[摘 要] 目的：探讨CD68+ 肿瘤相关巨噬细胞（TAM）、CD8+ T细胞、Foxp3+ Treg细胞等在肺腺癌（LUAD）组织中浸润分布及其与患者预后的关系。方法：收集2004年9月至2009年4月间在苏州大学附属第三医院手术切除的93例LUAD组织及78例癌旁组织，采用组织芯片（TMA）及多重免疫荧光（mIF）技术检测其中的免疫细胞浸润与分布，Wilcoxon秩和检验比较癌与癌旁组织、癌巢与间质中浸润水平的差异，χ2检验分析其浸润水平及CD8+/CD68+细胞比值与临床病理特征的关系，Kaplan-Meier法和COX模型分析影响患者OS的潜在危险因素。结果：与癌旁组织比较，癌组织中CD68+ TAM、CD8+ T细胞、Foxp3+ Treg细胞浸润水平均显著增加（均P<0.01），间质CD68+ TAM、CD8+ T细胞的浸润水平均显著高于癌巢（均P<0.01）。总CD68+ TAM、癌巢及间质CD68+ TAM浸润水平与淋巴结转移呈正向关联（均P<0.05），癌巢CD68+ TAM浸润水平与T分期呈正向关联（P<0.05），间质CD68+ TAM浸润水平与病理分级呈正向关联（P<0.05）；癌组织中CD8+/CD68+细胞比值与病理分级、淋巴结转移均呈负向关联（均P<0.05）。Kaplan-Meier生存分析显示，LUAD组织中总CD68+ TAM、癌巢及间质CD68+ TAM高浸润患者OS均短于低浸润患者（P<0.05或P<0.01）、癌组织中CD8+/CD68+细胞比值高患者OS显著长于低比值患者（P<0.05）。多因素COX模型分析示，LUAD患者年龄、TNM分期及癌组织中CD8+/CD68+ 细胞比值是影响患者预后的独立风险因素（P<0.05或P<0.01）。结论:高度浸润的CD68+ TAM与LUAD的进展、侵袭、转移和不良预后显著关联，而高CD8+/CD68+ 细胞比值是影响LUAD患者OS的独立保护因素。

OBJECTIVES: To identify the new designer drugs which are totally unknown and not in the routine testing list by the technologies such as high-resolution mass spectrometry in drug facilitated sexual assault, in order to solve the problem in actual cases. METHODS: The milky fluid from an actual case was extracted and analyzed using LC-QE, ¹H-NMR and GC-MS, respectively. The accurate masses and cluster ions isotope patterns of unknown compound were obtained by LC-QE. The molecular formula was confirmed as C₁₆H₁₂C₂N₂O based on the protons number of ¹H-NMR. The isomers diclazepam and 4-chlorodiazepam were separated and detected with GC-MS. RESULTS: The new designer benzodiazepine as diclazepam in the milky fluid was identified. The results provided direct evidence for the investigation and qualitative analysis of such cases. CONCLUSIONS The combined application of various methods, including LC-QE, ¹H-NMR and GC-MS, can be used to detect unknown new psychoactive substances.
Benzodiazepines/chemistry* ; Benzodiazepinones ; Chromatography, Liquid/methods* ; Designer Drugs/chemistry* ; Female ; Gas Chromatography-Mass Spectrometry/methods* ; Humans ; Male ; Mass Spectrometry/methods* ; Sex Offenses ; Substance Abuse Detection/methods* ; Toxicology/methods*