Objective To study the differential diagnostic value of joint determination of pleural effusion /serum CEA and NSE ratio for malignant pleural exudates.Methods There were 79 cases composed of 47 patients with malignant pleural effusion(malignant group) and 32 patients with tuberculous pleural effusion (tuberculous group) in this study.The content of CEA、NSE were detected by terminal reaction of enzymology. Pleural effusion/serum CEA and NSE ratio were calculated.The optimization critical value was determined with ROC curve.The sensitivity,specificity,accuracy and Youden index were determined respectively.Results The Pleural effusion/serum CEA and NSE ratio in the patients with malignant pleural effusion were higher than that with tuberculous pleural effusion,on the condition that the optimization critical value was P/S(CEA)≥1.1 or P/S(NSE)≥1.3,the sensitivity,specificity,accuracy and Youden index of joint determination of pleural effusion/serum CEA and NSE ratio were 91.49%,62.50%,79.94%,0.54 respectively by parallel test.And the sensitivity,accuracy and Youden index was higher in pleural effusion/serum CEA and NSE ratio significantly compared with the single test.Conclusion The joint determination of pleural effusion/serum CEA and NSE ratio,has great practical value in diferentiating benign from malignant exudates because of raising the sensitivity,accuracy and Youden index.

Objective: To investigate the liver injury in patients with sleep apnea hypopnea syndrome (SAHS) and its related factors. Methods: One hundred and thirty-four patients with moderate and severe SAHS (SAHS group) and 60 healthy volunteers (control group) were recruited randomly in the study. According to body mass index(BMI), the patients in SAHS group were divided into SAHS obesity group (69 cases), SAHS non-obesity group (65 cases),and the patients in control group were divided also into the obesity control group (30 cases)and the non-obesity control group (30 cases). Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST),γ-glutamyltransferase (GGT), triglyceride (TG) and cholesterol (CHO) were determined in both groups, as well as the state of liver morphology was observed by ultrasonic imaging. The incidence of nonalcoholic fatty liver disease (NAFLD)were evaluated in both groups, and the correlation analysis was done between serum levels of ALT, AST and index of sleep monitoring in SAHS group. Results: Compared with those of the control group, the serum levels of ALT, AST, GGT, TG and CHO were significantly higher in patients of SAHS group (P0.01 or P0.05), and the incidence of NAFLD in SAHS group was significantly higher (P0.01). There was no significant difference in liver injury between SAHS obesity group and non-obesity group ( P0.05). The serum levels of ALT and AST were positively correlated with AHI (r=0.601,0.352,P0.05), while negatively correlated with the LSaO2 (r=-0.513, -0.461,P0.05)and MSaO2 (r=-0.442, -0.305, P0.01). The level of serum ALT were related in multiple linear regression with AHI and LSaO2 (P0.01). Conclusions: The injury of liver and the higher incidence of NAFLD are existed in SAHS patients, the levels of liver enzymes are correlated to AHI and hypoxia during sleep. Chronic intermittent hypoxia might be an independent related factor for liver injury in SAHS patients.

Objective:To explore the role of DNA methylation and protein expression of PTEN and P27 in the carcinogenesis of endometrial carcinoma.Methods:PTEN and P27 gene methyaltion status were dectected with methylation specific PCR(MSP) and the corresponding protein expressions were measured by immunohistochemistry in 36 cases of endometrial carcinoma,17 cases of endometrial hyperplasia and 27 cases of normal endometrium.Results:The methylation rates of PTEN and P27 in endometrial carcinoma and hyperplasia were significantly higher than those in normal endometrium tissue(P0.05).The protein expressions of PTEN and P27 in endometrial carcinoma were significantly lower than those in normal endometrium and hyperplasia(P0.05).There was a positive correlation between PTEN and P27 protein expression(r=0.491,P=0.005).Conclusions:PTEN and P27 methylation may play an important role in the carcinogenesis and development of endometrial carcinoma.P27 gene methylation may be an early molecular event in endometrial carcinoma,which can be used as a predictive or preventive target for endometrial carcinoma.There were a positive correlation between PTEN and P27 protein expression.

目的:探讨恶性滋养细胞肿瘤的误诊原因及误诊防范。方法:回顾分析中山大学附属第一医院2001年10月至2009年12月收治恶性滋养细胞肿瘤中误诊病例14例的临床资料。结果:误诊为异位妊娠6例,卵巢肿瘤3例,胎盘残留3例,不全流产2例。最终确诊为绒癌8例,侵蚀性葡萄胎3例,异位绒癌2例,异位侵蚀性葡萄胎1例。结论:恶性滋养细胞肿瘤的正确诊断及鉴别诊断很重要,对于难以诊断的患者可以通过腹腔镜或开腹手术以明确诊断。

目的:探讨绒毛膜癌(缄癌)脑转移患者的临床表现、诊断及治疗.方法:回顾性分析8例绒癌脑转移患者的临床资料及诊治情况.结果:8例脑转移患者中5例继发于葡萄胎,足月产后发生2例,流产后发生1例.6例患者血β-HCG大于200100 U/L;2例行头部CT检查均发现病灶;6例行正规化疗后,4例脑转移症状近期即消失,脑转移症状缓解率为66.67%.结论:详细的病史询问、血β-HCG的测定及CT检查有助于诊断.在全身化疗及鞘内化疗的基础上,手术切除绒癌原发及转移灶对延长患者生存有益.

Objective:To explore the clinical effects of treatment of carcinoma in situs of cervix by laparoscopic total hysterectomy.Methods:All 187 patients with carcinoma in situ cervix diagnosed by cervical conization were treated at department of gynecology and obstetrics of the first affiliated hospital of Sun Yat-sen university since Feb.2003 to May 2008.Treatment group included 62 patients treated with laparoscopic total hysterectomy.The control group included 67 patients underwent abdominal hysterectomy and 58 patients performed vaginal hysterectomy.The clinical data of three groups were retrospectively analyzed and compared.Results:There was no significant difference in operative time,operative blood loss,flatus time,postoperative morbidity and hospital stay among 3 groups(P0.05).During postoperative follow-up of 15 to 72 months,1 patient was found with mild vaginal stump intraepithelial neoplasia in abdominal group,neither residual nor recurrent tumor was found in other patients of 3 groups.Conclusions:The effect of laparoscopic total hysterectomy for carcinoma in situs of cervx is as satisfactory as abdominal or vaginal hysterectomy,which offers advantages of minimal invasion and can view the intra-abdominal conditions.

OBJECTIVE:To investigate the therapeutic efficacy of recombination human growth hormone(rhGH)on the patients with chronic obstructive pulmonary disease(COPD)complicated with spontaneous pneumothorax(SP).METHODS:58 patients with COPD complicated with SP were randomly divided into two groups:29 cases in the control group received conventional therapy including anti-infection therapy,oxygen therapy and nutritional support,and another 29 in the trial group received low dose of rhGH(0.1 U·kg-1·d-1)hypo quaque nocte for 7 days started from the second day after admission in addition to the conventional therapy as employed for control group.The time of chest tube stay and the length of hospital stay were compared between the two groups.The body mass index(BMI)and serum levels of growth hormone(GH),insulin-like growth factor-1(IGF-1)and albumin(ALB)were measured in all cases before and after treatment.RESULTS:The time of chest tube stay and the length of hospital stay in the trial group vs.the control group were(5.5±1.8)d vs.(9.3±2.2)d(P 0.05)and(19.4±4.2)d vs.(26.8±5.0)d(P0.05),respectively.No significant differences were noted between the two groups before treatment in BMI,ALB,GH and IGF-1(P0.05);however,after treatment,all indexes(BMI,ALB,GH and IGF-1)were higher in the trial group than in the control group(P0.05).CONCLUSION:It has been proved that rhGH can improve the nutritional status,shorten the time for chest tube stay and length of hospital stay,and promote recovery for patients with COPD complicated with SP.

Objective To investigate the relationship between the consumption of antibacterial agents and drug-resistant rates of klebsiella pneumoniae(KP) in sputum cultivation in a hospital.Methods The total antibacterial consumption expressed as defined daily doses(DDD) per day per 100 beds,and the drug-resistant rates of KP were calculated,and the correlation between them was analyzed.Results The drug-resistant rates of KP to ceftazidime,piperacillin tazobactam,and cefoperazone sulbactam were positively associated with the consumption of amikacin(P 0.05).The analogous correlations were observed between the resistant rates of KP to ampicillin,ampicillin clavulanate acid,cefazolin,piperacillin tazobactam and the consumption of levofloxacin(P 0.05).Between the resistant rates of KP to ampicillin clavulanate acid,gentamycin,tobramycin,ciprofloxacin,levofloxacin and the consumption of cefoperazone sulbactam(P 0.05).And between the resistant rate of KP to ampicillin and the consumption of penicillin,clindamycin,piperacillin tazobactam(P 0.05).Conclusion There exists correlation between antimicrobial consumption and the drug-resistant rates of KP,which indicates that we should use antibiotics more legitimately and carefully in order to control the increase of drug resistance of bacteria.

目的 观察LEEP刀治疗宫颈上皮内瘤变的临床价值.方法 对2007年2月至2008年2月中山大学附属第一医院妇科门诊用LEEP刀治疗的56例活体病理提示有宫颈上皮内瘤变患者的临床资料进行回顾性分析.结果 手术时间最长25min,最短3min,平均8min,术中出血量2～25ml,平均10.6ml;治愈53例,3例病变残留需再次手术;52例病理检查满意,4例宫颈管组织因烧灼影响病理诊断.结论 LEEP刀治疗宫颈上皮内瘤变具有安全有效,患者不用住院即可治疗的优点,并且能保留完整、连续的标本进行病理检查;如果病变位于宫颈管可能因烧灼影响病理诊断.

Objective To study the distribution and drug resistance of the bacteria isolated from sputum culture of patients in hospital in Longgang district of Shenzhen,and to provide evidence for the rational use of antibacterial agents in clinic. Method All qualified sputum specimens from inpatients between January 2007 and June 2008 were cultured for bacterial isolation. The isolated bacteria were identified and tested for the susceptibility to antibiotics. Result 727 bacteria were isolated,most(81.2%,595 / 727)of which were Gram negative bacillus;a few of which were Gram positive (18.2% ,132 / 727). The 2 most common isolated Gram negative bacillus were Escherichia cob and Pseudomonas aeruginesa;the 2 most common isolating Gram positive bacillus were Staphylococcus aureus and Coagulase negative Staphylococcus. The result of drug sensitive test showed that there were high rates of drug resistance in most bacteria strains. Conclusion The rate of drug resistance of pathogenic bacteria to antibiotics is high. And the proportion of opportunistic pathogen bacteria increased apparently. Management should be further strengthened for rational use of antibiotic agents.

Objective To investigate the adjunctive therapeutic effect of recombination growth hormone(rhGH) on the elderly patients with pulmonary infection.Methods 53 elderly patients with pulmonary infection were randomly divided into rhGH group(n=25) and control group(n=28).The rhGH group were received hypodermic introl group were received standard therapy.Clinical efficacy were compared between two groups.The level of albumin (ALB),growth hormone (GH),insulin-llke growth factor-1 (IGF-1),leptin (LP) were measured and the body mass index(BMI) was observed in all cases before and after treatment.Results The overall efficacy of rhGH group and control group was 88.0% versus 60.7%.The results showed significant statistical difference between both groups(P＜0.05).After treating with rhGH for 10 days,the level of BMI,ALB,GH,IGF-1 and LP were increased in the rhGH group,which were(26.1±4.1)kg/m2;(38.4 ±6.6)g/L;(7.0 +0.9) μg/L;(27.3 ±6.1)μg/L;(6.9 ± 1.1)μg/Lrespectively.And the level of BMI,ALB,GH,IGF-1 and LP were (21.8 ± 3.4 ) kg/m2 ;( 29.5 ± 5.1 ) g/L;( 4.0 ±0.4) μg/L;( 22.0±3.8 )μg/L;( 3.8±0.8 )μg/L in the control group after treatment.The results showed significant statistical difference between both groups(P＜0.05).Conclusion There was obvious adjunctive therapeutic effect of rhGH to the elderly patients with pulmonary infection by improving the nutritional state of these patients.

目的从自然杀伤细胞(NK)表面表达CD69的情况,探讨肺癌患者的细胞免疫状态,为临床免疫治疗提供指引.方法用密度梯度离心法分离出肝素抗凝血外周血单核细胞(PBMC),用PDB刺激PBMC的条件下进行细胞培养,于2,12,24 h后收获细胞,进行anti-CD56-FITC与anti-CD69-PE免疫标记,利用流式细胞仪对标记细胞进行分析.结果体外刺激后,肺癌患者组各时点NK细胞中表达CD69的阳性细胞百分率分别是(28.73±1.99)%,(55.08±4.44)%,(68.07±3.52)%,与对照组各时点相比较,差异均有显著性(P＜0.05).结论肺癌患者NK细胞活化明显不足和功能严重障碍,该研究结果为肺癌患者的免疫治疗提供理论依据和新的指引.

应用高聚金葡素联合疑血酶治疗癌性胸水取得了较好的效果,现报道如下. 资料与方法:1995年至1998年间因恶性胸腔积液住院病例126例,其中男82例,女44例,平均年龄42岁.胸腔积液均由病理细胞学依据确诊(未作分类).随机分组:高聚金葡素组,共72例,其中男40例,女32例;顺铂组(对照组)54例,其中男29例,女25例.治疗组(高聚金葡素组)在细胞学确诊后即行闭式持续引流或胸穿抽液3～4次至胸液明显减少时,胸腔内注入NS 10ml+高聚金葡素5mg×4支+凝血酶2000u混合液,每天或隔天一次,共2～3次.顺铂组则向胸腔内注射顺铂60mg,隔天一次,共2～3次.所有病例未作全身化疗. 疗效判定:借助X线透视、B超、胸穿抽液及气促的症状改善情况判定胸腔积液的疗效.

目的:对慢性阻塞性肺气肿与老年性肺气肿的血清α1-抗胰蛋白酶(α1 -AT)和肺功能作检测,以探讨α1-AT在肺气肿发病机理中的作用. 方法:选择肺气肿患者50例(其中慢性阻塞性肺气肿32例,老年性肺气肿2 8例)和正常人20例,取静脉血用微量比浊法测定α1-AT,用肺功能测量仪检测肺功能.结果与结论:慢性阻塞性肺气肿患者α1-AT水平降低 ,而老年性肺气肿患者α1-AT变化不明显,前者α1-AT与1秒用力呼气量(FEV1)呈正相关,与残气量(RV)呈负相关,说明α1-AT降低可能是慢性阻塞性肺气肿形成的原因之一.

肺癌晚期约50%患者并发胸积液,且胸腔积液生长迅速,一般化疗效果欠佳.我们应用羟基喜树碱加凝血酶胸腔内注入治疗,疗效较好,现将结果报道如下.

肺癌晚期约50%患者并发胸腔积液,且胸腔积液生长迅速,一般化疗效果欠佳,我们应用羟基喜树碱及羟基喜树碱加凝血酶胸腔内注入治疗,疗效较好,现将结果报道如下.

目的:观察头孢唑肟与头孢噻肟对重症呼吸道感染的疗效.方法:对确诊为重症呼吸道感染92例患者随机分为头孢唑肟组45例(简称唑肟组)及头孢噻肟组47例(简称噻肟组),治疗前后均行血常规、尿常规、胸片、痰培养等检查.结果:唑肟组与噻肟组的治愈率及有效率分别为77.8%、53.2%(唑肟组 vs 噻肟组,P＜0.05)与91.1%、72.3%(唑肟组 vs 噻肟组,P＜0.05).结论:头孢唑肟治疗重症呼吸道感染优于头孢噻肟.