利培酮早期治疗反应及治疗方案调整对精神分裂症患者疗效的影响

目的:探讨根据利培酮早期治疗反应调整治疗方案对精神分裂症患者疗效及安全性影响。方法:120例精神分裂症患者随机分为两组,两组均给予利培酮单药治疗并于2周内滴定至4~6 mg/d;对照组以此剂量维持治疗;研究组治疗第2周末阳性与阴性症状量表(PANSS)减分率<20%的患者替换为奥氮平治疗(10~20 mg/d),减分率≥20%的患者继续利培酮治疗;疗程共8周。治疗前、治疗第2、4、8周末分别进行PANSS和治疗中出现的症状量表(TESS)评分。结果:研究组49例、对照组47例完成8周观察;治疗第4、8周末研究组PANSS总分、阳性症状分及治疗第8周末一般精神病理分显著低于对照组(P<0.05或P<0.01);阴性症状分各时间点两组间差异无统计学意义;治疗后各时间点TESS评分研究组明显低于对照组(P均<0.01)。结论:根据利培酮早期治疗反应调整治疗方案能明显改善精神分裂症患者的症状,减轻不良反应。

淋巴瘤治疗反应评价标准及其应用:第二部分

PET/CT在霍奇金淋巴瘤和非霍奇金淋巴瘤的治疗中期及治疗后评估中起着至关重要的作用。该文对PET/CT在淋巴瘤的治疗反应评估和干细胞移植前评估及预后价值进行了总结,旨在辅助制定临床治疗方案。笔者探索了PET/CT在不同亚型疾病中的优缺点及报告标准和最新进展。文章还特别关注了基于PET显像改变治疗方案的情况,该方面已逐渐成为临床管理的基石。

Preliminary assessing no-surgical treatment response in bronchogenic carcinoma with double-phase contrast material-enhanced computed tomography

Objective： To evaluate the efficacy of double-phase contrast material-enhanced computed tomography （CT） in assessing no-surgical treatment response in bronchogenic carcinoma preliminarily. Methods： 52 patients with bronchogenic carcinoma after no-surgical treatment underwent double-phase contrast material-enhanced computed tomography. Two spiral CT scans were obtained at 25 and 90 seconds respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 4 mUs by using an autoinjector. Precontrast and postcontrast attenuation on every scan was recorded and peak height was calculated. Enhancement pattern was evaluated on the images obtained at 25 and 90 seconds after injection of contrast medium. Results： Precontrast attenuation, postcontrast attenuation at 25 and 90 seconds were 42.20 ± 7.43 Hu, 57.35 ± 10.09 Hu and 71.85 ±12.45 Hu, respectively. No statistically significant difference in precontrast attenuation was found between our results in the study and the results in our old study （mean precontrast attenuation 40.70 Hu） which was obtained in cases before therapy （t = 1.455, P = 0.152 〉 0.05）. Peak height of bronchogenic carcinoma after no-surgical treatment （29.46 ±10.85 Hu） were significantly lower than that of bronchogenic carcinoma before therapy obtained in our old study （mean peak height 35.79 Hu; t = 4.206, P = 0.001 〈 0.05）. 32 of 52 cases showed homogeneous enhancement at 90 seconds. Of the 32 cases, there were 21 with inhomogeneous enhancement, 7 with inhomogeneous enhancement, 2 with central enhancement and 2 with peripheral enhancement at 25 seconds. Conclusion： Bronchogenic carcinoma after no-surgical treatment shows a gradual increase to the peak height after administration of contrast material. Peak heights can reflect the blood supply of bronchogenic carcinoma and might be index for evaluation of no-surgical treatment response in bronchogenic carcinoma.

Preliminary assessing no-surgical treatment response in bronchogenic carcinoma with changes in enhancement pattern

Objective： The aim of this study was to evaluate the efficacy of changes in enhancement pattern in assessing no-surgical treatment response in bronchogenic carcinoma preliminarily. Methods Thirty-three patients with bronchogenic carcinoma underwent two-phase contrast material-enhanced computed tomography prior to and after stopping no-surgical treatment more than one-month respectively. Two spiral CT scans were obtained at 25 and 90 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 3 mL/s by using an autoinjector. The sum of the tumor longest diameters （LD） prior to treatment, after treatment and the sum of the post-treatment tumor enhancement area LD on the images obtained at 90 s after injection of contrast medium were recorded, Precontrast and postcontrast attenuation on every scan was recorded and peak height was calculated. The significance of the difference among groups was analyzed by means of ANOVA, student t test and chi-square test. Results： The sum of the tumor LD prior to treatment, that of after treatment and the sum of the post-treatment tumor enhancement area LD on the images obtained at 90 s after injection of contrast medium were （4.49 ± 1.32）, （4.05 ± 1.63）, （3.36 ± 1.22） cm respectively and there were statistically significant dif- ferences among them （f= 5.467, P = 0.006）. The sum of the tumor LD prior to treatment was significantly higher than that of the post-treatment tumor enhancement area （P = 0.001）. No statistically significant difference in the sum of the tumor LD was found between the pre- treatment and the post-treatment （P = 0.207）. There was no statistically significant difference between the sum of the tumors LD and that of tumor enhancement area after treatment （P = 0.086）. The response rate （RR） （21.21%） according to changes in sum of the tumor LD was significantly lower than that （30.30%） according to changes in the sum of the post-treatment tumor enhancement area LD （x2 = 15.12, P 〈 0.05）, and the progressive diseases （PD） rate （21.21%） was significantly higher than that （12.12%; X2 = 14.12, P 〈 0.05）. No statistically significant difference was found between precontrast attenuation prior to treatment [（41.77±7.03） HU] and that after treatment [（41.89 ± 7.63） HU; t = 0.335, P = 0.740 〉 0.05]. Peak height of bronchogenic carcinoma prior to treatment [（36.50 ± 11.21） HU] were significantly higher than that after treatment [（29.91 ± 10.35） HU; t = 10.081, P = 0.001]. Conclusion： Therapeutic effect may be underestimated with use of changes in sum of the tumor LD. The changes in sum of tumor enhancement area LD in addition to peak height is suggested to be used in assessing no-surgical.treatment response in bronchogenic carcinoma.

Preliminary assessing no-surgical treatment response in bronchogenic carcinoma with three-phase contrast material-enhanced MRI

Objective:The aim of this study was to evaluate the efficacy of three-phase contrast material-enhanced MRI in assessing no-surgical treatment response in peripheral bronchogenic carcinoma preliminarily.Methods:Twenty-two patients with bronchogenic carcinoma after no-surgical treatment underwent three-phase contrast material-enhanced MRI.Three scans were obtained at 25 s,120 s and 180 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 2 mL/s by using an autoinjector.Precontrast and postcontrast signal intensity on every scan was recorded.Peak Height(PH) and Maximum Enhancement(Emax) were calculated.Enhancement pattern was evaluated on the images obtained at 120 s and 180 s after injection of contrast medium.Results:Precontrast signal intensity,postcontrast signal intensity at 120 s and 180 s were 478 ± 108,926 ± 209 and 1050 ± 252.PH(571 ± 225) and Emax(119 ± 49) of bronchogenic carcinoma after no-surgical treatment were significantly lower than those of bronchogenic carcinoma without any therapy(mean PH 655,mean Emax 150)(t = 2.178,P = 0.005 < 0.05,t = 4.196,P = 0.001 < 0.05).Six cases among 22 appeared homogeneous enhancement at 180 s.At 120 s,there were 4 cases with inhomogeneous enhancement,1 case with homogeneous enhancement,1 case with peripheral enhancement among the 6 cases.Conclusion:Bronchogenic carcinoma after no-surgical treatment shows a gradual increase to the PH after administration of contrast material.Three-phase contrast material-enhanced MRI can reflect the blood supply of bronchogenic carcinoma and might be effective approach for evaluation of no-surgical treatment response in bronchogenic carcinoma.