目的回顾分析经病理确诊的隐源性机化性肺炎临床、病理和影像学特征,以提高临床诊断水平。方法1993年4月至2005年10月在北京协和医院住院、经病理确诊的机化性肺炎23例,对其进行临床、影像学和病理学综合分析。结果23例机化性肺炎中5例为药物引起或合并结缔组织病,18例为隐源性机化性肺炎(cryptogen ic organ izing pneumon itis,COP)。其中10例经皮肺活检或经支气管肺活检,8例开胸肺活检或经胸腔镜肺活检,男8例,女10例,年龄(53.5±11.0)岁。气短、咳嗽及肺部爆裂音及湿性啰音是主要的症状和体征。肺功能显示限制性通气功能障碍(11例)及弥散障碍(18例)。胸部CT表现为磨玻璃样变(4例),肺实变(13例)伴支气管充气征(3例),胸腔积液(4例)。支气管肺泡灌洗液中淋巴细胞占细胞总数的0.40±0.16,中性粒细胞为0.15±0.08,嗜酸粒细胞为0.05±0.03;CD4/CD8为0.43±0.21。所有患者均给予糖皮质激素治疗。16例患者经随诊(8.67±6.21)个月仍存活,临床缓解或病情稳定。1例患者对糖皮质激素反应差,死于进行性加重的呼吸衰竭。另1例患者糖皮质激素治疗后出现肺部感染,死于感染性休克。结论临床表现及影像学特征对COP的诊断有一定的提示作用,但确诊需依靠病理检查。经皮肺活检或经支气管镜肺活检结合支气管肺泡灌洗液检查,对临床诊断隐源性机化性肺炎有较高的价值。
OBJECTIVE: To explore new methods for the early diagnosis of pancreatic cancer through detection of K-ras and p53 mutations in pancreatic juice and stool. METHODS: 201 patients in PUMC Hospital from 1994 - 2000 and 60...
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OBJECTIVE: To explore new methods for the early diagnosis of pancreatic cancer through detection of K-ras and p53 mutations in pancreatic juice and stool. METHODS: 201 patients in PUMC Hospital from 1994 - 2000 and 60 control individuals were enrolled in this study. K-ras point mutation was detected by PCR-RFLP while p53 mutation was detected by PCR-SSCP. RESULTS: K-ras mutation was found in pancreatic juice in 87.8% (36/41) of pancreatic cancer patients and 23.5% (4/17) of benign pancreatic disease patients. In 261 stool specimens, amplification found mutations successfully in 235 patients (90%). K-ras mutation was found in stool in 88% (66/75) of pancreatic cancer patients, 51.1% (24/47) of benign pancreatic disease patients and 19.6% (9/46) of normal individuals. p53 mutation was found in pancreatic juice in 47.4% (18/38) of pancreatic cancer patients and 12.5% (2/16) of benign pancreatic disease patients. p53 mutation was found in stool in 37.1% (23/62) and 19.1% (4/21) of chronic pancreatitis patients. CONCLUSION: K-ras mutation in pancreatic juice has higher diagnosis sensitivity and specificity, and therefore may be used as a supplement in the diagnosis of pancreatic cancer. Detection of K-ras mutation combined with p53 mutation in stool can aid in the screening of pancreatic cancer.
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