生长抑素及其类似物治疗致肝细胞型肝癌坏死一例并文献复习

肝细胞型肝癌(hepatocellular carcinoma,HCC)是常见的恶性肿瘤之一,每年约有50-100万新发病例,HCC在全球常见的肿瘤中位居第六位,因肿瘤导致死亡的原因中位于第三位[1].现有的治疗手段仍然有限,主要有肝切除、肝移植术、局部治疗和分子靶向治疗等.近年的研究发现,生长抑素(Somatostatin,SST)及其类似物(Somatostat ionanalogue,SSTA)不仅对绝大多数神经内分泌肿瘤有肯定疗效[2],而且对多种实体肿瘤亦有一定的作用[3],但是SSTA对HCC的治疗作用鲜有文献报道.

AIM To study the development of D (somatostatin-secreting) and P (bombesin-secreting) cells ofproventriculus from Shao ducks at different ages.METHODS Ninety Shao ducks were divided into nine groups, 10 ducks per group. The ducks were slayedgroupby group at the nine time points of week 0 (after hatching), 1, 2, 4, 6, 10, 14, 18 and 22.Proventriculus samples from each duck were collected, fixed by Bouin solution and embedded with paraffin.gections were made and stained with an avidin-biotin-peroxidase complex kit (Dako Co., Ltd. ) to visualizeD and P cells of each proventriculus. Thirty glandular lobes per duck were observed for enumeration of Dand P cells.RESULTS ① Both D and P cells were mostly oval or polygonal shape with dumpy cytoplasmic processesand located in the inner and central area of the glandular lobe. ② The D and P cells peaked at wk 18 and 6respectively. ③ There was no apparent correlation between D cells and the body weight until wk 4. Negativecorrelation was observed from wk 6 and reached a marked level at 18wk (r = -0.829, P<0.05).Individuals with maximum body weight had less D cells than those with minimum body weight from wk 10-wk 18.CONCLUSION The morphology and distribution of D and P cells in the proventriculus of Shao ducks weresimilar to Peking ducks, gooses and chickens. Both D and P cells had continuing development during thepostnatal period, though the rates of their development were different. If appeared that beyond a definitenumber of D cells, they were negatively correlated with the body weight.

Acute severe pancreatitis (ASP) was habitually called acute hemorrhagic necrotizing pancreatitis. Butaccording to the pathological finditgs of our 139 surgical cases, 59.7% belonged to necrotizing type, whilehemorrhagic necrotizing type only accounted for 23.0%. Involvement of pancreas is not necessarily diffuse,3.7% only affected pancreatic tail. The incidence of the disease is highest in 41 - 60 year age group. Earlyrecognition of severe type of the disease is always an emphasis in clinical studies. CT scanning is the maindiagnostic tool used. Clinical diagnostic criteria offer some help in clinical practice. Banks' criteria is morecommonly used in western countries instead of Ranson criteria in the past. For clinical evaluation of theprogress of the disease, APACHEII scoring method is commonly used. Classification of CT findings ishelpful in judging the severity of the disease. Once the diagnosis was definitely established, should it betreated surgically or managed by medical way? The pendulum had swung for many years. Our currentconsensus is “combined treatment system”. That is: patients with uninfected pancreatic necrosis shouldreceive non-surgical treatment. The success rate is over 85%. Cases of infected necrosis went downhill,vigorous treatment should be given immediately. Otherwise, late stage operation should by all means be considered and wait for localization of theinfection with the hope of complete cure after single drainage operation. “Obstructive biliary pancreatitis”and “Ruptured pancreatic abscess causing peritoritis” are indicated for immediate operation. Cure rate bynon-surgical treatment is significantly increased, with a success rate of operative treatment of 80%. Medicaltreatment is administered by the combined traditional Chirtese and Western medicine. Besides all thenecessary supportive and symptomatic treatment, three major aspects of treatment should be speciallyemphasized: ① pancreatic infection. According to the bacterial spectrum, concentration of antibiotics in thepancreas and drug sensitivity test, we advocate the use of quinolone class antidacterial agents such asimipenem, Ofloxacin,ciprofloxacin, etc as drug of first choice. ② Inhibition of pancreatic secretion usingGabexate mesilate or synthetic analogue of somatostatin. The two analogues that are widely used in China areOctreotide (Sandostatin) introduced to China earlier; and the 14-pepitide somatostatin (Stilamin) introducedlater but also has been used for some years. There were reports about the benefits and drawbacks of the twoand sometimes quite controversial. According to our experience in using these two analogues, we have notmet with serious side effects of Octreotide as reported in the western literatures. The action of Stilamin onsphincter of Oddi is causation of relaxation, but the action of Octreotide on it was quite controversial. Somereported about its spasmodic action on the sphincter. We have studied in dog experimentation and provedthat Sandostatin can significantly lower the basal pressure of sphincter of Oddi. Our consensus of their use inASP is that either can be used as available, except in most severe cases, we prefer Stilamin. However,Saadostatiu has some merits in the following conditions: It can be given hypodermically orintramuscatarly. It is more suitable for outpatients with milder disease. (?) Chronic pancreatitis with acuteflare up. ③ Treatment with traditional Chinese medicine: according to the Chinese theory of thepathogenesis -“wetness and heat stagnated at middle focus”, the principle of treatment is “relieving liver,adjutsting gas, clearing heat, drying wetness, getting through and driving down”. We have made aprescription consisting of several important ingredients, in the form of decoction. Since the 1980s, we havestudied a few Chinese herbal medicines separately. They were all proved to have promising effect. Inconclusion, in ASP, we advocate combination of Western and traditional Chinese medical treatment.

Of the three cardinal manifestations of chronic pancreatitispain, diabetes mellitus and steatorrhea, it is pain that brings the patient to the physician and is the most difficult to manage. The intractabale pain that is quite debilitating disrupts lifestyle and leads to functional incapacity, drug and alcohol dependency, and a drug-seeking behavior that occasionally might push the desperate patient to suicidal tendency. Painless CP is an exception that has been observed in nearly 5% to 10% of patients with all forms of chronic pancreatitis. Lack of pain is also a feature of the late onset idiopathic CP.

Previous studies have shown that somatic sensation by acupuncture and visceral nociceptive stimulation can converge in the nucleus tractus solitarii where neurons integrate signals impact-ing on the function of organs. To explore the role of the nucleus tractus solitarii in the protective mechanism of pre-moxibustion on gastric mucosa, nucleus tractus solitarii were damaged in rats and pre-moxibustion treatment at the Zusanli (ST36) point followed. The gastric mucosa was then damaged by the anhydrous ethanol lavage method. Morphological observations, enzyme linked immunosorbent assays, and western immunoblot analyses showed that gastric mucosa surface lesion and the infiltration of inflammatory cells were significantly ameliorated after pre-moxibustion treatment. Furthermore, the gastric mucosal damage index and somatostatin level were reduced, and epidermal growth factor content in the gastric mucosa and heat-shock protein-70 expression were increased. These results were reversed by damage to the nucleus tractus solitarii. These findings suggest that moxibustion pretreatment at the Zusanli point is protective against acute gastric mucosa injury, and nucleus tractus solitarii damage inhibits these responses. Therefore, the nucleus tractus solitarii may be an important area for regulating the signal transduction of the protective effect of pre-moxibustion on gastric mucosa.

注射用生长抑素致口唇麻木1例

病例:患者,女,53岁.2009年3月16日因"上腹部隐痛不适1月余,解黑便4天"入我院消化内科治疗.患者既往有胃窦溃疡出血史,无药物过敏史和家族药物过敏史,无家族遗传病史.体检:体温(T)36.8℃,脉搏(P)78次/分,呼吸(R)20次/分,血压(BP)120/70mmHg(1mmHg=0.133 kPa).

我院2005-2007年奥曲肽和生长抑素市场状况分析

生长抑素(somatostatin,SST)是1973年由Brazeau等从羊的下丘脑分离和提纯的生长激素释放抑制因子[1].研究证实,SST几乎对机体所有的生理性内分泌反应均有抑制作用,而且能广泛抑制细胞增殖活性,具有广泛的生理学作用,并与许多疾病的发生和发展有着密切关系,主要有4项抑制作用:神经传递、腺体分泌、平滑肌收缩和细胞增殖.

三腔二囊管压迫治疗食管-胃底静脉曲张破裂出血价值的再评价

食管-胃底静脉曲张破裂出血是肝硬化门静脉高压常见的并发症,是消化内科的急危重症.三腔二囊管压迫止血法是一种有效的止血方法,但随着生长抑素(somatostatin,SS)和质子泵抑制剂(proton pump inhibitor,PPI)的广泛应用,近年来三腔二囊管的使用越来越少.我们回顾性统计了应用SS联合PPI前、后6年的三腔二囊管的使用情况,旨在重新评价目前三腔二囊管在食管-胃底曲张静脉破裂出血时的应用价值.

血管内皮生长因子与生长抑素受体在胃癌组织中的表达及相关性研究

胃癌是消化系统中常见的恶性肿瘤,早期诊断困难,多数病例就诊时已达中晚期,预后较差.本研究通过对血管内皮生长因子(vascular endothelial growth factor,VEGF)和生长抑素受体(somatostatin receptor,SSTR)在胃癌组织中表达的研究,结合临床病理特征,探讨VEGF及SSTR的临床意义及相关性.

多肽受体介导的放射性核素靶向治疗的研究进展

利用放射性标记多肽类似物进行多肽受体靶向放射性核素治疗(PRRT),对于手术无法切除或转移性肿瘤病人来说是一种较新的和很有希望的治疗方法.20世纪80年代中期人们发现在一些肿瘤中可过度表达多肽激素受体,为了评估肿瘤受体表达情况则引入了放射性标记的多肽类似物,例如生长抑素、蛙皮素、神经降压素和胃泌素类似物等,其中常用的受体靶向制剂是各种生长抑素(somatostatin,SST)的类似物.

生长抑素受体显像和治疗研究进展

神经内分泌源性及一些非神经内分泌源性的肿瘤细胞表面均有SSTR高表达,利用放射性核素标记的生长抑素类似物(somatostatin analog,SSA)与SSTR特异性结合可使肿瘤显像,并可通过内吞作用进入细胞溶酶体内,进行靶向放疗;细胞毒素与SSA的偶联物同样可以与SSTR特异性结合,通过内吞作用进入细胞,起到靶向化疗的作用.

Objective:To evaluate the inhibitory effect of somatostatin analogue RC-160 on the growth of human endometrial cancer cells (HEC-1A) in vitro. Method: RT-PCR was used to examine the existence of somatostatin receptors on the HEC-1A cells. The anti-proliferative effect of RC-160 on the growth of HEC-1A cells was detected by using BrdU incorporation test. TUNEL staining was used to find out whether apoptosis was involved in the inhibitory process. Result: All the five somatostatin receptor subtypes were demonstrated in HEC-1A cells. RC-160 reduced the HEC-1A cell growth stimulated by serum in a dose-dependent manner. The effect was maximal at the concentration of 10-5M after 48 hours' treatment. No apoptosis was detected. Conclusion:Somatostatin analogue RC-160 can inhibit the proliferation of endometrial carcinoma cell line HEC-1A through binding to the somatostatin receptors on the cells. It seems that apoptosis is not mainly responsible for the inhibition.

生长抑素受体介导的放射性核素肿瘤治疗优化方案

放射性核素标记的生长抑素类似物(somatostatin analog,SSTA)与肿瘤细胞膜上生长抑素受体(somatostatin receptor,SSTR)特异性、高亲和力的靶向性结合,通过细胞内吞作用将放射性核素摄入肿瘤细胞,发挥内照射作用从而抑制肿瘤生长、促进肿瘤凋亡,这种治疗方法称为生长抑素受体介导的放射性核素治疗(somatostatin receptor targeted radionuclide therapy,SRTRT).

Objective To explore the correlation between neuropeptide and functional hypothalam ic amenorrhea (FHA)Materials & Methods The basic and GnRH-stimulated levels of serum FSH, LH and plasma β-endorphin (β-EP), somatostatin (SS) in 33 patients with FHA and 17 women with normal menstrual cycles were tested by RIA.Results β-EP level in FHA group was significantly higher than that in control group and had a negative correlation with FSH and LH. The basic SS level in FHA group had no significant difference compared with the control group, but it had negative correlation with LH and no correlation with FSH. β-EP level in FHA group decreased after being stimulated with GnRH, and reached its minimum value after 15 min, then gradually rose back to the basic level. β-EP level in control group had no regular changes. SS level in both group did not change obviously.Conclusion The increased level of β-EP may play an important role in FHA. GnRH can inhibit β-EP level to some extent, while the effect of SS on FHA deserve further research.