目的 探讨帕博利珠单抗联合卡培他滨、奥沙利铂治疗进展期胃癌的临床疗效及安全性.方法 以大连大学附属新华医院肿瘤内科收治的92例进展期胃癌患者为研究对象,按照随机数字法,将其分为对照组(卡培他滨+奥沙利铂,XELOX化疗,45例)和观察组(帕博利珠单抗联合XELOX化疗,47例),比较两组的临床疗效、毒副反应及生存率.结果 与对照组相比,观察组患者的治疗有效率(ORR)显著升高,差异具有统计学意义(80.95％vs.67.50％);观察组患者的化疗毒副作用如白细胞减少(7.14％vs.22.50％)、血小板减少(19.04％vs.40.00％)、贫血(14.28％vs.35.00％)和甲状腺功能减退(23.81％vs.45.00％)的发生率显著低于对照组;与对照组相比,观察组无进展生存率及总生存率明显提高.结论 帕博利珠单抗联合卡培他滨、奥沙利铂能够明显提高进展期胃癌患者的临床疗效,降低化疗期间的毒副反应,提升患者的生存率.

Objective To research the clinical efficacy of tegafur gimeracil and oteracil capsules versus capecitabine for advanced breast cancer. Methods Totally 82 advanced breast cancer patients from January 1, 2012 to June 30, 2015 were randomized into two groups: Tegafur gimeracil and oteracil capsules group (n = 40) and capecitabine group (n = 42). The response rate, disease control rate, survival time and adverse drug reaction of the two groups were recorded. Results There was no significant difference in the response rate (32. 5％ vs. 35. 7％, P = 0. 759) and disease control rate (72. 5％ vs. 81. 0％, P = 0. 365) between the two groups. The median survival time of tegafur gimeracil and oteracil capsules group and capecitabine group were 15 months and 14 months (χ2 = 0. 250, P = 0. 617). No significant difference was detected between the two groups in granulocytopenia, thrombocytopenia, weary and liver function damage (P ＞ 0. 05). The rate of hand-foot syndrome (5. 0％ vs. 35. 7％, P = 0. 001) and PONV (7. 5％ vs. 23. 8％, P = 0. 043) in tegafur gimeracil and oteracil capsules group were lower than those of capecitabine group. Conclusion There is no significant difference between tegafur gimeracil and oteracil capsules and capecitabine in clinical efficacy for advanced breast cancer, but tegafur gimeracil and oteracil capsules has a lower incidence of hand-foot syndrome and PONV.

Objective Explore stage II colon cancer, upper rectal cancer patients with general risk beneift from single agent adjuvant chemotherapy or not.MethodsForty cases of tumor tissues detected MLH1, MSH2, MSH6, PMS2 proteins by IHC test and conifrmed as pMMR status.Twenty cases as adjuvant chemotherapy group conifrmed as MSS phenotype by PCR who treated Raltitrexed which dose was 3 mg/m2, d1, ivgtt in 15 min, Q21d for 4 cycles. The survival time was determined according to the follow-up results, and the objective efficiency was evaluated. Adverse events were evaluated according to the NCI-TC 3.0 version of toxicity classiifcation criteria. The non-adjuvant chemotherapy group 20 cases were control. ResultsAdjuvant chemotherapy group objective effective rate was 95.0％ (19/20), the recurrence rate was 5.0％ (1/20), the control group recurrence rate 15.0％ (3/20), adjuvant chemotherapy group recurrence rate was lower than control group (χ2=5.556,P=5.556). Adjuvant chemotherapy group only occurred I or II degree adverse events,no cardiac toxicity,no influence on blood sugar.ConclusionspMMR and MSS phenotype stage II colon cancer, upper rectal cancer patients with general risk using Raltitrexed single-agent adjuvant chemotherapy were safe and effective.

目的 应用Cox回归分析探讨影响多发性骨髓瘤生存时间的危险因素.方法 以2010年1月1日—2016年6月30日在大连大学附属新华医院确诊的134例多发性骨髓瘤患者为研究对象,收集患者的临床分期、骨病分级、骨髓浆细胞百分数等资料,并随访观察其生存状况.采用Log-rank检验进行单因素分析筛选,将有意义的因素纳入Cox回归模型进行多因素分析.结果 研究对象的中位生存期为29个月,2年生存率为63.7％,5年生存率为14.9％.单因素分析结果显示,年龄、临床分期、骨病分级、骨髓浆细胞百分数、血红蛋白、血清白蛋白量、β2-微球蛋白、血肌酐、血清乳酸脱氢酶为影响患者生存的因素.Cox回归结果显示,年龄≥60岁、DS分期为Ⅲ期、血清白蛋白量<35 g/L、β2-微球蛋白≥3.5 mg/L和血肌酐≥10.7 nmol/L为影响患者生存时间的危险因素.结论 年龄、DS分期、血清白蛋白量、β2-微球蛋白和血肌酐可影响多发性骨髓瘤患者的生存时间.

目的 采用随机对照的研究方法,评价消癌平联合化疗对中晚期食道癌的治疗效果.方法 选择2013年1月1日-2016年12月31日于大连大学附属新华医院确诊的58例中晚期食管癌患者作为研究对象,随机分为观察组和对照组各29例.观察组应用消癌平+化疗进行治疗,对照组仅应用化疗.随访观察并评价两组患者的总有效率、疾病控制率及不良反应发生情况.结果 观察组的总有效率及疾病控制率差异无统计学意义(P>0.05).两组粒细胞减少、血红蛋白减少、肝功能损害、肾功能损害及口腔黏膜炎的发生率差异无统计学意义(P>0.05);观察组血小板减少及恶心、呕吐的发生率低于对照组,差异有统计学意义(P<0.05).结论 消癌平联合化疗对中晚期食道癌的治疗效果与单纯化疗相当,但可降低血小板减少和恶心、呕吐不良反应的发生率.

Objective: To evaluate the clinical efficacy of ulinastatin(UTI) in the patients with acute respiratory distress syndrome(ARDS).Methods: 160 patients suffered from ARDS in our department from January 2008 to January 2011 were selected and divided into UTI group(group A) and control group(group B).Two groups of patients are given the same synthetical treatment.The patients from group A were received UTI 60 units intravenous in addition to the synthetical treatment.We recorded the patients' vital signs,arterial blood gas analysis,blood biochemistry test results and outcomes respectively on starting treatment,treatment for 3 days and 7 days.SPSS 13.0 software was applied for statistical analysis of the results.Results: In group A the respiratory rate was less than the control group after treatment for 3 days;arterial blood gas analysis showed that all the patients' PO2,PO2/FiO2,SaO2 were increased,PO2,PO2/FiO2,SaO2 of group A was higher than that of group B.PO2/FiO2,SaO2 had significant difference between the two groups after three days of treatment(P<0.01).The blood biochemistry test results had significant statistical difference between the two groups after three days of treatment,(P<0.05).The mortality rate had significant statistical difference between the two groups(group A 34.29%,group B 38.26 %,P=0.0097)after three days of treatment.The duration of mechanical ventilation had significant statistical difference between the two groups [group A 7.54±3.27 day,group B 11.78 ±2.69 day,P=0.0086] after three days of treatment.Conclusions: High-dose UTI for ARDS may improve the clinical treatment effect of oxygenation index and reduce the duration of mechanical ventilation.

[Objective] To investigate the influence of atorvastatin on interleukin-1β(IL-1β) in plasma and inflammatory response of rats with sepsis.[Methods] Sepsis models were made with male SD rats.The sepsis models of rats were manufactured by cecal ligation and puncture(CLP).A total of 100 healthy rats were divided randomly into 4 groups(n=25) including sham-operation,CLP,low-dose atorvastatin(20 mg/kg·d) and high-dose(40 mg/kg·d) groups.The sepsis severities of the model animals were scored according to modified sepsis severity assessment standards of experimental animals.Blood samples from five rats in each group were collected to detect IL-1β concentration in plasma with ELISA at postoperative 0,3,6,12 and 24 hours.We compared the sepsis severity score and IL-1β concentration in plasma of the rats among these groups.[Results] At 0 h,the sepsis severity scores did not have significant difference among the four groups(P0.05).The variation of scores was not obvious in sham-operation group at the four time point,but at 3 h,6 h,12 h and 24 h,the scores in CLP,low-dose atorvastatin and high-dose atorvastatin groups decreased gradually.There was significant difference among the three groups(P0.01).At 0 h,IL-1β levels of plasma did not have significant difference among the four groups(P0.05).However at 3 h,6 h,12 h and 24 h,the IL-1β levels in plasma in CLP,low-dose atorvastatin and high-dose atorvastatin groups decreased gradually.There was significant difference among the three groups(P0.01).[Conclusions] Atorvastatin may be helpful for treatment of sepsis due to its ability to inhibits the release of IL-1β in sepsis rats.