HBVDNA阳性肝癌患者血清HBeAg检测与肝细胞癌复发转移的关系

目的：研究HBVDNA阳性肝癌（HCC）患者血清HBeAg检测与肝细胞癌复发转移的关系。方法：HBVDNA阳性HCC肝切除术患者60例,HBVDNA阴性HCC肝切除术患者60例。60例HBVDNA阳性HCC患者中依据肿瘤病灶局限、肉眼以及镜下均无肝内播散和门静脉浸润的低侵袭组,共28例;肿瘤组织伴有多发性肝内播散和（或）门静脉主肝癌栓者为高侵袭组,共32例。检测患者术前及术后1周血清HBVDNA水平,观察肝功能变化并检测血清HBeAg水平。结果：HBVDNA阳性组与HBVDNA阴性组比较,60例HBVDNA阳性HCC患者中HBeAg阳性患者为48例,阳性率为80％,60例HBVDNA阴性HCC患者中HBeAg阳性患者为12例,阳性率为20％,（P〈0．05）。不同侵袭组HBeAg表达比较：32例高侵袭组中29例HBeAg检测阳性,阳性率为90．62％,28例低侵袭组中19例HBeAg检测阳性,阳性率为67．86％,（P〈0．05）。结论：早期肝癌患者血清HBVDNA和HBeAg可作为肝细胞癌复发转移监测指标。     

多肿瘤标志物蛋白芯片检测系统对原发性肝癌的诊断价值评价

目的：研究多肿瘤标志物蛋白芯片诊断系统用于原发性肝癌的诊断价值。方法：采用多肿瘤标志物蛋白芯片诊断系统，检测分析72例原发性肝癌患者、64例良性肝病患者和30例门诊体检者血清的12种常见肿瘤标志物，包括糖原199（CA199）、神经原特异性烯醇化酶（NSE）、癌胚抗原（CEA）、糖原242（CA242）、铁蛋白（FER）、β-人绒毛膜促性腺激素（β-HCG）、甲胎蛋白（AFP）、游离前列腺特异抗原（f-PSA）、前列腺特异抗原（PSA）、糖原125（CA125）、人生长激素（HGH）、糖原153（CA153）。主要从真实性、可靠性两方面评价其诊断效能。结果：多肿瘤标志物蛋白芯片诊断系统诊断原发性肝癌的真实性评价指标：灵敏度93．1％、特异度29．7％、误诊率（α）70．3％、漏诊率（β）6．9％、阳性似然比1．32、阴性似然比0．23、诊断指数123％、Youden指数0．23、粗符合率63．2％；可靠性评价指标（一致性相关系数）：CA199（0．846P〈0．01）、NSE（0．858P〈0．01）、CEA（0．906P〈0．01）、CA242（0．864P〈0．01）、FER（0．913P〈0．01）、β-HCG（0．881P〈0．01）、AFP（0．894P〈0．01）、f-PSA（0．836P〈0．01）、PSA（0．875P〈0．01）、CA125（0．866P〈0．01）、HGH（0．887P〈0．01）、CA153（0．875P〈0．01）。结论：多肿瘤标志物蛋白芯片诊断系统对原发性肝癌有一定的辅助诊断价值，进一步改进其肿瘤标志物组合，对原发性肝癌的诊断效能会更好。     

HS-AFP在肝癌早期诊断及鉴别诊断中的价值

目的：探讨肝癌特异性甲胎蛋白（HS—AFP）对肝细胞癌的诊断及鉴别诊断价值。方法：对105例肝癌患者及151例良性肝病血清HS—AFP及AFP进行检测，并对10例HS—AFP阳性的良性肝病患者进行15个月随访观察。HS—AFP采用不连续缓冲系统PAGE结合Westernblot分离检测，AFP采用化学发光法测定。结果：105例肝癌患者HS—AFP和AFP〉200μg／L阳性率分别为60．0％和50．5％（P〉0．05），良性肝病患者HS—AFP阳性率显著低于AFP〉200μg／L的阳性率（P〈0．05）。AFP处于50～400μg／L范围的肝癌组HS—AFP阳性率为77．1％，良性肝病组阳性率为13．6％（P〈0．01），151例良性肝病中有10例HS-AFP出现阳性，其中3例于随访期间检出肝癌。11例小体积肝癌HS—AFP阳性率（45．5％）高于AFP〉200μg／L的阳性率（18．2％）。结论：HS—AFP对肝癌的诊断价值优于AFP浓度。对肝癌高危人群监测HS—AFP有助于肝癌的早期诊断。对血清AFP中低浓度升高的良恶性肝病有较高的鉴别诊断价值、     

荧光检测外周血AFP mRNA的表达与肝癌的相关性研究

目的：研究定量检测原发性肝癌患者外周血单个核细胞（PBMC）甲胎蛋白信使核糖核酸（AFP mRNA)表达的意义。方法：应用荧光定量聚合酶链反应（FQ－PCR）定量检测51例原发性肝癌，10例转移性肝癌，18例非肝癌的恶性肿瘤，16例慢性肝病患者的外周血单个核细胞（PBMC）甲胎蛋白mRNA。结果：AFP mRNA在非肝癌的恶性肿瘤患者无异常表达，在转移性肝癌（20％，2／10），慢性肝病（6．3％，1／16），原发性肝癌（37．3％，19／5）、AFP mRNA的基因拷贝数和肝癌TNM分期[1]，门静脉癌栓，肝外转移显著相关，而与肿瘤大小及血清AFP值无相关性。结论：巢式FQ－PCR检测肝癌患者外周血AFP mRNA异常预示有血源性转移的可能，可作为肝癌的诊断，肿瘤分期和有无肝外转移及愈合的指标。     

手术联合^125I粒子永久性植入治疗肝癌的临床研究

目的：评价术中联合放射性^125I粒子植入治疗原发性及继发性肝癌的安全性、疗效及剂量。方法：48例术前评估有手术指征的肝癌患者用计算机三维治疗计划系统术前或术中制定治疗计划，术中依据所制定的剂量，应用瘤体内植入或平面插植技术将^125I粒子永久性植入，平均每例26粒，肿瘤匹配周边剂量为90—120Gy，术后验证和质量评估；观察治疗前后病人血象、免疫指标、临床症状、脏器功能（ALT、AST）、肿瘤标记物（AFP、CEA）、肿瘤影像学（CT）等的变化。结果：中位随访期23个月，瘤体积≤20cc者治疗有效率75．6％，瘤体积21—64cc者有效率69．6％，1、2、3年生存率分别为72．9％、47．9％、25．0％；术前、术后1周及术后3个月血象虽有显著差异，但均在正常范围，免疫指标前后变化无统计学意义；治疗后病人临床症状缓解率为93．2％（41／44），ALT、AST由异常降至正常水平者占80．0％（32／40），AFP、CEA降低超过原数值50％者占75．0％（15／20）、73．1％（19／26）；无相关死亡，无放射相关严重并发症；术后验证和质量评估满意。结论：术中联合放射性^125I粒子植人治疗原发性及继发性肝癌疗效显著、方法简便、使用安全，采用粒子活度0．5—0．8mCi、肿瘤匹配周边剂量90—120Gy合理可行。     

α干扰素和5-氟尿嘧啶对肝癌切除术后转移复发抑制作用的实验研究

目的：研究α干扰素（interferon-α，IFN-α）和5-氟尿嘧啶（5-fluorouracil，5-FU）在肝癌转移模型中对肿瘤切除术后转移和复发的影响。方法：裸鼠人肝癌转移模型（LCI-D20）40只，随机分成4组即对照组（生理盐水）、干扰素组（IFN-α2a）、5-FU组和联合组（5-FU与IFN-α2a）。观察肝癌切除后肿瘤复发、肝内播散及肺转移，检测复发瘤血管生成相关指标（MVD、VEGF、bFGF和SMA），并检测血清AFP。结果：对照组、干扰素组、5-FU组和联合组肝内复发率分别为100％、90％、100％和80％；肝内出现播散灶率分别为100％、60％、70％和10％；与对照组比较，干扰素组和联合组复发瘤体积、肝内播散灶数量、肺转移率和转移灶数量均明显减少（P〈0．05）；两药联合应用对抑制肿瘤转移和复发有协同效应；干扰素对肝癌血管形成有良好的抑制作用，与对照组及5-FU组比较有统计学意义（P〈0．05）。结论：干扰素和5-FU均可抑制肝癌术后肿瘤复发与转移，二者联用有协同作用。     

GP73、AFP、CA －199联合检测在原发性肝癌诊断中的应用价值

目的：探讨高尔基体蛋白73（GP73）、甲胎蛋白（AFP）和糖类抗原199（CA －199）联合检测对原发性肝癌（PLC）诊断的意义。方法：54例原发性肝癌患者均为邯郸市人民医院住院患者,采用酶偶联吸附法（ELISA 法）检测 GP73、化学发光免疫分析法检测 AFP、CA －199,并与55名健康对照者进行比较。结果：原发性肝癌组血清 GP73、AFP 及 CA －199水平较对照组均明显升高,差异均有统计学意义（P 均＜0．01）。PLC组 GP73、AFP 及 CA －199水平呈显著正相关（r ＝0．729、0．651、0．627,P 均＜0．05）。三项肿瘤标记物联合测定的阳性率为87．0％,明显高于单项分别测定 GP73、AFP、CA －199阳性率,其阳性率分别为48．1％、77．8％和33．3％,差异有统计学意义（P ＜0．05）。结论：血清 GP73、AFP、CA －199联合检测可明显提高原发性肝癌的阳性检出率,对原发性肝癌的早期诊断具有重要的临床意义。     

男性肝细胞肝癌术后预后因素分析

目的：探讨男性肝细胞肝癌术后的预后影响因素方法：利用COX回归回顾性分析2000年1月至2005年12月天津医科大学附属肿瘤医院经病理证实的接受肝细胞肝癌根治术治疗的426例男性肝细胞肝癌患者的临床病理学资料和预后特点．并与同期接受肝细胞肝癌根治术的71例女性肝细胞肝癌患者的临床病理学资料和预后特点进行比较结果：男性肝细胞肝癌患者的1年生存率和3年生存率分别为54．9％（234／426例）和31．0％（132／426例），女性肝细胞肝癌患者的1年生存率和3年生存率分别为56．3％（40／71例）和40．8％（29／71例），女性肝细胞肝癌患者的预后好于男性，但男、女性肝细胞肝癌怠者的总生存率相比无统计学差异（P〉0．05）单因素分析显示：饮酒、GGT、AFP、肿瘤大小、数目、门昧瘤栓（PVTT）、TNM分期和Edmondson分级为男性肝细胞肝癌患者预后的影响因素（P〈0．05）；AFP、Edmondson分级为女性肝细胞肝癌患者预后的影响因素（P〈0．05）。COX回归多因素分析显示：饮酒、AFP、肿瘤大小、门脉痛栓和Edmondson分级为男性肝细胞肝癌患者预后的独立影响因素（P〈0．05），Edmondson分级为影响女性肝细胞肝癌患者预后的独立因素（P〈0．05）结论：饮酒、AFP、肿瘤大小、门脉瘤栓和Edmondson分级等因素对男性肝细胞肝癌患青有预后价值，Edmondson分级为影响女性肝细胞肝癌患者预后的独立因素。     

蛋白芯片多肿瘤标志物联合诊断肝癌指标的筛选及应用

目的：探讨多指标联合诊断肝癌的价值及组合。方法：采用蛋白芯片法检测12项肿瘤标志物；术前肝癌组69例，对照组69例。结果经SPSS软件的多元逐步回归法处理。结果：12项指标中筛得肝癌联合诊断有价值的指标为：AFP、Ferritin、CA125。经组合判别，AFP Ferridn和AFP Ferfifin CA125的诊断效率较单项指标高，均达84．1％。增加CA125指标未见诊断效率提高，但敏感性、特异性、阳性预期值、阴性预期值较未增加该指标更趋平衡，每项值均等于或大于82．6％。结论：AFP、Ferrifin、CA125是肝癌联合诊断的理想指标；从敏感性、特异性、诊断效率、阳性预期值、阴性预期值五项标准综合考虑，AFP Ferrifin CA125联合的效果最佳。     

肝癌肝移植术后复发的诊治

目的：分析影响肝癌肝移植术后复发的危险因素，总结复发后治疗经验。方法：根据46例肝癌肝移植患者术后有无复发转移分为未复发组（33例）和复发组（13例）。结果：肝癌肝移植术后随访2年，未复发组与复发组的原发肿瘤直径分别为（8．7±2．3）cm和（9．2±2．5）cm（P〈0．05）；未复发组与复发组有门静脉癌栓等血管侵犯分别为12．1％和69．2％（P=0．001）。复发组经积极治疗后6个月、1年和2年生存率分别为100％、92％和16％。结论：肝癌肝移植术后肿瘤复发患者的总体预后差，治疗棘手，因此，重点为预防，并尽可能早期发现，积极治疗，以提高患者的生存期。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

甲状腺手术的技巧及副损伤的预防和处置

鉴于甲状腺手术是普外科的常见手术，为求其日渐完美，以有益于病人，现根据作者的体会，并结合阅读相关文献，就其手术操作、喉返神经处理、甲状旁腺处理进行扼要阐述。