外泌体在膀胱癌中的现状与展望

外泌体是一种由人体细胞分泌的具有双层膜结构的囊性小泡,是胞外囊泡中的一种类型。研究显示,外泌体通过多种途径参与细胞间的信息传导,在膀胱癌的发生、发展和凋亡过程中发挥着重要作用。同时,外泌体的膜结构可以保护其内容物不被人体酶类物质所分解,因此可以作为载体携带相关治疗因子进入膀胱癌细胞。外泌体在膀胱癌的诊治过程中展现出了良好的应用价值,但同时也面临着一些技术挑战,现对上述问题进行文献综述,希望能为膀胱癌的诊疗提供参考。     

下尿路梗阻性肾积水患者逼尿肌功能变化

目的：探讨下尿路梗阻性肾积水患者逼尿肌功能变化。方法：对20例（3．5－73岁）下尿路梗阻导致的肾积水组和10例（13－67岁）无肾积水的对照组进行膀胱压力容积测定与压力－流率测定，并记录不同膀胱灌注量的逼尿肌基础压力。结果：下尿路梗阻性肾积水组逼尿肌－括约肌协同失调（DSD）11例（55％），逼尿肌功能过度活跃5例；而对照组仅发现1例（10％）DSD，未发现有逼尿肌功能过度活跃。下尿路梗阻性肾积水组平均膀胱顺应性显著低于对照组（P＜0．05），而下尿路梗阻性肾积水组平均逼尿肌基础压力，平均逼尿肌最大收缩压和残余尿量均显著高于对照组（P＜0．05），且下尿路梗阻性肾积水组在灌注量逐渐增加时高逼尿肌基础压力发生率逐渐增加。结论：下尿路梗阻性肾积水多伴有逼尿肌功能异常，提示膀胱逼尿肌功能改变与下尿路梗阻性肾积水的形成及发展有一定的相关性。     

下调uPAR表达抑制高侵袭性人膀胱癌细胞系T24的迁移与侵袭

目的探究尿激酶型纤溶酶原激活物受体(u PAR)的表达对高侵袭性人膀胱癌细胞系T24体外增殖与侵袭的影响,以及哺乳动物靶向雷帕霉素靶蛋白复合物2(m TORC2)可能的作用。方法设计合成针对u PAR、Rictor、PTEN基因的siRNA和阴性对照NC siRNA。将对数增殖期T24细胞随机分为5组,并设为实验组siu PAR、siRictor、siRictor+siu PAR、siu PAR+si PTEN和对照组NC。用瞬时转染法将以上siRNA及相应组合分别转入5组T24细胞;分别用RT-qPCR和Western blot检测mRNA及蛋白的表达;用MTT法和Transwell侵袭实验分别检测u PAR siRNA对T24细胞增殖及侵袭的影响。结果 T24细胞中u PAR mRNA和蛋白的表达量显著上调(P0. 05)。沉默u PAR能够显著下调T24细胞中磷酸化Akt Serine-473(P-Akt S473)的表达量(P0. 05),并抑制T24细胞的迁移与侵袭(P0. 05)。敲除PTEN基因的T24细胞中,沉默u PAR基因促进Akt S473磷酸化(P0. 05)。结论沉默u PAR能够抑制T24细胞的迁移与侵袭,在T24细胞中u PAR可能是m TORC2的上游调控因子。     

普乐可复对肾脏毒性的实验研究

目的 :探讨普乐可复 (FK5 0 6 )对肾脏的毒性及其机制。方法 :分别给小鼠腹腔注射生理盐水、FK5 0 6 5mg·(kg·d) -1和 10mg·(kg·d) -1,连续用药 7d后断头采血 ,检测血肌酐 (Cr)、尿素氮 (BUN)、血栓素 B2 (TXB2 )和 6 酮 前列腺素F1α(6 keto PGF1α) ,并剖腹取其肾脏行常规病理检查。结果 :FK5 0 6 5mg·(kg·d) -1组血清BUN、Cr、TXB2明显高于空白对照组 (P均 <0 0 5 ) ,6 keto PGF1α较之显著降低 (P <0 0 5 ) ;光镜下可见肾近曲小管上皮细胞混浊肿胀 ,肾小球萎缩不明显。FK5 0 6 10mg·(kg·d) -1组血清BUN、TXB2明显高于FK5 0 6 5mg·(kg·d) -1组 (P <0 0 5 ) ,6 keto PGF1α显著降低 (P <0 0 5 ) ;光镜下可见肾小球萎缩 ,纤维化 ,严重者肾小球结构消失 ,肾近曲小管上皮细胞混浊肿胀。结论 :FK5 0 6的肾毒性主要表现为肾小球和肾小管损伤后的肾功能下降 ,其机制与肾脏血管内皮细胞损伤有关     

马根维显动态增强核磁共振评价肾积水疗效

目的了解马根维显(Gd-DTPA)动态增强核磁共振(MRI)评估肾积水术后疗效的应用价值。方法单侧肾积水患者11例,年龄7～42岁,平均19.5岁,均为男性;左侧肾积水9例,右侧2例;病因经静脉尿路造影(intravenousurography,IVU)和B超确诊,10例为先天性肾盂输尿管连接部狭窄(pelvicureterjunctionobstruction,PUJO),1例为输尿管中段慢性炎症所致不完全性梗阻;10例PUJO实施狭窄部成形术,另1例施行输尿管狭窄段切除并输尿管端端吻合术。应用Gd-DTPA作为对比剂,分别在术前1个月和术后3个月实施动态增强MRI检查,选取肾实质、肾盂和集合系统的类圆形区域作为兴趣区(regionofinteresting,ROI),计算不同时间点不同兴趣区的信号强度(signalintensity,SI)和相对信号强度(relativeSI,RSI),绘制T-SI曲线,对术前术后肾脏的形态和功能状态进行评估和比较。结果积水肾脏术前肾实质与术后综合评价无显著性差异(P>0.05),肾盂和集合系统排泄对比剂明显减慢,各ROI和SI以及持续时间与术后肾脏相比均有明显的差异(P<0.05)。结论动态增强MRI作为一种简单、安全无创的技术、联合评估肾形态和功能,对于评价肾积水手术疗效具有重要的临床价值。     

女性膀胱颈非霍奇金淋巴瘤1例

<正>患者女,76岁。以"尿频、尿痛1周"为主诉入院。小便伴有灼烧感,体型消瘦,低热,体温波动在38℃左右,无肉眼血尿。患者30年前曾行绝育手术,15年前因胆结石行"胆囊切除术"。彩色超声显示肝内强回声(钙化灶),子宫肌壁间钙化灶,宫腔及盆腔积液。体检:全身浅表淋巴结未见肿大,尿道增粗,尿道外口可见一约1cm肿物,质地脆,触之易出血,表面可见大量白色分泌物。中下腹部CT平扫示肝左叶钙化灶,双肺底炎症,左侧胸膜     

经皮肾镜取石术治疗老年上尿路结石41例分析

目的 探讨采用经皮肾镜取石术治疗老年高危患者上尿路结石的有效性及安全性.方法 回顾性分析运用微创经皮肾镜取石术治疗41例老年上尿路结石患者的临床资料.结果 41例中,一次取净结石30例,二次取净结石2例,三次取净结石2例,结石总取净率82.9%;平均手术时间120 min,平均术中出血量46 ml,平均住院时间10 d.无严重并发症发生.结论 微创经皮肾镜取石术治疗老年高危患者上尿路结石创伤小,出血少,结石取净率高,并发症少,恢复快.     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.     

膀胱癌576例流行病学分析

目的 分析膀胱癌的流行病学资料及不同手术方法的疗效.方法 对我院2004年1月至2008年12月收治的576例膀胱癌患者的临床资料进行回顾性分析.结果 576例膀胱癌中93.2%为移行细胞癌,腺癌3.0%,鳞癌2.3%,其他1.5%;经尿道膀胱肿瘤电切术、膀胱部分切除术3年复发率分别为45.2%、52.7%;Ta～T1、T2、T3、T4期3年生存率分别为93.4%、72.2%、50.8%、10.3%,根治性膀胱全切3年生存率为83.1%.结论 膀胱癌好发人群为40岁以上的男性,绝大多数为移行细胞癌;其生存率随着分级、分期的增加而降低.