目的 探讨四区域腰椎间孔注射联合五联法治疗复杂性膝关节痛的临床价值.方法 选取2020年1月至2021年7月北京核工业医院四○一院区确诊为复杂性膝关节痛采用四区域腰椎间孔注射联合五联法治疗的80例患者(A组)和仅采用五联法治疗的80例患者(B组).比较两组患者治疗前与治疗1、3个月后视觉疼痛模拟评分(VAS)、数字疼痛评分(NRS)及Oswestry功能障碍指数(ODI)量表的差异.结果 与治疗前比较,治疗1、3个月后两组患者VAS评分、NRS评分及ODI得分均逐渐降低,且A组均低于B组(均P＜0.05).结论 四区域腰椎间孔注射联合五联法治疗复杂性膝关节痛疗效显著,不良反应小,值得临床推广.

目的:探讨嗜铬细胞瘤/副神经节瘤(pheochromocytoma/paraganglioma,PPGLs)术后骨转移患者的临床特征及早期(术后2年内)发生骨转移的危险因素.方法:收集60例初诊为PPGLs术后骨转移患者的临床资料并分析骨转移的危险因素及骨转移灶的分布差异.结果:60例PPGLs患者单发骨转移14例(23.3％),多发者46例(76.7％).发生骨转移的中位时间为84个月,早期骨转移者15例(25％).单因素分析示PPGLs患者的年龄与早期骨转移有关(χ2=6.207,P=0.045).早期骨转移中年龄<60岁者多见,差异有统计学意义(χ2=25.600,P=0.000).PPGLs共发现骨转移灶353处,其中胸椎转移79处.27例(45.0％)患者出现骨转移相关并发症,依次为骨痛(88.9％)、麻木(51.9％)、骨折(37.0％)、瘫痪(11.1％)及高钙血症(3.7％).结论:PPGLs患者的年龄与早期骨转移有关,年龄<60岁者发生早期骨转移多见,绝大多数骨转移发生在手术2年以后.PPGLs骨转移灶通常为多发,其中以胸椎转移最为常见.骨转移相关并发症最常见为骨痛.

目的:对比分析嗜铬细胞瘤(PCC)及肾上腺以外的副神经节瘤(EAPGLs)术后骨转移患者的临床差异。方法:回顾性收集2015年1月至2022年10月北京核工业医院收治的确诊为术后骨转移的PCC患者(PCC组)和EAPGLs患者(EAPGLs组)各30例，分析两组患者的一般临床特征及骨转移临床表现的差异。结果:PCC组与EAPGLs组性别、年龄、肿瘤长径及Ki-67指数(%)差异无统计学意义(均 P>0.05)。二者均以多发骨转移常见且出现骨痛、麻木、骨折、瘫痪及高钙血症等相关并发症，两组间差异无统计学意义(均 P>0.05)。PCC组与EAPGLs组患者各确诊骨转移灶199处及154处，最常见的转移部位均为躯干骨的胸椎，颅骨及四肢骨转移少见，两组在颅骨、躯干骨及四肢骨转移灶的分布差异无统计学意义(均 P>0.05)。 结论:PCC及EAPGLs术后骨转移患者的一般特征及骨转移的临床表现差异无统计学意义。

1 病例介绍 患者,女,47岁,因"发现肺结节2年,肺结节切除术后1个月"于2021年4月收治于北京胸科医院.2019年7月患者行甲状腺癌术前检查时胸部CT平扫发现左肺上叶小结节,直径约0. 5 cm,建议复查.患者偶有胸闷,无发热、咳嗽、咳痰、气促、胸痛、咯血等不适,体重未见明显下降.

目的 分析基因突变对嗜铬细胞瘤/副神经节瘤(PPGL)患者的临床特征及预后的影响.方法 回顾性分析北京核工业医院2019年1月至2022年6月收治的PPGL患者的临床特征、无进展生存期(PFS)在是否存在基因突变方面的差异.结果 PPGL患者临床表现多样,以高血压最常见(78％).26例(51％)患者出现基因突变,类型以SDHB最多(62％);具有基因突变患者中有20例(77％)有高血压.是否具有基因突变在年龄方面差异具有统计学意义(P＜0.05).有基因突变组患者的中位PFS(27个月)短于无基因突变组(80个月),差异有统计学意义(P＜0.05).结论 PPGL患者无论有无基因突变其临床表现以高血压最为常见,临床症状多样,缺乏特异性.基因突变以SDHB最为常见,具有基因突变的患者年龄相对较轻,并且出现疾病进展速度较快.

Pheochromocytoma/paraganglioma is an adrenal tumor that secrets catecholamines and is extremely rare in pregnant women. Its clinical presentation is lack of specificity, and the combination of low prevalence and nonspecific clinical presentation makes diagnosis and treatment difficult. In this study, the clinical data and prognosis of 5 pregnant patients with pheochromocytoma/paraganglioma were analyzed. It was found that hypertension first occurred in 4 patients during pregnancy, and the clinical manifestations of each case were different. Surgical treatment is the first choice in the treatment, patients who cannot operate can choose radionuclide therapy, chemotherapy and targeted therapy. Through follow-up, they all showed recurrence and metastasis at different times. Among them, the patients who continued to be pregnant to the middle and late stages of surgical treatment progressed rapidly, and there were multiple bone metastases throughout the body in a short period of time, and two cases died in a short period of time. Therefore, effective diagnosis, individualized treatment and lifelong follow-up are particularly important.

目的:对比研究131I-MIBG显像、18F-FDG PET/CT显像与99Tcm-MDP-WBS多模态显像在嗜铬细胞瘤/副神经节瘤(PCC/PGL)骨转移病灶中的诊断价值.方法:回顾性分析本院收治的PCC/PGL患者共30例,所有患者均伴骨转移且已行以上三种检查(检查的时间间隔为3个月内).以病理、影像学检查及临床随访结果作为骨转移的诊断依据.比较三种检查方法检测PCC/PGL骨转移病灶的灵敏度、特异性、阳性及阴性预测值和准确性.使用SPSS 25.0软件分析,采用McNemar检验比较三种检查方法诊断骨转移的价值.结果:30例PCC/PGL患者共检查出骨异常病灶302处,确诊为骨转移病灶271处.131 I-MIBG显像、18 F-FDG PET/CT显像与99 Tcm-MDP-WBS在诊断PCC/PGL骨转移病灶时的灵敏度、特异性、阳性和阴性预测值及准确性分别是92.00％、96.30％、99.60％、54.17％、92.38％;96.00％、92.59％、99.25％、69.44％、95.70％和88.39％、62.86％、94.78％、41.51％、85.43％.三种检查方法在诊断PCC/PGL骨转移病灶时18 F-FDG PET/CT显像灵敏度最高,131 I-MIBG显像特异性最好.三种检查方法的诊断效能经McNemar检验,差异有统计学意义(P<0.05).结论:131I-MIBG显像可作为PCC/PGL骨转移的首选检查方法并指导后续131I-MIBG治疗,18 F-FDG PET/CT显像和99 Tcm-MDP-WBS可作为可疑病灶131 I-MIBG显像阴性时的有效补充.

Objective To explore the disease diagnosis and evaluation value of serum chromaffin A (CgA) in pheochromocytoma and paraganglioma (PPGL). Methods A total of 80 patients with PPGL who were hospitalized and treated with 131I-metaiodobenzyl guaniodine (131I-MIBG) from June 2017 to June 2021 were selected in Beijing Nuclear Industry Hospital Radionuclide Diagnostic and Treatment Center. Serum CgA levels were detected by double-antibody sandwich enzyme-linked immunosorptive assay (ELISA), and the expression and signifi cance of CgA in metastatic and advanced PPGL were evaluated. The clinicopathological characteristics (sex, age, tumor functional status, and the presence or absence of distant metastasis) of PPGL patients were recorded, and the levels of CgA were grouped and compared. Results There was no signifi cant diff erence in serum CgA level in PPGL patients with diff erent gender, age, tumor site and tumor functional status (P ＞0.05). The level of CgA in PCC group and PGL group was similar, and there was no statistical signifi cance (P＞0.05). The level of CgA in the ineff ective group was signifi cantly higher than that in the eff ective group, and the diff erence was statistically signifi cant (P＜0.05). Conclusion Serum CgA determination has certain signifi cance in the diagnosis and evaluation value of disease progression and metastatic PPGL.

目的 探究下调XRCC6对人结直肠癌细胞凋亡、侵袭的影响及其与ATM/CHK1/p53信号通路的相关性.方法 将人结直肠癌细胞SW620分为对照组、si-NC组和si-XRCC6组.MTT法检测各组细胞活力;流式细胞法检测各组细胞凋亡水平;细胞划痕实验检测各组细胞迁移能力;Transwell检测各组细胞侵袭能力;定量聚合酶链反应(qPCR)检测ATM、CHK2、p53的转录水平;免疫印迹(Western blot)检测ATM、CHK2、p53的蛋白表达和磷酸化(p-ATM、p-CHK2、p-p53)水平.结果 MTT实验结果表明,与对照组和si-NC组相比,si-XRCC6组细胞活力显著降低(P＜0.05);流式细胞实验结果表明,与对照组和si-NC组相比,si-XRCC6组细胞存活比例降低(P＜0.01),早期凋亡比例增加(P＜0.01),晚期凋亡细胞比例显著增加(P＜0.01),si-NC组和si-XRCC6组差异无统计学意义(P＞0.05);细胞划痕及Transwell实验结果表明,与对照组和si-NC组相比,si-XRCC6组细胞迁移能力降低(P＜0.01),侵袭能力降低(P＜0.01).qPCR及Western blot结果表明,与对照组和si-NC组相比,si-XRCC6组细胞ATM、CHK2、p53的转录和蛋白表达水平有上升的趋势,其磷酸化蛋白p-ATM、p-CHK2、p-p53表达水平也具有上升的趋势.结论 下调XRCC6可以抑制人结直肠癌细胞活性,诱导细胞早期凋亡,其机制可能与ATM、CHK2、p53信号通路的调控及其磷酸化水平的调控相关.

目的 分析伴多原发癌(multiple primary carcinoma,MPC)的分化型甲状腺癌(differentiated thyroid cancer,DTC)的临床特征,为伴MPC的DTC患者提供临床诊治思路.方法 对2014年1月至2017年5月在我院行131I治疗的DTC患者1140例的临床资料进行回顾性分析,以DTC及MPC为检索条件在病案查询系统进行检索,采用Warran修订的MPC诊断标准逐一筛选,对临床资料进行整理,统计学分析.结果 伴MPC的DTC病例28例,占同期收治DTC的2.46％(28/1140).男女之比为1:6.年龄32～68岁,平均年龄54.3岁.DTC中所伴MPC以乳腺癌为最多,共15例,其次为肺癌,6例.同时性MPC 13例,DTC与乳腺癌、肾癌、肺癌同时发生较为常见.异时性MPC 15例,发现异时性MPC平均时间间隔为6.52年.DTC作为首发癌,发现第二原发癌平均时间为4.14年.非DTC首发癌12例,发现DTC平均时间为7.08年.平均随访时间40.9个月,所有患者均存活.结论 伴多原发癌的分化型甲状腺癌具有一定的临床特点.应重视第二原发癌的发生,早发现,早诊断,早治疗,改善预后,提高患者生存率.

目的 研究胸部CT联合BRAFV600E对放射性碘难治性分化型甲状腺癌(RAIR-DTC)伴肺转移患者的诊断,和肺转移瘤预后因子.方法 118例RAIR-DTC伴有肺结节患者,其中明确诊断为甲状腺癌肺转移55例,甲状腺癌伴良性结节的63例.观察比较联合诊断与单独检测胸部CT、BRAFV600E对RAIR-DTC伴肺转移的诊断价值;观察RAIR-DTC伴肺转移的发病和生存情况;分析影响RAIR-DTC伴肺转移预后的相关因素.结果 联合诊断敏感度为94.5％明显高于其他两种诊断的81.8％和69.1％,差异具有统计学意义(P<0.05).肺转移瘤<1 cm组的4年和8年生存率分别为76.3％、50.8％均高于肺转移瘤≥1 cm组的54.2％、25.4％,差异均具有统计学意义(P<0.05);转移瘤<1 cm组的中位生存期(mOS)为(116±9.8)个月长于转移瘤≥1 cm组的(80.6±6.5)个月,差异具有统计学意义(P<0.05).BRAFV600E、肺结节大小是影响RAIR-DTC伴肺转移患者临床独立预后因素.结论 胸部CT联合BRAFV600E,应用于RAIR-DTC伴肺转移患者,有助于增加诊断效能,为早期肺转移癌提供诊断依据.

目的探讨儿童分化型甲状腺癌（DTC）肺转移的临床特征及 131 I治疗效果。方法回顾分析14例首次接受 131 I治疗时年龄≤18岁的DTC肺转移患儿的临床资料。结果 14例患儿中男5例、女9例,平均年龄（12.71±3.05）岁,均在甲状腺全切或次全切术后接受 131 I治疗,平均接受 131 I治疗4次,中位累积剂量为9.43（8.25～19.74）GBq。14例患儿治疗后完全消除4例（28.6%）、好转或稳定8例（57.1%）、无效或进展2例（14.3%）,有效率为85.7%（12/14）。中位随访时间63.4（6～124）月,患儿生存率为100%,中位无进展生存期63.5个月,2年无进展生存率84.61%,5年无进展生存率80.0%。结论儿童DTC肺转移发生率较高, 131 I治疗有效。

近年来,全球甲状腺癌的发病率都处于逐渐增加的趋势,女性人群尤为显著.当怀孕与甲状腺癌不期而遇,不少女性感到手足无措.下面就大家关心的几个问题予以介绍. 甲状腺癌会遗传给孩子吗 有研究表明:约5％的甲状腺癌患者有同种类型甲状腺癌家族史.四分之一的甲状腺髓样癌具有家族遗传性.分化型甲状腺癌也有家族聚集性,一级亲属应该高度警惕.但另有观点认为,最常见的甲状腺癌类型都是散发的,对于乳头状癌或是滤泡癌,无需进行家族性筛查.患病风险增加不等于一定患病.

分化型甲状腺癌(DTC)患者甲状腺全切或近全切术后常需要对患者行131 Ⅰ治疗,131 Ⅰ单次治疗剂量超过400 MBq时,需住院隔离.随着DTC患者的不断增加,131 Ⅰ应用越来越广泛,应用量越来越大,辐射防护问题受到人们的广泛关注.本文从病房环境防护、患者自身防护、医护人员防护及周围人群防护等几方面介绍了131 Ⅰ治疗后患者住院期间及出院后应该采取的防护措施及应注意的一些事项,可以更好地保护患者、医护人员及公众的健康.

目的 探讨儿童及青少年分化型甲状腺癌(DTC)的临床病理特征并评价131Ⅰ治疗的疗效.方法 回顾性分析30例接受甲状腺全切或次全切手术和131Ⅰ治疗的儿童及青少年DTC患者的临床资料,按照年龄14岁为切点值将患者分为儿童组(＜14岁)(17例)和青少年组(14 ～ 18岁)(13例).对30例患者的临床病理特征及131Ⅰ治疗次数和剂量进行分析,并进行疗效和短期副作用评价及随访.结果 30例患者淋巴结转移的发生率为86.7％,肺转移的发生率为36.67％.患者平均接受131Ⅰ治疗2.43次,平均累积剂量为8.71 GBq.其中儿童组患者平均治疗2.29次,平均累积剂量5.89 GBq,青少年组患者分别为2.61次和12.41 GBq.无肺转移组患者平均治疗1.73次,平均累积剂量为5.85 GBq,肺转移组患者分别为3.63次和14.30 GBq.30例患者肿瘤完全缓解率(CR)为56.7％,部分缓解率(PR)为23.3％,稳定率(SD)为20.0％.无肺转移组的CR率为73.7％,PR率为10.5％,SD率为15.8％;肺转移组的CR率为27.3％,PR率为45.5％,SD率为27.3％.131Ⅰ治疗后3天内颈部肿胀疼痛发生率为16.7％,胃肠道反应发生率为33.3％.结论 儿童及青少年DTC患者的淋巴结转移和肺转移发生率较高,131Ⅰ治疗儿童及青少年DTC是一种有效的治疗方法.

目的 分析嗜铬细胞瘤(PCC)患者的心血管损害临床表现特征.方法 回顾性分析2012年4月至2016年12月中国核工业北京四○一医院收治的60例嗜铬细胞瘤患者的临床资料.分析患者的一般资料,PCC的部位、性质和治疗情况,患者各种临床表现和临床指标水平和心电图检查结果,并比较不同临床表现、临床指标水平和检查结果中患者所占比例情况.结果 60例嗜铬细胞瘤中位于左右侧肾上腺分别为26和32例,位于双侧2例,其中恶性49例,良性11例.男性发病率高于女性.51例(85.00％)有高血压表现.27例(45.00％)有头痛、心悸、多汗三联征表现,头痛、心悸、多汗所占比例分别为61.67％、68.33％和60.00％.患者生化检查中出现心肌酶谱、甘油三酯、血糖和尿酸等指标升高的比例分别为26.67％、33.33％、38.33％和31.67％.在心电图检查中,窦性心动过速(41.67％)和左室高电压(26.33％)较为常见.结论 心脏损害为嗜铬细胞瘤患者最为常见的并发症,且高血压及心律失常为嗜铬细胞瘤患者最为典型的临床表现,在临床工作中需要认真鉴别.

Objective To explore the drug allergy causes,countermeasures and its effects during 131I Metuximab Injection in treatment of primary hepatic carcinoma.Methods We collected clinical data of 203 cases of using Iodine[131I] Metuximab Injection in treatment of patients with primary hepatic carcinoma.For patients with drug allergy,we analyzed patient's clinical manifestation,treatment measures,and outcome.Results Among 203 cases of patients with the use of Iodine [131I] Metuximab Injection,there were 4 patients with drug allergies with the incidence rate 1.68％.For the first treatment,the incidence of allergy was 0.99％,while the second time had the incidence of allergy of 4.17％,and the third time had incidence of allergy 11.1％.One patient had serious adverse reactions to anaphylactic shock.After the active treatment,4 cases of allergy patients were mostly cured,without having complications,with the clinical cure rate 100％,and the mortality rate 0％.Conclusion The fast and accurate judgments of patient status,as well as the timely effective treatment can improve the cure rate of allergic reaction.Severe allergic reactions of patients may be associated with repeated use of Iodine[131I] Metuximab Injection.

Objective :To observe and analyze the clinical effect of Shenqi Shiyiwei Granules in preventing bone marrow suppression in-duced by 131I in differentiated thyroid cancer. Methods 300 patients with differentiated thyroid cancer who underwent surgical treatment from June 2014 to June 2016 in the hospital were selected and divided into the control group and the study group in accordance with the random number table method, 150 cases in each group. The control group was given 131I treatment, and on this basis, the study group based was given Shenqi Shiyiwei Granules. The neutrophils and white blood cell levels in the two groups were observed and com-pared. Results There was no significant difference in neutrophils and white blood cell count between the two groups before treatment ( P > 0. 05 ) . After 4 and 8 weeks of treatment, the neutrophils and white blood cell count of the study group were significantly higher than those of the control group ( P < 0. 05 ) . The incidence of adverse reactions was 16. 67% in the study group and 13. 33% in the control group, the difference was not statistically significant ( P > 0. 05 ) . Conclusion Shenqi Shiyiwei Granules in preventing bone mar-row suppression induced by 131I in differentiated thyroid cancer has clear effect, it is better to prevent white blood cells and granulo-cytes, which is worthy of clinical promotion.

Objective To explore the value of serum neuron-specific enzyme (NSE) in evaluation of malignant pheochromocytoma.Methods Eighty-five patients with malignant pheochromocytoma were choose between January 2014 and June 2015 in the hospital for the 131I-MIBG treatment and were divided into stable disease group (72 cases) and progress disease group (13 cases).Serum NSE levels in patients were measured with electrochemical luminescence method and analyzed between groups.Results The level of NSE in the progressive disease group was significantly higher than that in the stable disease group(82.21±52.75) ng/mL vs.(11.03±3.33) ng/mL.The difference was statistically significant (P<0.05).Tumor progression in malignant pheochromocytoma patients were associated with obviously increased serum NSE(82.21±52.75) ng/mL vs.(11.75±2.51) ng/mL;the difference was statistically significant (P<0.05).After 1 year of follow-up, 11 patients had increased NSE with 4 cases dead of disease.Conclusion Serum NSE has certain significance in condition evaluation and prognosis judge of progressive malignant pheochromocytoma.

目的 评价99TcmO4-甲状腺静态显像在分化型甲状腺癌术后患者中发现转移病变的价值.方法 480例分化型甲状腺癌术后患者131I治疗前行99TcmO4-甲状腺静态显像评估残余甲状腺大小,治疗后行131I全身显像比较分析,必要时SPECT/CT融合显像,两位核医学医师盲法阅片,评价及比较病变情况.结果 99TcmO4-甲状腺静态显像、治疗剂量131I全身显像的阳性率分别为83.75％、98.5％.99TcmO4-甲状腺静态显像灵敏度84.9％.99TcmO4-静态显像与131I全身显像符合率为83.75％.10例患者99TcmO4-甲状腺静态显像发现转移病变,改变原计划治疗剂量及方案.结论 99TcmO4-甲状腺静态显像作为甲状腺癌术后残余甲状腺评估方法,能够提前发现部分转移病变,对于指导治疗剂量的制定具有一定意义.