近年胰腺癌的发病率明显增加，过去10年，美国及欧洲的发病率已达到8/10万～12/10万，我国与其相近似。胰腺癌的治疗效果至今却难以令人满意，5年生存率无显著提高。主要的原因是由于胰腺的位置深在，胰腺癌又缺乏特异性的临床表现，早期诊断非常困难，大多数患者到医院就诊时已属于Ⅱ、Ⅲ、Ⅳ期肿瘤。治愈的唯一可能性是肿瘤的外科切除，但根治性手术切除率仅为18.6%，5年生存率在0～24%。未治疗者中位生存期为6～8个月。目前，随着影像学技术、内窥镜和腹腔镜超声等多项检查手段的应用与普及，对胰腺癌能否切除可以做出较准确的术前评估，这对合理地选择治疗方法，提高手术切除率，避免不必要的“开腹探查”有着重要的意义。
ObjectiveTo establish a predictive model for survival and study it’s clinical value by reviewing the information of patients with hilar cholangiocarcinoma. MethodsMedical record of 196 patients with hilar cholangiocarcinoma were analyzed retrospectively. Seventeen possible clinicopathologic factors were selected. Cox model was used for univariate and multivariate analysis. Prognostic index (PI) was calculated based on the results of multivariate analysis. Patients with different PI were divided into three different risk level groups in order to compare the survival rate. Individual expected survival rate was calculated based on the median PI. Log cumulative hazards function plot was used to test Cox model proportional hazards assumption (PH assumption). ResultsThe significant prognostic factors influencing the survival rate were surgical procedure, surgical margin, and preoperative total bilirubin level (Plt;0.05). The predictive formula was PI=0.815×preoperative total bilirubin level+0.580×surgical margin－0.713×surgical procedure. According to the value of PI, all patients were divided into 3 groups, low risk group (PI≤－0.642), middle risk group (－0.642lt;PIlt;1.364), high risk group (PI≥1.364), and survival rate declined between groups and in groups with statistically significant difference (Plt;0.05). ConclusionThis model for survival can predict the prognosis of patients with hilar cholangiocarcinoma individually and help to conduct individual clinical therapy.
目的探讨髓样细胞分化蛋白88（MyD88）在重症急性胰腺炎（SAP）发病机理的作用。 方法将48只小鼠按随机数字表法随机分为SAP组（32只）与正常对照组（16只）；再将2组小鼠随机（随机数字表法）分为6、12、24及48 h组，SAP组各亚组每组8只，正常对照组每亚组4只。SAP组小鼠腹腔注射20% L-精氨酸以诱导SAP模型，正常对照组小鼠仅腹腔注射生理盐水。分别于建模术后6、12、24及48 h处死小鼠，取其动脉血，采用ELISA方法检测血清中白细胞介素-1β（IL-1β）、白细胞介素-10（IL-10）及肿瘤坏死因子-α（TNF-α）浓度；同时取其胰腺组织（正常对照组仅术后6 h取材），用逆转录-聚合酶链反应（RT-PCR）方法检测胰腺组织中MyD88 mRNA和核因子-κB（NF-κB）mRNA的表达水平，并进行HE染色。 结果镜下见SAP组小鼠的胰腺组织随时间进展其炎症逐渐加重。各时点SAP组小鼠的IL-1β、IL-10及TNF-α浓度均高于正常对照组（P＜0.05）；各时点SAP组与正常对照组（6 h组）相比较，其胰腺组织中MyD88 mRNA及NF-κB mRNA的表达水平均较高（P＜0.05）。各时点SAP组小鼠MyD88 mRNA的表达水平与血清IL-1β、IL-10及TNF-α的浓度和NF-κB mRNA的表达水平均呈正相关（P＜0.01）。 结论MyD88的表达对SAP的发生和发展可能均具有重要的作用。