胃肠间质瘤Ki-67的表达特点及其临床意义

Dual Cycle and Dual Channel Regimen in the Treatment of Severe Ovarian Hyperstimulation Syndrome with Pregnancy

中文关键词:  心肌营养素-1 缺氧缺血性脑病 心肌损伤 心功能 Tei指数

中文摘要:

      目的 探讨胃肠间质瘤中增殖细胞核抗原Ki-67的表达特点及其临床意义。方法 回顾性分析我院胃肠外科自2012年7月至2013年9月期间收治的97例胃肠间质瘤患者的临床特征、病理免疫组化结果、治疗和随访情况，分析Ki-67的表达特点及其临床意义。结果 原始病例数112，失访15例，97例具有完整的随访和临床病理资料。随访3~24个月（中位时间15个月），复发或转移30例（30.9%），其中4例死亡。在不同年龄、性别分布中，Ki-67表达差异无统计学意义（ P>0.05）；在肿瘤部位、肿瘤长径、美国国立卫生研究院（NIH）危险度分级和核分裂象中，Ki-67表达差异有统计学意义（ P均<0.05），且肿瘤越大、NIH危险度级别越高、核分裂象数越多，Ki-67表达指数越高，呈正相关（ P<0.05）；Ki-67、核分裂象和复发转移有关（r分别为0.395,0.266， P<0.05）。Cox多因素分析示：Ki-67( P<0.001，相对危险度=0.387，95%可信区间：0.229~0.654)和核分裂象（ P=0.005，相对危险度=0.494，95%可信区间：0.304~0.805）是影响术后无复发生存的独立危险因素。生存分析示：Ki-67表达指数影响中高危患者的预后。结论 Ki-67与肿瘤长径、NIH危险度分级和核分裂象相关，并能辅助评估胃肠间质瘤患者的预后。

英文摘要:

      Objective To determine the 50% effective dose（ED ₅₀ ）of intrathecal isobaric bupivacaine in combined spinal-epidural anaesthesia with epidural volume extension for caesarean surgery. Methods Eighty-four women undergoing elective caesarean sections were randomly assigned to seven groups, receiving intrathecally isobaric bupivacaine in a dosage of 6, 7, 8, 9, 10, 11 or 12 mg (n=12 per group), respectively. Ten mL normal saline was injected through an epidural catheter at a rate of 0.5 mL/s. Successful induction was defined as Hollmen pinprick block grade 2 at a height equal to or higher than T6. Success (surgery) was defined as success (induction) plus no requirement for epidural supplementation throughout surgery. The ED ₅₀ values were determined using a logistic regression model. Results The ED ₅₀ for success (induction) and success (surgery) were 8.121 mg ( 95% confidence interval: 7.421-8.821) and 9.012 mg (95% confidence interval:7.747-10.280), respectively. With increase in amount of intrathecal bupivacaine, time to success (induction) was shortened ( P<0.05), resulting in increased successful numbers for both induction and surgery. No differences were found in the use of phenylephrine, haemodynamic stability and the occurrence of nausea and vomiting among groups. Conclusion When combined with epidural volume extension, intrathecal bupivacaine has an ED ₅₀ of 8.121 mg and 9.012 mg for success (induction) and success (surgery), respectively, in women undergoing caesarean sections.