<正>胸腔积液在临床上很常见,其中,恶性胸腔积液发生率约20%~30%[1]。恶性胸腔积液的发生率高,死亡率高,明确诊断后中位生存期仅4~9个月[2]。胸膜穿刺活检是目前临床公认的检测胸腔积液的金标准,其特异性高,但是具有创伤性,操作上也较繁琐,因此,临床上需寻求更简便、快速的方法进行检测,同时具有较高的特异性和敏感性,以减轻患者的痛

目的:探讨血管内皮生长因子( VEGF)及其受体在小细胞肺癌中的表达及意义.方法:采用免疫组化方法检测未经任何治疗的小细胞肺癌患者无淋巴结转移与有淋巴结转、广泛期与局限期肿瘤组织VEGF及其受体的表达.结果:小细胞肺癌患者组织VEGF及VEGFR-3表达在有淋巴结转移组均高于无淋巴结转移组,广泛期小细胞肺癌患者组织VEGF及VEGFR-3的表达均高于局限期.结论:小细胞肺癌患者组织VEGF及VEGFR-3表达在有淋巴结转移组均高于无淋巴结转移组,广泛期小细胞肺癌患者组织VEGF及VEGFR-3的表达均高于局限期.

目的探讨联合检测胸腔积液中血管内皮生长因子（VEGF）、癌胚抗原（CEA）、α-L岩藻糖苷酶（AFU）含量对良恶性胸腔积液的鉴别诊断价值。方法回顾性分析34例恶性和27例良性胸腔积液中VEGF、CEA、AFU的检测资料。VEGF检测采用双抗体夹心酶联免疫吸附法（ELISA），CEA检测采用放射免疫分析技术．AFU使用0LYMPUSAU400全自动生化分析仪检测分析。结果在恶性疾病组中，VEGF、CEA、AFU含量明显高于良性疾病组；VEGF、CEA、AFU对恶性胸腔积液诊断其敏感性分别为85．6％、70．6％、88．8％，特异性分别为92．6％、96.3％、82．2％，准确性分别为88．8％、82．0％、85．2％，与CEA单项检测比较．VEGF、CEA、AFU三项联合检测，以任意一项阳性为阳性判断可提高诊断敏感性和准确性。结论VEGF、CEA、AFU联合检测可提高恶性胸腔积液的敏感性和准确性．对良性胸腔积液的鉴别有重要的临床意义。

Objective To explore the value of interferonⅡ,vascular endothelial growth factor,C-reactive protein and adenosine deaminase in differential diagnosis of tuberculous and malignant pleural effusion.Methods 122 cases with tuberculous pleurisy,56 cases of malignant pleural effusion,48 cases of tuberculous pleural effusion,18 cases of inflammatory and other pleural fluid were studied.The serum and pleural fluid levels of IFN-γ,VEGF-C,CRP and ADA serum in those patients were detected.Results The IFN-γ,CRP and ADA levels in tuberculous pleural effusion were higher than in malignant pleural effusion(P0.01).According to the receiver operator characteristic(ROC) curve,when 100ng/L was regarded as critical value of IFN-γ,the sensitivity and specificity of IFN-γ in diagnosing tuberculous pleural effusion were 83.1% and 92.3% respectively.When 45U/L ADA was regarded as critical value of ADA,the sensitivity and specificity of ADA in diagnosing tuberculous pleural effusion were 85.6% and 96.3% respectively.When 110mg/L was regarded as critical value of CRP,the sensitivity and specificity of CRP were 79.1% and 84.2% respectively.When combine detection of three markers,the diagnosis sensitivity and specificity were 87.8% and 86.0% respectively.The VEGF-C concentration in malignant pleural effusion was higher than that in tuberculous pleural effusion and inflammatory and other pleural effusion(P0.01).When the ratio of VEGF-C to ADA≥8,the sensitivity and specificity in diagnosis of malignant pleural effusion were 86.3% and 82.6% respectively,and the ration VEGF-C to ADA≤3,the sensitivity and specificity in diagnosis of tuberculous pleural effusion were 85.1% and 87.1% respectively.Conclusion The combined detection of IFN-γ,CRP and ADA could improve sensitivity and specificity in diagnosing tuberculous pleurisy.The concentration ratios of VEGF-C to ADA have clinical value in differential diagnosis of pleural effusions.

急性脑梗死易引起继发性心脏损害,表现为心脏功能的紊乱及心电活动的改变,这在临床上称为脑心综合症.已有一些研究表明,10％～ 27％急性脑梗死患者血清肌钙蛋白含量升高[1-3].为探讨急性脑梗死患者血清超敏肌钙蛋白含量升高与脑梗死的诊断和预后的关系.本文对66例急性脑梗死患者和50名健康查体者血清超敏肌钙蛋白hs-TNT含量进行了分析.资料与方法1一般资料2009年10月至2010年10月本院收治的发病48h内,经过颅脑CT确诊的66例急性脑梗死患者,符合1995年中华医学会第4次全国脑血管病学术会议确定的诊断标准[4].排除以下病例:近期心肌梗死、心力衰竭、心脏手术后、肾功能不全、怀孕妇女、严重痴呆.66例急性缺血性卒中患者为观察组,男43例,女23例,年龄43 ～ 81岁,平均年龄58.9±11.8岁.所有患者在首次采血前未使用抗炎、扩容、扩血管、溶栓等药物治疗.患者治疗10天后,58例再次检测hs -TnT含量.选择同期健康体检者50名为对照组,男25名,女25名,年龄41 ～78岁,平均年龄55.3 ±11.2岁,均无心、肝、脑、肾疾病和感染性疾病及糖尿病,头部CT检查无颅内疾病.

目的:探讨凝集素微量离心柱法(lens eulinaris.agglutinin (LCA)-coupled spin column,ACSC)法检测甲胎蛋白异质体(alpha-fetoprotein isoforms,AFP-L3)对甲胎蛋白(alpha-fetoprotein,AFP)阳性的良恶性肝病鉴别诊断价值.方法:采用凝集素微量离心柱法及电化学发光法检测92例原发性肝癌( hepatocellular carcinoma,HCC),45例慢性肝炎及肝硬化患者血清中AFP及AFP-L3浓度,以AFP-L3％≥10％为阳性判断标准,分析AFP-L3％与良恶性肝病的关系.结果:ACSC法检测AFP-L3％对92例原发性肝癌(HCC)的灵敏度是85.86％,对45例慢肝、肝硬化的特异性为95.56％,诊断准确度为89.05％,在受试者工作特征曲线(receiver operatin characteristic curve,ROC)曲线下的面积为0.9226.结论:ACSC法检测AFP-L3指标在PHC鉴别诊断中具有临床价值.

目的:探讨血清血管内皮生长因子( VEGF)在小细胞肺癌中的诊疗价值.方法:采用放射免疫分析法(RIA)测定40例小细胞肺癌患者有淋巴结转移与无淋巴结转移,局限期与广泛期血清VEGF含量的变化,并同时测定正常对照组48例血清VEGF的含量.结果:小细胞肺癌患者血清VEGF浓度较健康对照高,差异有显著意义(p＜0.05).无淋巴结转移与有淋巴结转移结果对两组进行t检验,p＞0.05,差异无显著意义.广泛期血清VEGF浓度高于局限期(p＜0.05),差异有显著意义.结论:小细胞肺癌患者血清VEGF浓度明显高于正常对照组,可以作为小细胞肺癌肿瘤标志物的辅助实验,小细胞肺癌广泛期患者VEGF浓度高于局限期患者,提示VEGF浓度可作为分期的辅助指标.但与是否有淋巴结转移无统计学意义.

目的:探讨血清VEGF在乳腺癌诊治中的临床价值.方法:采用放射免疫分析法(RIA)测定60例乳腺癌患者术首,其中56例术后血清VEGF含量的变化,并同时测定正常对照组40例血清VEGF的含量.结果;乳腺癌患者术首,术后1个月血清VEGF含量明星高于对照组,经统计学处理,差异有显著性(P<0.01).术前组血清VEGF含量明显高于术后1个月组(P<0.01).结论:血清VEGF含量在乳臃癌的发生发展中具有重要作用,检测血清VEGF含量有助于乳腺癌患者的诊断和疗效判断.