

Evaluation of Staging Systems for Colorectal Cancer

An alternative way to implement the Akaike Information Criterion (AIC) is proposed for the evaluation of staging systems for colorectal cancer.     

Evaluation of lncRNA FOXD2-AS1 Expression as a Diagnostic Biomarker in Colorectal Cancer

Background:Colorectal cancer (CRC) is still considered one of the prevalent cancers worldwide. Investigation of potential biomarkers for early detection of CRC is essential for the effective management of patients using therapeutic strategies. Considering that, this study was aimed to examine the changes in lncRNA FOXD2-AS1 expression through colorectal tumorigenesis. Methods:Fifty CRC tumor tissues and fifty adjacent normal tissue samples were prepared and involved in the current study. Total RNA was extracted from the samples and then reverse transcribed to complementary DNA. Next, the expression levels of lncRNA FOXD2-AS1 were evaluated using real-time PCR in CRC samples compared to normal ones. Also, receiver operating characteristic curve analysis was used to evaluate the diagnostic value of FOXD2-AS1 for CRC.Results:The obtained results showed that the expression level of FOXD2-AS1 gene was significantly (p<0.0001) up-regulated in tumor tissues compared to normal marginal tissues. Also, a significant correlation was observed between higher the expression of FOXD2-AS1and the differentiation of tumor cells. Furthermore, ROC curve analysis estimated an AUC value of 0.59 for FOXD2-AS1, suggesting its potential as a diagnostic target.Conclusion:Taken together, the current study implied that tissue-specific upregulation of lncRNA FOXD2-AS1 might be appropriate diagnostic biomarkers for CRC. Nonetheless, more studies are needed to validate these results and further illustrate FOXD2-AS1 function through colorectal tumorigenesis.Key Words: Biomarker, Colorectal cancer, FOXD2-AS1, lncRNA, qRT-PC     

A Systematic Review and Meta-Analysis of Diagnostic and Prognostic Serum Biomarkers of Colorectal Cancer

Background

Our systematic review summarizes the evidence concerning the accuracy of serum diagnostic and prognostic tests for colorectal cancer (CRC).

Methods

The databases MEDLINE and EMBASE were searched iteratively to identify the relevant literature for serum markers of CRC published from 1950 to August 2012. The articles that provided adequate information to meet the requirements of the meta-analysis of diagnostic and prognostic markers were included. A 2-by-2 table of each diagnostic marker and its hazard ratio (HR) and the confidence interval (CI) of each prognostic marker was directly or indirectly extracted from the included papers, and the pooled sensitivity and specificity of the diagnostic marker and the pooled HR and the CI of the prognostic marker were subsequently calculated using the extracted data.

Results

In total, 104 papers related to the diagnostic markers and 49 papers related to the prognostic serum markers of CRC were collected, and only 19 of 92 diagnostic markers were investigated in more than two studies, whereas 21 out of 44 prognostic markers were included in two or more studies. All of the pooled sensitivities of the diagnostic markers with > = 3 repetitions were less than 50%, and the meta-analyses of the prognostic markers with more than 3 studies were performed, VEGF with highest (2.245, CI: 1.347–3.744) and MMP-7 with lowest (1.099, CI: 1.018–1.187)) pooled HRs are presented.

Conclusions

The quality of studies addressing the diagnostic and prognostic accuracy of the tests was poor, and the results were highly heterogeneous. The poor characteristics indicate that these tests are of little value for clinical practice.     

肺外结核病微生物学诊断方法的研究和应用进展

肺外结核病指由结核分枝杆菌（Mycobacterium tuberculosis, MTB）感染所引起的发生在肺部以外器官和部位的结核病。近年来肺外结核的发病率逐渐升高,未能得到早期有效治疗的肺外结核病患者可能并发畸形、截瘫甚至死亡等严重后果。微生物学检测方法对从病原学角度诊断肺外结核病至关重要。基于此,总结了近年来肺外结核病细菌学检查方法、结核分枝杆菌的抗原检测与分子生物学检测等微生物学诊断方法的概况及应用进展,并对这些检测方法的优缺点及适用范围进行了分析、比较,以期为今后肺外结核病病原学诊断的研究提供相关信息。     

Intermediate Monocytes but Not TIE2-Expressing Monocytes Are a Sensitive Diagnostic Indicator for Colorectal Cancer

We have conducted the first study to determine the diagnostic potential of the CD14++CD16+ intermediate monocytes as compared to the pro-angiogenic subset of CD14++CD16+TIE2+ TIE2-expressing monocytes (TEMs) in cancer. These monocyte populations were investigated by flow cytometry in healthy volunteers (N?=?32) and in colorectal carcinoma patients with localized (N?=?24) or metastatic (N?=?37) disease. We further determined blood levels of cytokines associated with monocyte regulation. The results revealed the intermediate monocyte subset to be significantly elevated in colorectal cancer patients and to show the highest frequencies in localized disease. Multivariate regression analysis identified intermediate monocytes as a significant independent variable in cancer prediction. With a cut-off value at 0.37% (intermediate monocytes of total leukocytes) the diagnostic sensitivity and specificity ranged at 69% and 81%, respectively. In contrast, TEM levels were elevated in localized cancer but did not differ significantly between groups and none of the cytokines correlated with monocyte subpopulations. Of interest, in vitro analyses supported the observation that intermediate monocytes were more potently induced by primary as opposed to metastatic cancer cells which may relate to the immunosuppressive milieu established in the advanced stage of metastatic disease. In conclusion, intermediate monocytes as compared to TIE2-expressing monocytes are a more sensitive diagnostic indicator of colorectal cancer.     

Diagnostic Potential of Zinc Finger Protein-Specific Autoantibodies and Associated Linear B-Cell Epitopes in Colorectal Cancer

Colorectal cancer is one of the most common cancers worldwide with almost 700,000 deaths every year. Detection of colorectal cancer at an early stage significantly improves patient survival. Cancer-specific autoantibodies found in sera of cancer patients can be used for pre-symptomatic detection of the disease. In this study we assess the zinc finger proteins ZNF346, ZNF638, ZNF700 and ZNF768 as capture antigens for the detection of autoantibodies in colorectal cancer. Sera from 96 patients with colorectal cancer and 35 control patients with no evidence of cancer on colonoscopy were analysed for the presence of ZNF-specific autoantibodies using an indirect ELISA. Autoantibodies to individual ZNF proteins were detected in 10–20% of colorectal cancer patients and in 0–5.7% of controls. A panel of all four ZNF proteins resulted in an assay specificity of 91.4% and sensitivity of 41.7% for the detection of cancer patients in a cohort of non-cancer controls and colorectal cancer patients. Clinicopathological and survival analysis revealed that ZNF autoantibodies were independent of disease stage and did not correlate with disease outcome. Since ZNF autoantibodies were shared between patients and corresponding ZNF proteins showed similarities in their zinc finger motifs, we performed an in silico epitope sequence analysis. Zinc finger proteins ZNF700 and ZNF768 showed the highest sequence similarity with a bl2seq score of 262 (E-value 1E-81) and their classical C2H2 ZNF motifs were identified as potential epitopes contributing to their elevated immunogenic potential. Our findings show an enhanced and specific immunogenicity to zinc finger proteins, thereby providing a multiplexed autoantibody assay for minimally invasive detection of colorectal cancer.     

Comparison of Diagnostic Methods in the Evaluation of Onychomycosis

Onychomycosis is a common nail problem, accounting for up to half of all nail diseases. Several nail disorders may mimic the onychomycosis clinically. Therefore, a sensitive, quick, and inexpensive test is essential for screening nail specimens for the administration of the proper drug. The aim of this study was to compare 4 different diagnostic methods in the evaluation of onychomycosis and to determine their sensitivity, specificity, positive predictive value, and negative predictive value. In a cross-sectional study, nail specimens were collected from 101 patients suspected to have onychomycosis during a 14-month period. The nail specimens were examined using potassium hydroxide (KOH) 20 %, KOH-treated nail clipping stained with periodic acid-Schiff (KONCPA), and calcofluor white (CFW) stain, and grew a fungal culture. The culture was chosen as the gold standard for statistical analysis using the McNemar and chi-square tests. Out of 101 patients, 100 (99 %) patients had at least 1 of the 4 diagnostic methods positive for the presence of organisms. The positive rates for the fungal culture, KOH preparation, CFW, and KONCPA were 74.2, 85.1, 91.09, and 99.01 %, respectively. The sensitivity and negative predictive value of KONCPA was 100 %. KONCPA was the most sensitive among the tests and was also superior to other methods in its negative predictive value. KONCPA was easy to perform, rapid, and gave significantly higher rates of detection of onychomycosis compared to the standard methods of KOH preparation and fungal culture. Therefore, KONCPA should be the single method of choice for the evaluation of onychomycosis.     

结/直肠癌的潜在治疗靶点

传统的结/直肠癌化疗药物,作用选择性较低,副反应明显,疗效欠佳,患者病死率居高不下.寻找新型治疗药物,十分必要.在结/直肠癌发病机制的探索过程中,研究者发现:一些分子的变化影响着疾病进程,对病情起指示作用,有可能成为治疗靶点.围绕这些分子设计药物,制定治疗方案,有望提高疗效,改善病人生存质量,降低不良反应的发生.本文就结/直肠癌的部分潜在治疗靶点:EGFR,VEGF,HADC,COX-2,PPARγ及galectin-3做一综述.