目的 探讨胰腺淋巴瘤和胰腺癌的鉴别诊断及治疗。方法 回顾性分析我院2000年1月至2008年4月期间经病理确诊的5例胰腺淋巴瘤患者的临床资料。结果 本组5例患者临床症状以腹痛、发热、黄疸为主，除1例外血浆CA19-9均正常，临床表现无法区分胰腺淋巴瘤和胰腺癌，CT等影像学有助于鉴别诊断。胰腺淋巴瘤CT增强扫描后均见强化表现，胰管不粗，和周围大血管关系紧密，邻近血管结构被推移，但无浸润、包绕现象。治疗以化疗为主，除1例失访外，其余4例分别存活24、14、14、13个月。结论 胰腺淋巴瘤是一种罕见的疾病，临床症状缺乏特异性，极易与胰腺癌混淆，治疗和预后却与胰腺癌不尽相同，临床上应该尽量通过CT或超声下穿刺明确诊断，以避免不必要的手术。
Objective To investigate the mRNA expressions of liver X receptor α (LXRα), farnesoid X receptor (FXR), steroid xenobiotic receptor (SXR) and liver receptor homolog 1 (LRH-1) gene in patients with cholesterol gallstone (CGS) disease in order to elucidate the biomolecular pathogenesis of gallstone formation. Methods Twenty-seven patients with CGS (CGS group) and 10 controls without gallstones (control group) were included in this study. Serum lipid composition (total cholesterol, triglyceride, high density lipoprotein cholesterol, apoprotein B, apoprotein A1), gallstone cholesterol concentration and biliary composition (cholesterol, bile salts, lecithin) were assayed. Biliary total lipid and cholesterol saturation index (CSI) were calculated. mRNA expressions of LRH-1, FXR, SXR and LXRα gene were determined by real-time polymorphism chain reaction. Results Serum high density lipoprotein cholesterol concentration was lower in CGS group than that in control group 〔(0.93±0.05) mmol/L vs (1.33±0.09) mmol/L, P＜0.001〕 and serum apoprotein A1 was also lower in CGS group than that in control group 〔(1.19±0.05) g/L vs (1.36±0.06) g/L, P＜0.05〕. There were no differences in serum total cholesterol, triglyceride and apoprotein B between two groups (Pgt;0.05). CSI was higher in CGS group than that in control group (1.17±0.02 vs 0.79±0.10), P＜0.001. Biliary cholesterol was also higher in CGS group than that in control group 〔(7.96±0.39) mol% vs (5.26±0.89) mol%, P＜0.01〕, while biliary total lipid was lower in CGS group than that in control group 〔(104.72±10.51) g/L vs (154.24±14.20) g/L, P＜0.05〕. There were no differences in bile salts and lecithin between two groups (Pgt;0.05). Expression of LRH-1 gene was higher in CGS group than that in control group (14.18±1.80 vs 7.22±2.22), the difference was statistically significant (P＜0.05). There were no differences in mRNA expressions of LXRα, FXR and SXR gene between two groups (Pgt;0.05). Conclusion CGS disease may be related to increased expression of LRH-1 gene.
目的 报道10例血清CA19-9明显升高的胆管良性疾病病例。方法 回顾性分析2004年1月至2006年3月期间我院收治并经手术证实的10例血清CA19-9明显升高（gt;500 U/ml）的胆管良性病变病例。结果 患者中男4例，女6例，年龄30~85岁，CA19-9为532.32~12 000.00 U/ml，除1例患者CA125轻度升高外，其他患者血清CEA、CA125及AFP均正常。胆总管结石8例，肝内胆管结石1例，原发性硬化性胆管炎1例； 除1例外均存在不同程度阻塞性黄疸。经治疗后8例CA19-9水平在30 d内降至正常，另2例分别于术后2个月和3个月内降至正常。结论 CA19-9在胆管恶性肿瘤诊断方面的意义仍需进一步研究。