變應性肉芽腫性血管炎又稱Churg—Strauss綜合征(CSS )，是一種以哮喘、血和組織中嗜酸粒細胞增多、血管外壞死性肉芽腫為特征的系統性小血管炎。該病臨床罕見，國外報道其發(fā)病率約為24/100萬。由于該病早期臨床表現不典型，容易誤診，現將我院收治的2例CSS患者報告如下。臨床資料 例1 患者男性，56歲。因“反復胸悶氣喘伴咳嗽28個月，雙手發(fā)麻6個月，加重10 d”，于2007年12月1日入院。2005年8月起無明顯誘因經常感胸悶氣喘，活動時明顯，伴咳嗽，咳少量白色黏痰，在外院診斷為肺炎，經抗感染治療可好轉。2006年6月2日胸部CT示兩肺紋理粗亂，右中葉、左舌葉見少許小片狀影；2006年6月6日支氣管鏡檢查見氣管支氣管黏膜充血水腫，腔內少量白色分泌物；痰找抗酸桿菌陽性，于2006年6月7日第1次住院。病程中，體重減輕10 kg。既往于2005年5月22日因雙側鎖骨上窩淋巴結腫大行淋巴結活檢，活檢病理示慢性反應性增生；1:2000 PPD試驗 紅腫大小為10 mm×11 mm，有水泡。查體:雙肺未聞及干濕性啰音。入院后查血常規(guī)：白細胞（WBC）總數11.1×109/L，血紅蛋白96 g/L，血小板計數192×109/L；血結核抗體弱陽性（酶標法）；肝功能：球蛋白82.1 g/L，白蛋白28.3 g/L；腎功能正常；血沉 115 mm/1 h；尿常規(guī)：潛血（±），痰找結核菌6次陰性；腹部CT平掃+增強提示右腎上腺腫瘤（嗜鉻細胞瘤可能性大）；心臟彩超及動脈血氣正常。診斷為肺結核，支氣管結核，右腎上腺嗜鉻細胞瘤，于2006年6月19日予3HLEZ/9HL方案抗結核及抗感染治療，2006年6月26日癥狀好轉出院，但仍感活動時胸悶氣喘，復查血常規(guī)：WBC總數8.3×109/L，血紅蛋白95 g/L，血小板計數400×109/L；肝功能：球蛋白68.5 g/L，白蛋白26.3 g/L；腎功能正常。于2006年9月1日因雙下肢關節(jié)痛自行停用抗結核治療。2006年9月11日行右腎上腺嗜鉻細胞瘤切除治療。
【摘要】 目的 探討后程適形放射治療（3 dimensional comformal radiation therapy，3D-CRT）同步化學療法治療Ⅲ期非小細胞肺癌（non-small-cell lung cancer，NSCLC）的近期療效?！》椒ā∷鸭?005年1月-2008年6月NSCLC患者共115例，其中53例行單純后程3D-CRT（單放組），62例行后程3D-CRT聯合同步化學療法（聯合組），所有患者均經病理證實為Ⅲ期NSCLC。兩組放射治療方案均采用常規(guī)分割治療加后程3D-CRT，DT 62～72 Gy。聯合組化學療法采用TP（紫杉醇 + 順鉑）方案?！〗Y果 單放組和聯合組近期療效（完全緩解+部分緩解）分別為75.47%、91.94%，差異有統計學意義（Plt;0.05）。單放組和聯合組的治療不良反應主要有白細胞、血小板減少，放射性食管炎，放射性氣管炎，惡心、嘔吐等胃腸道反應。骨髓抑制和消化道反應，聯合組稍高于單放組。經對癥治療后，所有患者均可耐受?！〗Y論 后程3D-CRT聯合TP方案化學療法較單純后程適形放射治療明顯提高Ⅲ期NSCLC近期療效?；颊吣褪苄陨锌伞＊ァ続bstract】 Objective To observe the recent therapeutic effect of late course 3 dimensional conformal therapy concomitant with chemotherapy on locally advanced stage Ⅲ non-small-cell lung cancer (NSCLC). Methods From January 2005 to June 2008, 115 patients with stage Ⅲ NSCLC were confirmed by pathology, in whom 53 only underwent late course conformal therapy (radiotherapy group), and another 62 underwent late course conformal therapy concomitant with chemotherapy (combined group). The radiotherapy schema of the two groups was routine division plus late course conformal therapy (with DT 62-72 Gy). The chemotherapy schema in the combined group was performed with TP (paclitaxel and DDP). Results The recent curative effect (complete remission plus partial remission) in radiotherapy group and combined group was 75.47% and 91.94%, respectively (Plt;0.05). The frequent adverse reactions in the two groups included leucocytopenia, thrombocytopenia, radioactive esophagitis, radioactive tracheitis, nauseated, and emesia. The rate of bone marrow depression and alimentary canal reaction in combined group was higher than that in the radiotherapy group. In the two groups, all patients could tolerance the treatments. Conclusion Late course 3 dimensional conformal therapy concomitant with TP schema chemotherapy for NSCLC could raise the recent curative effect. The patients could tolerance the treatments.
【摘要】 目的 剪切修復偶聯因子1（ERCC1）是核苷酸外切修復家族中的重要成員，它在核酸損傷修復過程和凋亡過程中起著重要作用；存活蛋白（Survivin）屬凋亡抑制蛋白家族，是迄今發(fā)現的最強的凋亡抑制因子之一。研究中初步探索晚期非小細胞肺癌（non-small-cell lung cancer，NSCLC）中ERCC1和Survivin與鉑類化學療法敏感性的關系及其相關性?！》椒ā?001年1月－2002年6月對51例晚期NSCLC（ⅢB或Ⅳ期）標本經免疫組織化學檢測ERCC1和Survivin的表達，患者行至少2周期含鉑方案化學療法，2周期化學療法后評價療效，采用SPSS 13.0軟件就檢測指標和化學療法療效評價進行相關統計分析。 結果 ERCC1和Survivin在腫瘤組織中陽性表達率分別為58.8 %（30/51）和76.5 %（39/51）。ERCC1陰性組化學療法有效率高于陽性組（Plt;0.05），5年生存時間高于陽性組（Plt;0.05）；Survivin陰性組化學療法有效率雖高于陽性組，但無統計學意義（Pgt;0.05），其5年生存時間與陰性組比較無差別（Pgt;0.05）。Spearman相關分析提示ERCC1與Survivin之間無相關性（rs=-0.088，P=0.537）?！〗Y論 ERCC1和Survivin可能與NSCLC的發(fā)生相關，ERCC1可能與腫瘤的預后相關，并對化學療法療效具有一定預測價值。ERCC1和Survivin之間耐藥機制可能各不相同。【Abstract】 Objective Excision repair cross-complementing 1 (ERCC1), an important member of the DNA repair gene family, plays a key role in nucleotide excision repair and apoptosis of tumor cells. Survivin, a member of inhibitor of apoptosis protein (IAP) family, is one of the most powerful factors in inhibiting apoptosis up to now. This study is to explore the value of ERCC1 and Survivin in predicting the sensitivity of non-small cell lung cancer (NSCLC) to platinum-based chemotherapy and the interrelationship between the two markers. Methods From January 2001 to June 2002, expressions of ERCC1 and Survivin of 51 advanced NSCLC patients (Ⅲ B or IV) were tested through immunohistochemistry. The patients were treated with at least 2 cycles of platinum-based chemotherapy. The curative effect was evaluated later, and the relationship among detected data, curative effect of chemotherapy and patients′ clinical parameters were analyzed with SPSS 13.0 software. Results The positive expression rates of ERCC1 and Survivin in NSCLC tissues were 58.8 % (30/51) and 76.5 % (39/51), respectively. The effective rate of chemotherapy and 5-year survival rate for the negative group of ERCC1 were significantly higher than those for the positive group (Plt;0.05). The results for Survivin were similar to those for ERCC1, but there was no statistical significance (Pgt;0.05). We also found there was no relationship between ERCC1 and Survivin by Spearman′s correlation analysis (rs=-0.088, P=0.537). Conclusion ERCC1 and Survivin may be correlated with the development of NSCLC, and ERCC1 may be related to curative effect and prognosis of NSCLC. There was probably no mechanism of coordination or regulation in multi-drug resistance between ERCC1 and Survivin.
目的 觀察消化道腫瘤患者服用甲羥孕酮（medroxyprogesterone acetate, MPA）對化療后骨髓抑制的影響。 方法 2008年11月-2009年8月，將接受化療的消化道腫瘤患者共100例隨機分為治療組(MPA加化療組，54例)及對照組(單純化療組，46例)，2周期化療后評價骨髓抑制狀況和生活質量變化。 結果 治療組和對照組化療后白細胞、血紅蛋白和血小板Ⅰ~Ⅱ度骨髓抑制發(fā)生率沒有差異（Pgt;0.05），但治療組Ⅲ~Ⅳ度骨髓抑制發(fā)生率低于對照組，KPS評分改善率高于對照組（Plt;0.05）。未見明顯不良反應。 結論 MPA可有效減輕化療后骨髓抑制。