肿瘤肺泡腔内播散与肺腺癌的临床病理特征及对肺癌外科治疗和预后影响的研究进展

肿瘤肺泡腔内播散(tumor spread through air spaces, STAS)作为一种新的病理侵袭方式,与诸多临床病理因素紧密相关。在肺腺癌中,微乳头和实体型病理亚型与之关系最为密切;针对早期肺腺癌存在STAS,手术类型的治疗上肺叶切除似乎优于亚肺叶切除而获益,可能上调早期肺癌的病理分期;同时,STAS与鳞癌等非小细胞肺癌(non-small cell lung cancer, NSCLC)关系密切。此外,STAS的术中冰冻切片病理检测困难,亦有争议存在。STAS作为肿瘤复发的独立危险因素,亦是提示预后不良的重要因素,本文将STAS的研究现状和进展作一综述。

细支气管肺泡癌22例报告

细支气管肺泡癌是起源于Ⅱ型肺泡细胞的原发性肺癌,在临床上,可分为结节型和弥漫型。我院1981年1月～1990年12月收治22例,均经病理细胞学证实,现报告如下。一般资料1.年龄及性别:男19例、女3例。年龄35岁～70岁,35岁～40岁4例、41岁～50岁3例、51岁～60岁11例、60岁～70岁4例。2.发病率及分型:22例病人占同期肺癌住院总数的1％(22/2203)。其中孤立结节型7例,右侧6例、左侧1例;弥漫型15例。

细支气管肺泡癌的胸片与CT易误诊因素分析

目的:通过分析25例误诊的细支气管肺泡癌(BAC)的胸片与CT的X线征象,了解其易误诊的原因及影响因素,以期提高胸片与CT诊断的准确率。材料与方法:对25例误诊并经病理证实的BAC患者的胸片与CT的X线征象进行回顾性分析,明确诊断依据,采用Leeks等报道的3型分类法把BAC分为:单结节型、肺叶或肺段实变型、弥漫结节型。结果:误诊25例中4例(4/25,16%)为单结节型,14例(14/25,64%)为肺叶或肺段实变型,7例(7/25,28%)为弥漫结节型。其中8例(8/25,32%)误诊为结核,12例(12/25,48%)误诊为炎症性病变;5例(5/25,20%)误诊为良性肿瘤。结论:BAC在病因上最常误诊为结核和炎症,X线分型上最常误诊的是肺叶或肺段实变型,BAC误诊影响因素主要在于其临床症状和X线表现均为多样性而少有特征性,对BAC的影像学表现及其类型没有足够的认识。通过采用CT引导下经皮肺穿刺活检术,以及利用高分辨率CT和薄层CT扫描筛查,能提高BAC的确诊率。

单核细胞趋化蛋白-1与COPD大鼠气道炎症的研究

目的 探讨单核细胞趋化蛋白 - 1(MCP- 1)在慢性阻塞性肺疾病 (COPD)发病机制中的作用。方法 采用单纯熏香烟法建立 COPD模型 ,支气管肺泡灌洗计数支气管肺泡灌洗液 (BAL F)中细胞总数与肺泡巨噬细胞(AM)计数 ,以酶联免疫吸附法 (EL ISA )测定 BAL F和血清中的 MCP- 1及肿瘤坏死因子 -α(TNF-α)水平。采用图像分析系统测定肺平均内衬间隔 (ML I)、平均肺泡数 (MAN )和肺泡腔面积与总面积比 (PAA )。结果 COPD组ML I、PAA比正常对照组增高 ,而 MAN低于对照组 ,差异均有统计学意义 (P<0 .0 1)。 COPD模型组 BAL F中MCP- 1、TNF-α水平、细胞总数和 AM计数均高于正常对照组 (P<0 .0 1)。模型组血清中 MCP- 1〔(32 .75± 10 .91)pg/ ml〕与对照组〔(2 4 .13± 6 .92 ) pg/ ml〕相比无统计学差异 (P>0 .0 5 )。模型组 BAL F中 MCP- 1水平与 AM数目和 TNF-α水平 (r=0 .86 1,P<0 .0 1;r=0 .86 8,P<0 .0 1) ,以及 TNF-α水平与 AM数目 (r=0 .84 ,P<0 .0 1)均呈密切正相关 ,但血清中 MCP- 1水平、TNF-α水平与 BAL F中的 AM数目均无相关性 (r=0 .4 88,P>0 .0 5 ;r=0 .132 ,P>0 .0 5 )。结论 MCP- 1与

弥漫型支气管—肺泡癌的临床与X线诊断探讨

细支气管—肺泡癌(简称BAC)发病率较低,约占原发性支气管癌的2～5％。由于本病缺乏特征性表现,易误诊。现将我院10余年来所遇到的经病理学证实的19例弥漫型BAC作一分析。

Effects of electroacupuncture pretreatment on M1 polarization of alveolar macrophages in rats with acute lung injury

Objective:To observe the effects of electroacupuncture(EA)pretreatment on M1 polarization of alveolar macrophages(AMs)in rats with acute lung injury(ALI)induced by lipopolysaccharide(LPS),and to explore the potential protective mechanism of EA.Methods:Forty Sprague-Dawley rats were randomly divided into a normal group,a model group,and three groups of EA pretreatment[including a Chize(LU5)group,a Zusanli(ST36)group and a Chize(LU5)plus Zusanli(ST36)group],with eight rats in each group.The model rats of ALI were established by instilling LPS[2 mg/(kg·bw)]into the trachea of rats for 3 h.The rats in each EA pretreatment group were pretreated with EA for 30 min per day at the corresponding bilateral acupoints 6 d before instilling LPS.Three hours after modeling,the pulmonary function of the rats was tested,and the lung tissue was taken to calculate the ratio of lung wet weight to dry weight(W/D).The pathological lung changes and the injury score were observed by hematoxylin-eosin staining.The contents of tumor necrosis factor(TNF)-α,interleukin(IL)-1β,and myeloperoxidase(MPO)in rat's bronchoalveolar lavage fluid(BALF)were detected by enzyme-linked immunosorbent assay.The mRNA and protein expression levels of M1 macrophage markers clusters of differentiation 86(CD86),inducible nitric oxide synthase(iNOS),and its signaling pathway factor Toll-like receptor(TLR)4,and nuclear factor-κB(NF-κB)p65 in the alveoli were detected by fluorescence quantitative polymerase chain reaction and Western blot,respectively.Results:After being induced by LPS,the pulmonary function of the model rats showed that the forced expiratory volume in 0.1 s(FEV0.1),forced expiratory volume in 0.3 s(FEV0.3),and their respective ratios of FEV to forced vital capacity(FVC)(including FEV0.1/FVC and FEV0.3/FVC)were significantly decreased(P<0.01),while the W/D of lung tissue was increased(P<0.01).The score of lung injury was significantly higher(P<0.01).The contents of TNF-α,IL-1β,and MPO in the BALF and the mRNA and protein expression levels of CD86,iNOS,TLR4,and NF-κB p65 in the lung tissue were significantly increased(P<0.01).After EA pretreatment,the FEV0.1,FEV0.3,FEV0.1/FVC,and FEV0.3/FVC were significantly increased,the lung injury score decreased significantly,and the contents of TNF-α,IL-1β,and MPO in the BALF and the expression levels of CD86,iNOS,TLR4,and NF-κB p65 mRNAs and proteins in the alveoli decreased significantly(P<0.05 or P<0.01).Compared with the other two single acupoint groups,the contents of TNF-α,IL-1β,and MPO in the BALF and the expression levels of CD86,iNOS,TLR4,and NF-κB p65 mRNAs in the alveoli in the Chize(LU5)plus Zusanli(ST36)group were significantly lower(P<0.01).Conclusion:EA pretreatment at Chize(LU5)and Zusanli(ST36)can inhibit inflammation and reduce pulmonary injury in ALI rats induced by LPS.The effect of the combination of Chize(LU5)and Zusanli(ST36)is better than that of using these two acupoints separately,and its mechanism may be related to the inhibition of AMs'M1 polarization by down-regulation TLR4/NF-κB signaling pathway.

I期非小细胞肺癌术后复发转移的预测因素研究进展

肺癌严重威胁人类健康。Ⅰ期非小细胞肺癌患者即使接受根治性切除手术,仍有部分出现早期复发转移,预后不良,生存期缩短。近年研究发现:同为Ⅰ期NSCLC患者,存在肿瘤经肺泡腔隙扩散、肺腺癌病理新分类中的高分级(微乳头/实体)亚型、淋巴血管浸润;影像组学异常和微小残留病灶阳性的患者,更易发生术后复发转移,因此除传统TNM分期系统和脏胸膜受侵之外,上述因素可作为预测术后病情的指标,本文拟对这些预测因素的研究进展进行综述。