大肠癌化疗后脂肪肝的临床研究

目的:研究大肠癌患者化疗后脂肪肝的发生率及其危险因素.方法:分析270例大肠癌患者化疗前后肝脏CT表现及实验室生化指标(AST、ALT、ALP、GGT、TG、CHOL、HDL、LDL)的变化.结果:化疗3个月、6个月及1年后,发生脂肪肝的例数分别为21例(7.8％)、64例(23.7％)、58例(21.5％),化疗后患者肝功能指标及血脂水平较化疗前均有不同程度的升高,差异具有统计学意义(P ＜0.05,除外高密度脂蛋白),脂肪肝组转氨酶及血脂水平均比非脂肪肝组高,差异具有统计学意义(P＜0.05,除外胆固醇).结论:大肠癌患者化疗后可以发生脂质代谢异常,导致肝脏的脂肪性病变,部分发展为脂肪肝.     

艾滋病相关非霍奇金淋巴瘤38例治疗及预后分析

摘 要：［目的］ 探讨艾滋病相关非霍奇金淋巴瘤的临床特点、预后。［方法］ 38例化疗疗程大于2程，随访日期大于1年及以上的艾滋病合并非霍奇金淋巴瘤患者入组，分析患者的治疗方法及预后情况。［结果］ 38例中有30例患者在化疗期间出现Ⅲ~Ⅳ度骨髓抑制，只有8例患者按原定化疗剂量完成化疗，有6例患者因化疗相关毒副作用使用分段化疗(CR率类似)且OS及EFS、OS率无明显差异。5例在化疗期间仍使用NNRTIs与PIs行HAART治疗的患者均出现反复的IV度骨髓抑制及肝功能损害。38例患者中有16例CR，4例CRu，10例PR，3例SD，5例PD。38例患者生存期最长47个月，最短3个月，中位生存时间16个月。［结论］ 艾滋病相关非霍奇金淋巴瘤患者普通化疗方案耐受度差，且抗感染治疗及抗病毒治疗与化疗药物间有明显相互作用，使用整合酶抑制剂和分段化疗可提高患者的耐受度和缓解率。     

非霍奇金淋巴瘤CHOP方案失败后用利妥昔单抗联合化疗的临床效果研究

摘 要：［目的］ 探讨非霍奇金淋巴瘤CHOP方案失败后采用利妥昔单抗联合化疗的临床效果。［方法］ 选取CHOP方案治疗失败的非霍奇金淋巴瘤患者78例,随机分为观察组和对照组,每组患者39例。对照组患者改用二线ICE方案治疗,第1~3天静脉注射依托泊苷(VP-16)100mg/m2,第2天静脉注射异环磷酰胺(IFO)5g/m2和卡铂(CBP)按曲线下面积（AUC）=5,max=800mg,每隔3周重复上述疗程。观察组给予利妥昔单抗联合化疗,第1天静脉注射利妥昔单抗375mg/m2,第2天静脉注射环磷酰胺600mg/m2、表阿霉素70mg/m2和长春新碱1.4mg/m2,第1~5天口服强的松40mg/m2,每隔3周重复上述疗程,两组均给予6个疗程,对比治疗后安全性以及临床疗效。［结果］ 观察组治疗后总有效率92.32%,明显高于对照组（66.67%）,两组比较有显著统计学差异（χ2=7.86,P<0.01）;观察组治疗后生存时间超过30个月患者占82.05%,对照组仅为43.59%,两组比较有显著统计学差异（χ2=7.99,P<0.01）;观察组不良反应Ⅰ级程度4例,Ⅱ级2例,Ⅲ和Ⅳ级均为0例,对照组Ⅰ级程度9例,Ⅱ级 16例,Ⅲ和Ⅳ级分别为7例和8例,两组比较有统计学差异（Z=2.23,P<0.05）。［结论］ 非霍奇金淋巴瘤CHOP方案失败后采用利妥昔单抗联合化疗能够有效提高患者生存率,在提高临床疗效的同时不良反应发生率明显减少。     

非霍奇金淋巴瘤患者化疗后肝功能损害与乙肝病毒标志物的相关性分析

目的探讨非霍奇金淋巴瘤患者化疗期间肝功能损害与乙肝病毒（HBV）标志物阳性表达的相关性。方法 65例非霍奇金淋巴瘤患者,其中乙肝病毒阳性32例,均采用EPOCH方案化疗。结果乙肝病毒阳性非霍奇金淋巴瘤患者,化疗期间肝功能损害较乙肝病毒阴性者明显,肝功能损害总体发生率为46.9%VS18.2%,P值=0.013,差异有统计学意义。合并乙肝大三阳或乙肝小三阳者Ⅲ～Ⅳ度肝功能损害发生率较高,达33.3%,无化疗相关死亡病例。结论乙肝病毒阳性非霍奇金淋巴瘤患者化疗后肝功能损害发生率较乙肝病毒阴性者高。乙肝大三阳、乙肝小三阳患者尤其明显。建议非霍奇金淋巴瘤患者化疗前进行乙肝两对半检查,并监测肝功能。     

原发性胃肠道非霍奇金淋巴瘤的治疗

原发性胃肠道非霍奇金淋巴瘤的治疗陈绍锋徐东波王伟然①广东省农垦中心医院肿瘤内科（湛江市５２４００２）我院于１９８０年１月至１９９１年６月共收治原发性胃肠道非霍奇金淋巴瘤（ＮＨＬ）４３例，临床符合Ｄａｗｓｏｎ的诊断标准［１］。本文就其治疗方面进行讨论。...     

感染乙肝病毒的非霍奇金淋巴瘤化疗方案的研究

目的杂乙肝病毒（HBV）的非霍奇金淋巴瘤患者的化疗方案。方法回顾性分析96例非霍奇金淋巴瘤（NHL）及39例感染乙肝病毒的其它实体瘤（肝癌除外）患者化疗后肝损害及乙型肝炎的发生情况。结果经过2个周期正规化疗后，HBV阳性的NHL患者经化疗后肝损害发生率为52．2％（12／23），HBV阴性的NHL患者后肝损害发生率23／3％（17／73），P＜0．01；HBV阳性的NHL患者用含有类因醇激素方案化疗后乙直炎发生率39．1％（9／23），HBV阳性的其它实体瘤（肝癌除外）患者用不含类固醇激素方案化疗后乙型肝炎发生率12．8％（5／39），P＜0．05／。结论HBV阳性的NHL患者化疗后易发生肝损害及乙型肝炎，故在化疗时应尽量避免选用含皮质激素的方案。     

自体造血干细胞移植治疗侵袭性恶性淋巴瘤

[目的]探讨自体外周血十细胞移植对侵袭性恶性非霍奇金淋巴瘤的疗效。[方法]31例侵袭性恶性非霍奇金淋巴瘤（NHL）患者使用化疗或放化疗同步进行的诱导缓解治疗达部分缓解（PR）或完全缓解（CR）后，行自体外周血干细胞移植治疗，部分患者移植后进行免疫治疗6～12个月。[结果]31例患者中位随访时间53个月，总生存率（OS）87．0％，无事件生存率（EFS）80．6％、其中CR后移植持续缓解率为88．0％，PR后移植持续缓解率为50．0％。[结论]自体外周血干细胞移植治疗侵袭性恶性非霍奇金淋巴瘤疗效确切，移植前达到CR患者疗效更佳。     

原发性肺淋巴瘤11例临床特点分析

目的探讨原发性肺淋巴瘤的发病情况、临床特点、影像学特点、治疗及预后情况。方法回顾性分析了11例原发性肺淋巴瘤的临床资料及随访情况。结果11例患者中,霍奇金淋巴瘤2例,非霍奇金淋巴瘤9例（B细胞性4例,T细胞性4例,未分型1例）。临床症状多表现为咳嗽,咳痰,胸背部疼痛。影像学多表现为肺部肿块,边缘不规则,增强可强化,部分伴有肺不张。9例非霍奇金淋巴瘤患者中6例化疗的同时接受了放疗,3例仅接受了化疗,2例霍奇金淋巴瘤只接受了化疗。除了1名患者因各种因素造成脱落随访外,剩余10例随访患者的总生存期为15～102个月（中位生存期为84．5个月）。结论肺内淋巴瘤患者临床表、影像学检查无特异性．易误诊．治疗以化疗为主．辅以放疗．     

系统性硬化症与恶性肿瘤发生的Meta分析

摘 要：［目的］ 探讨恶性肿瘤在系统性硬化症(SSc)中的发病风险和特征,为采取早期干预措施提供依据。［方法］ 检索PubMed、Embas、Web of Science和中国期刊全文数据库,收集2017年5月之前国内外公开发表的相关文献。应用Stata11.0软件进行统计分析,合并不同条件下恶性肿瘤的标化发病比(SIR)及其95%可信区间(CI),对于异质性较大的恶性肿瘤合并结果,通过Meta回归检验异质性来源。［结果］ 共纳入12篇研究,累积研究对象18927人。经Meta分析,恶性肿瘤的SIR为1.47(95%CI：1.28~1.68),其中肺癌、非霍奇金淋巴瘤和血液系统肿瘤的SIR分别为3.16(95%CI：2.21~4.52)、2.60 (95%CI：1.63~4.16)和2.57(95%CI：1.80~3.69)。男性SSc患者发生恶性肿瘤的总风险、肺癌、非霍奇金淋巴瘤以及血液系统恶性肿瘤的风险均高于女性患者。Meta回归结果显示患者的平均年龄(β=0.043,P=0.052)与研究的平均随访时间(β=-0.062,P=0.088)是恶性肿瘤可能异质性的因素,而患者平均年龄(β=0.138,P=0.045)是肺癌的可能异质性的因素。［结论］ 与普通人群相比,SSc患者中恶性肿瘤的发生率有所增加,尤其是肺癌、非霍奇金淋巴瘤和血液系统肿瘤的发病风险明显增加,因此在SSc患者的随访过程中需警惕恶性肿瘤的发生。     

16例非霍奇金淋巴瘤合并乙肝病毒感染患者化疗发生肝功能损害的探讨

非霍奇金淋巴瘤是一种起源于淋巴造血组织的实体瘤,化疗是治疗非霍奇金淋巴瘤的主要手段之一。但是临床上非霍奇金淋巴瘤患者常感染HBV(乙肝病毒),化疗后出现肝功能损害,甚至出现重症肝炎。为了探讨非霍奇金淋巴瘤合并HBV感染患者化疗发生严重肝功能损害的防治,我们选择2004至2005年武汉大学中南医院放化疗科和孝感市中心医院肿瘤科收治的16例非霍奇金淋巴瘤患者进行回顾性研究,现报告如下。一、资料与方法1.一般资料:本组16例均为经病理组织证实的非霍奇金淋巴瘤患者,呈中高度恶性,分期为Ⅱ~Ⅳ期。男10例,女6例。年龄35~62岁,中位年龄42…     

替吉奥和卡培他滨在一线化疗获益的转移性鼻咽癌患者中维持治疗疗效比较

目的:观察替吉奥和卡培他滨分别在转移性鼻咽癌患者一线化疗后维持治疗的有效性和安全性。方法:回顾性分析2016年01月至2019年12月在我院收治的接受过4~6周期一线化疗后有临床获益的转移性鼻咽癌患者91例,其中26例患者一线化疗后选择观察,31例患者使用替吉奥维持治疗,34例患者使用卡培他滨维持治疗。评价维持治疗疗效,比较替吉奥和卡培他滨维持治疗的疗效及不良反应、筛查可能获益的临床指标。结果:与观察组相比,替吉奥组和卡培他滨组患者的中位PFS显著延长（16.9个月,17.1个月 vs 6.9个月,P＜0.001）;替吉奥组和卡培他滨组的PFS差异无统计学意义;维持治疗组的不良反应主要为白细胞减少、贫血、血小板减少、黏膜炎、手足综合征、皮疹、恶心呕吐、肝功能损害,多为0-2级,未发生4级不良反应。其中替吉奥组患者的口咽黏膜炎发生率高于卡培他滨组,但差异无统计学意义。卡培他滨组的手足综合征发生率高于替吉奥组（P＜0.05）。单因素分析结果显示,一线化疗后,肿瘤病灶能在维持治疗中继续缩小,是PFS延长的独立预后因素。结论:替吉奥和卡培他滨均能作为转移性鼻咽癌患者的维持治疗药物,有助于提高PFS,不良反应可耐受。     

Adult Gaucher disease in association with primary malignant bone tumors

BACKGROUND: Malignant neoplastic disorders are more common in patients with Gaucher disease (GD) than in the general population. Very few cases of primary malignant bone tumors in association with GD have been reported to date. Thus, the recommendations for an adequate therapy are often based on limited professional experience. To their knowledge, the authors report the first case of a leiomyosarcoma of the bone in a patient with GD and report another patient with GD and an anaplastic large cell non-Hodgkin lymphoma with localized osseous manifestation. A review of the literature is included. METHODS: The clinical, radiologic, and histologic data of the authors' two patients who had GD and primary malignant bone tumor are presented. Epidemiologic data, clinical data, and treatment results from published reports of 18 patients who had GD and various malignancies and the authors' 2 patients were compared and evaluated. RESULTS: Radiographic examination showed a destructive osteolytic lesion in a case of a leiomyosarcoma of the bone and in a case of anaplastic, large-cell, non-Hodgkin lymphoma. In both cases, the bone marrow architecture was partially effaced by sheets of large histiocytic cells with striated or fibrillary cytoplasm. In both patients, chemotherapy was performed. Whereas the patient who had the leiomyosarcoma showed poor recovery of the bone marrow that necessitated withdrawal of aggressive chemotherapy, the patient who had non-Hodgkin lymphoma and enzyme therapy tolerated the chemotherapy well. In spite of local control after preoperative radiotherapy and hemipelvectomy, the first patient developed lung metastases and finally died. The second patient was continuously free of disease at a follow-up examination 32 months after chemotherapy and radiotherapy. In a total of 20 patients who had malignant disorders and GD, the numbers of males and females were equivalent, and the mean age was 55 years. Approximately 33% presented with a cancer originating in the bone. In 16 patients, follow-up data were available. Of these, after a mean follow-up of 36 months (range, few days-108 mos), only 2 patients were continuously free of disease, and one patient was alive with disease. The other patients had died of disease or hemorrhagic complications of GD. CONCLUSIONS: Because there is a relatively high incidence of malignant disorders of the bone, the study suggested that malignant disorders have to be included in the differential diagnosis of painful lytic lesions in patients who have GD. Evaluation of the expense and value of enzyme therapy to patients who have GD should be undertaken with regard to the incidence of malignant disorders and patient survival.     

苯丁酸氮芥单药治疗复发难治性低度恶性非霍奇金淋巴瘤37例临床观察

 目的 探讨苯丁酸氮芥（chlorambucil）单药治疗复发难治性低度恶性非霍奇金淋巴瘤（NHL）的临床效果。方法 37例既往曾接受多种常规方案化疗的低度恶性NHL患者,在病情再次快速出现进展时,选用苯丁酸氮芥单药治疗。所有患者均经病理学诊断,其中B细胞来源27例,T细胞来源10例。使用过的化疗方案数为2 ~ 5种（包括CHOP,IMVP-16,DHAP,IVAC,MINE）,累计中位疗程数为11个周期。苯丁酸氮芥单药治疗0.15 mg／kg,1次／d,持续口服3个月后,评价近期疗效,临床受益患者以2 mg／d口服维持治疗12个月。结果 应用苯丁酸氮芥治疗复发难治性低度恶性NHL的近期疗效达62.2 %,中位无病生存期（DFS）为11个月,毒副反应主要表现在可耐受的Ⅰ~Ⅱ度消化道反应和骨髓抑制反应。结论 苯丁酸氮芥单药口服维持治疗复发难治性低度恶性NHL有确切疗效,毒副反应可耐受,安全性好。     

Salvage chemotherapy in resistant malignant lymphomas (author's transl)

A salvage chemotherapy was used in advanced malignant lymphomas resistant to previous chemotherapy. The chemotherapy schedule consisted by the monthly administration of vindesine and continuous infusions of bleomycins, associated with cis-diammine-dichloro-platinum in Hodgkin's disease (patients resistant to MOPP and ABVD protocols) and with DTIC in non-Hodgkin lymphomas (patients resistant to CHOP or equivalent protocol). In 10 patients with advanced Hodgkin's disease (stages III and IV), one complete remission and four partial regressions were achieved. Five patients are still alive after 6 and 14 months. In 15 non-Hodgkin lymphoma patients, two complete remissions and seven partial regressions were achieved. Eight patients are still alive after 4 to 12 months. Severe toxicities related to the chemotherapy protocol have never been observed. These results demonstrate the efficiency of the described chemotherapy schedules in advanced malignant lymphomas resistant to visual therapy.     

胰腺脂肪浸润与胰腺癌的相关性分析

目的:在经超声内镜行胰腺检查患者中评价胰腺脂肪浸润与胰腺癌的相关性。方法:回顾性收集我院2019年1月至2021年12月行超声内镜胰腺检查的患者年龄、性别、胰腺超声内镜检查结果、胰腺占位性病变穿刺结果及临床生化指标并进行统计学分析。结果:本研究共纳入1 070例患者,其中胰腺癌93例,占8.7%,胰腺脂肪浸润229例,占21.4%,单因素相关性分析显示:年龄、性别、胰腺脂肪浸润均与胰腺癌显著相关,总胆固醇与低密度脂蛋白与胰腺癌患者中的胰腺脂肪浸润显著相关。Logistics多因素回归分析显示:年龄、性别、胰腺脂肪浸润均为胰腺癌的独立危险因素。结论:胰腺脂肪浸润与胰腺癌显著相关并是其独立的危险因素。     

HBV感染与淋巴瘤患者化疗后肝功能损害的相关性分析

目的:观察乙型肝炎病毒(HBV)感染对恶性淋巴瘤患者化疗后肝功能损害的影响.方法:采用ELISA法检测207例淋巴瘤患者的乙肝五项指标并常规检测肝功能,以同期住院的207例其他恶性肿瘤患者为对照进行比较.结果:淋巴瘤患者HBV感染率显著高于其他恶性肿瘤患者(19.8%vs 9.7%,P=0.004).HBsAg阳性淋巴瘤患者化疗后肝功能损害的发生率明显高于HBsAg阴性者(58.5%vs 27.7%,P=0.000),且明显高于HBsAg阳性的其他恶性肿瘤患者(58.5%vs 30.0%,P=0.036).淋巴瘤患者化疗后发生肝功能损害与HBV感染密切相关(P=0.000),而与患者年龄、性别、病理类型、免疫分型、临床分期、PS评分、是否应用激素等均无关.结论:携带HBV的淋巴瘤患者接受化疗时更易引发肝功能损害.     

Estimating late adverse events using competing risks after autologous stem-cell transplantation in aggressive non-Hodgkin lymphoma patients

BACKGROUND: Consolidative autologous stem-cell transplantation (ASCT) is a valuable option in high-risk or disease recurrence large-cell non-Hodgkin lymphoma patients (NHL); however, its long-term toxicity must still be assessed. METHODS: Among the 439 lymphoma patients transplanted at our institution from January 1, 1993, to January 1, 2002, 158 exhibited aggressive NHL. The median age of the patients was 46 years (range, 18-69), 98 males and 60 females. Ninety (57%) patients received first-line ASCT. The median number of prior chemotherapy regimens was 2 (range, 1-10). Thirty-eight (24%) patients received total body irradiation conditioning. Here we report the adverse events which occurred at least 30 days after ASCT and before disease recurrence. RESULTS: After a median follow-up of 3 years, the overall and disease-free survival rates were 61% and 55%, respectively. Sixty-eight late adverse events affected 43 (27%) patients, leading to a cumulative incidence of 34% at 3 years. Infections were the most frequent adverse events (n = 13), followed by neurologic (n = 12), pulmonary (n = 6), or cardiovascular (n = 4). Eight malignancies were diagnosed (six solid, two hematologic), leading to a cumulative incidence of 3.7% at 3 years. Taking into account the competing risks, multivariate analysis revealed that the number of progressions (relative risk [RR] = 2.68) and a mitoxantrone-containing conditioning regimen (RR = 2.98) significantly increased the incidence of late toxicity. CONCLUSION: ASCT is effective in patients with aggressive NHL with a poor prognosis. However, careful long-term follow-up of survivors is recommended because of the increase in malignant and nonmalignant toxicities.     

Management of Malignant Lymphoma in the Elderly an Eortc retrospective evaluation

A retrospective Eortc study was carried out in order to evaluate the incidence, clinico-pathoiogical findings and outcome of non-Hodgkin lymphoma and Hodgkin's disease in patients 70 years of age or older. A significant proportion of non-Hodgkin lymphoma, mostly with high-intermediate grade of malignancy occurs in these patients. Aggressive treatment, in particular chemotherapy with 3 drugs or more administered to elderly patients 70 years or older, median age 77 years, is associated with significant lethal and severe toxicity. Prospective randomized studies are clearly needed in order to evaluate the activity and the toxicity of intensive chemotherapy regimens specifically devised for patients aged 70 years or older with unfavourable non-Hodgkin lymphoma. Hodgkin's disease is unfrequently (5%) seen in patients 70 years of age or older. Mixed cellularity, B symptoms and stage III and IV account for 50, 47 and 47% of the cases respectively. Aggressive treatment is not associated with an increased lethal and severe toxicity compared with conservative treatment although 1 patient died of bone marrow toxicity after MOPP. Survival of patients 70 years or more with Hodgkin's disease seen in 1984 seems shorter than that in younger patients, especially due to high incidence of unfavourable prognostic factors, such as B symptoms and advanced stages.     

TURBT术后联合化疗与根治性膀胱切除术治疗肌层浸润性膀胱癌的疗效对比研究

目的:分析对比经尿道膀胱肿瘤切除术（transurethral bladder tumor,TURBT）术后联合静脉化疗与根治性膀胱切除术治疗肌层浸润性膀胱癌的临床效果以及生活质量。方法:回顾性分析2014年07月至2017年03月我院肌层浸润性膀胱癌患者73例,其中TURBT术后行静脉化疗39例为观察组,行根治性膀胱切除术34例为对照组。观察对比两组围术期指标、术后并发症发生情况、术后随访2年内复发和生存情况以及患者术后生活质量评价。结果:观察组手术时间、术中出血量、住院时间均明显低于对照组,差异有统计学意义（P＜0.05）。观察组术后并发症总发生率为10.3%（4/39）;对照组术后并发症总发生率为32.4%（11/34）,两组比较差异有统计学意义（P＜0.05）。观察组和对照组术后3个月、6个月复发率比较无显著差异（P＞0.05）;12、24个月的复发率比较均有显著差异（P＜0.05）。两组患者术后12、24个月的无复发生存率比较均有显著差异（P＜0.05）;两组患者术后6个月、12个月总体生存率比较无显著差异（P＞0.05）,观察组术后24个月总体生存率显著高于对照组（P＜0.05）。观察组患者术后社会功能评分、心理功能评分、躯体功能评分均显著高于对照组（P＜0.05）。结论:TURBT术后联合静脉化疗治疗肌层浸润性膀胱癌效果显著,术后并发症少,恢复快,可以提高患者术后生活质量,适合临床长期推广应用。     

Primary nervous-system lymphoma

Primary nervous-system lymphoma is a rare type of non-Hodgkin lymphoma, which is confined to the nervous system. This disease is managed quite differently from the usual treatment of either primary brain tumours or systemic non-Hodgkin lymphoma. Although whole-brain radiotherapy results in responses in more than 90% of cases, this treatment is associated with high relapse rates and with delayed neurotoxicity in elderly patients. First-generation chemotherapy regimens used successfully in systemic non-Hodgkin lymphoma (eg cyclo-phosphamide, adriamycin, vincristine, and prednisone) are ineffective in primary nervous-system lymphoma, partly because of the blood-brain barrier. Median survival of patients treated with radiotherapy alone or chemotherapy plus radiotherapy is similar, and ranges from 10 to 16 months. The addition of methotrexate-based chemotherapy has improved survival for these patients, extending median survival to more than 30 months. When used alone, methotrexate-based chemotherapy is associated with significantly fewer treatment-associated toxic effects. Leptomeningeal lymphoma and intraocular lymphoma are topics of particular relevance in primary nervous-system lymphoma and are addressed in this review.