目的 分析131Ⅰ治疗Graves病的疗效及影响因素.方法 收集431例Graves病患者,记录每位患者性别、年龄、病程、ATD治疗史、甲状腺质量、FT3、FT4、TSH、131Ⅰ剂量、每克甲状腺组织给予的131I平均剂量.对131Ⅰ治疗疗效按完全缓解、甲减、好转、无效或复发进行评价,其中完全缓解和甲减为治愈组,好转、无效或复发为未治愈组,采用单因素(t检验、Mann-Whitney U检验、χ2检验)及多因素(logistic回归)分析确定131Ⅰ疗效的影响因素.结果 131Ⅰ治疗后3、6个月治愈率分别为68.7％(296例)、74.0％(319例).单因素分析结果显示治愈组131Ⅰ治疗前平均年龄(36.93±0.57岁)、甲状腺质量(47.26±1.03克)、131Ⅰ剂量(8.7±0.32mCi)均显著低于未治愈组[分别为(39.58±1.16岁)、(56.63±2.07克)、(10.63±0.58mCi),P值分别为0.044、0.000、0.005].多因素分析结果显示年龄(OR=0.966,95％可信区间=0.945～0.987,P=0.002)、甲状腺质量(OR=0.899,95％可信区间0.849～0.952,P=0.000)、131Ⅰ剂量(OR=1.410,95％可信区间=1.082～1.837,P=0.011)是影响疗效的主要因素.结论 131Ⅰ治疗Graves病疗效显著,年龄、甲状腺质量、131Ⅰ剂量是疗效的主要影响因素,对于年老、甲状腺质量大的患者应增加131Ⅰ剂量.

目的:探讨分化型甲状腺癌(differentiated thyroid carcinoma,DTC)患者131I治疗后早期甲状腺球蛋白抗体(TgAb)变化幅度与疗效的关系.方法:回顾性分析2014年10月至2017年2月于中山大学附属第三医院接受131I治疗的TgAb阳性DTC患者72例.131I治疗后12个月行疗效评估,疗效分为完全缓解、部分缓解、疾病稳定、疾病进展.根据131I治疗后1.5个月及3个月的TgAb变化情况分为下降组、稳定组、升高组,分析3组间的疗效差异,再行TgAb变化差值(ΔTgAb)、TgAb变化幅度(ΔTgAb％)预测疗效的受试者工作特征(receiver operating characteristic,ROC)曲线分析.结果:各组中年龄及性别构成比等差异无统计学意义.TgAb下降、稳定、升高3组间疗效差异有统计学意义(x2=22.267,P＜0.001),两两比较显示TgAb下降组疗效优于稳定、升高组,稳定组与升高组间疗效差异无统计学意义(x2=0.372,P=0.730).分别以ΔTgAb,ΔTgAb％作ROC曲线预测疗效,ROC曲线下面积分别为0.808和0.895,约登指数最大值分别为0.581和0.781.其中ΔTgAb％的ROC曲线下面积更大,对应的敏感度、特异性、阳性预测值、阴性预测值分别为95.24％,82.86％,76.9％,96.7％.结论:TgAb阳性的DTC患者经131I治疗后早期TgAb变化幅度对DTC疗效有较好的预测价值,可作为临床早期有价值的参考指标之一.

目的:探讨分化型甲状腺癌(DTC)术后首次131I治疗时间选择对疗效的影响.方法:回顾性分析2013年5月至2017年2月于中山大学附属第三医院首次接受131I治疗的DTC患者329例.根据2013年国内131I治疗分化型甲状腺癌指南,131I治疗剂量为30～200 mCi,131I治疗后6个月行疗效评估,疗效分为临床治愈、好转、稳定、进展.根据2015版ATA指南将131I治疗前患者分为中危、高危;按手术与131I治疗时间间隔分为四组:A组(＜1个月)、B组(1～3个月)、C组(＞3～6个月)、D组(＞6 ～ 12个月).分析四组不同时间间隔的DTC患者疗效是否有差异.采用X2检验、Fisher确切概率法分析数据.结果:各组中年龄及性别构成比等无显著性差异.中危DTC患者中不同时间间隔的四组疗效无差异(P =0.937).高危DTC患者中不同时间间隔的四组疗效有差异(P =0.017),D组的疗效差于其他各组,其余各组间疗效无差异.结论:中危DTC患者手术后12个月内行首次131I治疗时间间隔对疗效影响不大.高危DTC患者中时间间隔＞6～12个月组的疗效较其他组差,建议高危DTC患者宜在手术后6个月内进行首次131I治疗.

Objective To explore the value of hydronephrosis volume measured by 64 slice CT scan, evaluating renal function in patients with obstructive hydronephrosis.Methods The patients performed with both single photon emission computed tomography(SPECT) renal dynamic imaging and 64 slice CT scan in three days were chosen, 176 cases included finally.The images of renal dynamic imaging were divided into normal renal function group, mild renal impairment group, moderate renal impairment group and severe renal impairment group according to glomerular filtration rate (GFR) measured by SPECT.At the same time, CT three-dimensional reconstruction technique has been used to measure the volume of hydronephrosis, compare the differences of hydronephrosis volume among these groups, and future analyze the correlation of hydronephrosis volume with renal GFR value.Results The hydronephrosis volume of the four groups were respectively (31.47±3.81) cm3,(83.43±7.81) cm3,(208.53±15.47) cm3 and (577.31±61.32) cm3.There was statistical significance among these groups (P<0.01),except between normal renal function group and mild renal impairment group.The volume of hydronephrosis showed positive correlations with renal GFR (r=-0.614).Conclusion The volume of hydronephrosis measured by 64 slice CT has positive correlation with GFR measured by SPECT, which could reflect renal function to some extent.

Objective To enhance the 18 F-FDG uptake capacity of hepatic carcinoma cells .Methods Hepatic carcinoma cell HepG2 and normal hepatic cell L02 were incubated for 2 h, 4 h, 6 h, 8 h, 12 h and 24 h with the dexam-ethasone of 10-8 mol/L,10-7 mol/L,10-6 mol/L,10-5 mol/L or 10-4 mol/L.The control group was treated without dexa -methasone.After that, 1 μCi 18 F -FDG was added for incubation into each group for 1 h, and the radioactivity counts were assessed subsequently.Results Dexamethasone significantly inhibited uptake capacity of the 18 F -FDG in HepG2 with the concentrations of 10-8 mol /L and 10-7 mol /L; promoted it with concentrations of 10-5 mol/L and 10-4 mol/L;and had no effect on it with the concentration of 10-6 mol/L (P <0.05).Meanwhile, Dexamethasone significantly inhibi -ted uptake capacity of the 18 F -FDG in L02 with the concentrations of 10-8 mol/L, 10-7 mol/L and 10-6 mol/L; promo-ted it with concentrations of 10-4 mol /L; and had no effect on it with the concentration of 10-5 mol/L (P <0.05).The 18 F -FDG uptake capacity of HepG2 was significantly higher than L02, and the difference was significantly enlarged by pre -treatment by dexamethasone (P <0.05).Conclusion Dexamethasone has biphasic effect on the 18 F -FDG uptake capacity of hepatocytes.The appropriate concentration of dexamethasone can enlarge the 18 F -FDG uptake difference be-tween HepG2 and L02.

Objective To evaluate image features and diagnostic value of radionuclide bone imaging for differentiating malignant and benign costovertebral joint lesions.Methods Data of 60patients with various cancers and costovertebral joints lesions in radionuclide bone imaging were retrospectively analyzed.Taken high resolution CT(HRCT),clinical follow-up and pathologic results as diagnostic standards,the image features of radionuclide bone imaging for differentiating malignant and benign costovertebral joint lesions were explored,and the sensitivity and specificity were evaluated.Results Among 60patients with radioactive anomaly concentration rib ridge joint lesions,54(54/60,90.00%)were proved bone metastases by HRCT.Rib bone imaging in spinal joints radioactive anomaly concentration center located at frame side or vertebral lateral,present as vertical and horizontal strips.When concentration with center on lateral ribs was defined as bone metastase,the sensitivity and specificity of radionuclide bone imaging was 59.26%(32/54)and 83.33%(5/6),respectively. When horizontal bar concentration was defined as positive,the sensitivity and specificity was 29.63%(16/54)and 100%(6/6),respectively.Furthermore,when center on lateral ribs concentration or horizontal bar concentration were defined as positive,the sensitivity and specificity was 88.89%(48/54)and 83.33%(5/6),respectively.Conclusion For radionuclide whole body bone imaging,radioactive anomaly consistence lesions on costovertebral joint,especially punctiform lesions with centre approaching to rib and transverse lesions are probably bone metastases.

Objective To construct lentiviral vectors carrying small interference RNA (siRNA) of alpha-fetoprotein(AFP) followed by transfection into hepatocellular carcinoma cells and to assess the efficiency of AFP gene silencing.Methods The AFP-specific positive siRNA and non-specific negative siRNA were designed and constructed prior to insertion to the recombinant lentiviral vectors carrying green fluorescent protein (GFP) gene.This was followed by transfection into human hepatocellular carcinoma cells HepG2 and subsequent screening of cell strains with GFP expression,and were assigned into lentivirustransfected positive siRNA group and lentivirus-transfected negative siRNA group respectively.Furthermore,liposome-transfected positive siRNA group,liposome-transfected negative siRNA group,siRNA group which treated with AFP siRNA but without transfection reagent,and blank control group were established simultaneously.The efficiency of transfection was assessed under fluorescent microscope,and the relative expression of AFP mRNA and protein in HepG2 cells was determined via fluorescent quantitative polymerase chain reaction and immunoblotting assay.In addition,the inhibition rate of AFP gene expression was compared among all groups.Results Lentiviral vectors were associated with effective transfection of siRNA into HepG2 cells.The siRNA transfected with lentivirus yielded considerably higher inhibition rate of AFP mRNA than that with liposomes,as evidenced by fluorescent quantitative polymerase chain reaction (92.1％vs 74.3％,P＜0.05).Immunoblotting assay showed that higher inhibition rate of AFP protein was in favor of siRNA transfected with lentivirus,but not with liposomes (88.2％ vs 63.7％,P＜0.05).Conclusion AFP siRNA transfected with lentivirus is associated with more effective inhibition of AFP expression in HepG2 cells.

<正>患者女,72岁,因"上腹不适伴嗳气、排气增多1月余"入院。患者1个多月前无诱因出现进食时及饭后剑突下刺痛,持续4～5min,可自行缓解,近1个月来嗳气及排气增多,2天前进食时呕吐1次,无呕血。查体未见异常。胃镜:距门齿35cm处至胃底见巨大肿物,表面见深溃疡和污苔,周围结节状隆起,有渗血。临床初步诊断为"胃癌待除外"。骨显像:中腹部L3水平放射性浓集,双肾影增浓,呈"倒八字"征,双侧肾盏显像剂

<正>病例1患者男性,74岁。因阴茎肿块6月,破溃2月入院。伴咳嗽,咳黏液泡沫痰,量少。既往慢性阻塞性肺疾病10余年。查体:桶状胸,呼吸音粗,可闻及哮鸣音。阴茎可见一约2 cm×2 cm×3 cm大小菜花状肿块,质硬,以基底为重,表皮破溃,尿道外口未见异常。

肾小球滤过率(GFR)是临床评估肾功能的重要指标,其测定是通过某种滤过标志物的滤过率而得到的。菊粉清除率是测定GFR的金标准,肌酐及其预测方程、尿素氮和放射性核素清除率也是临床常用的方法。近来发现胱抑素C和碘海醇是比肌酐更理想的GFR标志物,其清除率可更准确评估肾功能。该文主要对GFR测定方法的优缺点及近年来的研究进展进行综述。