近年胰腺癌的發病率明顯增加，過去10年，美國及歐洲的發病率已達到8/10萬～12/10萬，我國與其相近似。胰腺癌的治療效果至今卻難以令人滿意，5年生存率無顯著提高。主要的原因是由于胰腺的位置深在，胰腺癌又缺乏特異性的臨床表現，早期診斷非常困難，大多數患者到醫院就診時已屬于Ⅱ、Ⅲ、Ⅳ期腫瘤。治愈的唯一可能性是腫瘤的外科切除，但根治性手術切除率僅為18.6%，5年生存率在0～24%。未治療者中位生存期為6～8個月。目前，隨著影像學技術、內窺鏡和腹腔鏡超聲等多項檢查手段的應用與普及，對胰腺癌能否切除可以做出較準確的術前評估，這對合理地選擇治療方法，提高手術切除率，避免不必要的“開腹探查”有著重要的意義。
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.
目的探討髓樣細胞分化蛋白88（MyD88）在重癥急性胰腺炎（SAP）發病機理的作用。 方法將48只小鼠按隨機數字表法隨機分為SAP組（32只）與正常對照組（16只）；再將2組小鼠隨機（隨機數字表法）分為6、12、24及48 h組，SAP組各亞組每組8只，正常對照組每亞組4只。SAP組小鼠腹腔注射20% L-精氨酸以誘導SAP模型，正常對照組小鼠僅腹腔注射生理鹽水。分別于建模術后6、12、24及48 h處死小鼠，取其動脈血，采用ELISA方法檢測血清中白細胞介素-1β（IL-1β）、白細胞介素-10（IL-10）及腫瘤壞死因子-α（TNF-α）濃度；同時取其胰腺組織（正常對照組僅術后6 h取材），用逆轉錄-聚合酶鏈反應（RT-PCR）方法檢測胰腺組織中MyD88 mRNA和核因子-κB（NF-κB）mRNA的表達水平，并進行HE染色。 結果鏡下見SAP組小鼠的胰腺組織隨時間進展其炎癥逐漸加重。各時點SAP組小鼠的IL-1β、IL-10及TNF-α濃度均高于正常對照組（P＜0.05）；各時點SAP組與正常對照組（6 h組）相比較，其胰腺組織中MyD88 mRNA及NF-κB mRNA的表達水平均較高（P＜0.05）。各時點SAP組小鼠MyD88 mRNA的表達水平與血清IL-1β、IL-10及TNF-α的濃度和NF-κB mRNA的表達水平均呈正相關（P＜0.01）。 結論MyD88的表達對SAP的發生和發展可能均具有重要的作用。