58例甲状腺髓样癌降钙素及其基因相关肽检测的临床意义

目的:探讨甲状腺髓样癌患者降钙素及其基因相关肽的变化规律以指导临床治疗方案的选择和患者预后的判断。方法:对58例甲状腺髓样癌患者血清中降钙素进行分析及应用免疫组织化学方法观察相应标本中降钙素及其基因相关肽的表达情况;对新入组患者进行放射免疫学测定。结果:1)术前降钙素水平正常与升高的患者之间,颈淋巴结转移存在显著性差异(P<0.01)。2)术后1个月降钙素水平正常与升高的患者之间,肿瘤复发存在显著性差异(P<0.01)。3)约98%的患者肿瘤标本降钙素染色呈阳性,而降钙素基因相关肽的阳性率为87.8%。4)部分术前降钙素水平正常的患者降钙素基因相关肽水平升高。5)术后1周左右降钙素下降至一稳定水平。结论:降钙素可以作为指导甲状腺髓样癌诊断和治疗的重要指标,检测降钙素基因相关肽有助于部分降钙素阴性的甲状腺髓样癌患者术前诊断。

27例原发性甲状腺淋巴瘤的临床分析

目的 :分析甲状腺原发恶性淋巴瘤的临床表现、诊断及治疗。方法 :回顾1975～1999年间收治的甲状腺淋巴瘤27例 ,分析其临床表现 ,病理分型、临床分期、治疗方案及预后。结果 :原发甲状腺淋巴瘤复发及死亡率,综合治疗者(5/24)低于单纯手术者(3/3) ;低度恶性(3/17)低于中高度恶性者(5/10) ;Ⅰ期 (1/16)低于Ⅱ期 (7/11) ;腺内者(3/19)低于侵出腺外者(5/8,P<0.05)。结论 :甲状腺淋巴瘤的预后与病理分型、临床分期及治疗方案密切相关 ;

Investigation of Calcitonin and Calcitonin Gene-related Peptide in 88 Cases of Medullary Thyroid Carcinoma

Objective： To investigate the changes of calcitonin （CT） and calcitonin gene-related peptide （CGRP） in patients with medullary thyroid carcinoma （MTC）. Methods： Fifty-eight cases of MTC were selected and the relationship between the CT levels and metastasis was investigated. The immunohistochemical method was used to detect the expression of CT and CGRP in the 58 samples of MTC tissues. The CT and CGRP in 30 newly diagnosed MTC inpatients were measured before operation and in the first few days after operation using a radioimmunoassy. Results： （1） The rate of residual tumor had a significant difference between the normal serum CT group one month after operation and the elevated group at the same period （P〈0.01）. （2） Immunohistochemical study revealed the positive rate of CT was about 98%, and that of the CGRP was 87.8%. （3） Part of the patients had an elevated CGRP levels while CT levels was normal. （4） The serum CT levels were decreased to a stable range one week after operation. Conclusion： CT is a useful index to evaluate the efficacy of surgical treatment. The measurement of serum CGRP is helpful in the diagnosis of MTC, especially for those whose preoperative CT levels are normal.

EGFR及其配体EGF与甲状腺乳头状癌淋巴转移的关系研究

目的 研究EGFR及其配体EGF与甲状腺乳头状癌淋巴结转移的关系。方法 本实验采用免疫组化S -P法 ,检测了 2 5 1例甲状腺乳头状癌表皮生长因子受体 (EGFR) ,分析了受体表达情况与淋巴转移间的关系。并检测了 5 3例甲状腺乳头状癌患者血清及尿液中表皮生长因子 (EGF)的水平。结果 在甲状腺乳头状癌中 ,EGFR出现高水平表达 ,阳性率为 6 6 9% ,明显高于对照组。不同病理分型间 ,阳性率有所不同。包膜内型、腺内型和腺外型阳性率分别为 2 9 4%、73 9%和 71 3% ,其差别有统计学意义。当出现淋巴结转移时 ,EGFR阳性率升高。N0 转移组及N1组EGFR阳性率为 88 7% ,91 0 %明显高于N0 无转移组 (19 5 % ) ,有显著性差异。经相对危险度计算和线性趋势分析表明 ,随EGFR染色强度升高 ,转移风险升高 ,二者间呈线性关系。甲状腺乳头状癌患者血清及尿液中存在着高水平的EGF。甲状腺乳头状癌患者血清EGF水平为 1 6 8± 5 6 μg/L ,尿液中为 37 2± 10 8μg/L ,均高于甲状腺腺瘤组和正常对照组。提示EGF与肿瘤的发生有密切关系。结论 在N0 期甲状腺乳头状癌病例中 ,EGFR阳性应高度考虑颈淋巴结转移 ,从而为临床选择治疗方案提供参考。