Interleukin 1 receptor antagonist (IL1RA) in acute leukaemia: IL1RA is both secreted spontaneously by myelogenous leukaemia blasts and is a part of the acute phase reaction in patients with chemotherapy- induced leucopenia

Abstract: Blast cells derived from peripheral blood of patients with acute myelogenous leukaemia (AML) were cultured in vitro and interleukin 1 receptor antagonist (IL1RA) concentrations determined in culture supernatants. AML blasts derived from patients classified as AML-M4 and AML-M5 subtype showed an increased release of IL1RA. IL1α and IL1β caused a similar increase in AML blast release of IL1RA, and addition of anti-ILl antibodies decreased IL1RA release. IL1RA release from AML blasts was also increased by stem cell factor, tumour necrosis factor α (TNFα), granulocyte-macrophage colony-stimulating factor and macrophage colony-stimulating factor, whereas interleukin 3, interleukin 6, leukaemia inhibitory factor and granulocyte colony- stimulating factor did not significantly alter IL1RA release. When investigating IL1RA serum levels, serum concentrations were decreased in acute leukaemia patients with chemotherapy-induced cytopenia compared with healthy controls. Serum levels of both IL1RA as well as IL1β and soluble TNFα receptors increased when the leucopenic patients developed complicating bacterial infections.     

中西医结合治疗恶性肿瘤化疗后白细胞减少症40例临床观察

目的临床观察中西医结合治疗恶性肿瘤化疗后白细胞减少症的治疗效果;方法78例恶性肿瘤病人随机分为中西医结合治疗组(简称治疗组)40例,单纯西药治疗组(简称对照组)38例。治疗7天为1个疗程,两组病人均服药2个疗程;结果治疗组总有效率为92.50％,对照组总有效率为76．28％,治疗组白细胞恢复时间,临床症状改善程度等方面明显优于对照组(P<0．05);结论提示中西医结合治疗能有效减轻化疗对骨髓造血功能的抑制,升高白细胞作用显。     

肺癌化疗相关性白细胞减少的危险因素分析

目的探讨肺癌化疗后发生化疗相关性白细胞减少（CIL）的危险因素。方法采用回顾性病例对照研究的方法,将192例肺癌化疗后发生CIL患者（CIL组）和100例无CIL患者（对照组）的临床指标进行单因素和多因素分析。结果在292例肺癌化疗患者中,共192例出现CIL,发生率为65．8％,其中28例（14．6％）为Ⅲ-Ⅳ级CIL。两组的性别（P=0．691）、年龄（P=0．245）、基础疾病（P=0．670）差异无统计学意义。CIL组的体质量下降率、PS评分、治疗前白细胞计数、治疗前血小板计数、曾接受化疗次数与对照组比较差异有统计学意义（P〈0．05）。多因素分析显示治疗前白细胞减低（OR=11．852）、体质量下降率≥5％（OR=0．324）、曾接受化疗次数≥3（OR=2．709）是肺癌化疗后发生CIL的独立危险因素。结论治疗前白细胞减低、体质量下降率≥5％、曾接受化疗次数≥3是肺癌化疗后发生CIL的独立危险因素。     

骨髓抑制从肾论治机制研究进展

对骨髓抑制与肾虚的关系以及骨髓抑制从肾论治的临床和实验研究进行综述,提出研究中存在的问题以及新方法,为研究补肾法干预肿瘤放化疗导致的骨髓抑制开拓新思路。     

升白胶囊对辐射所致小鼠白细胞减少症影响的研究

目的探讨升白胶囊对辐射所致小鼠外周血白细胞减少症的影响以及升高白细胞的作用机制。方法将60只小鼠随机分为5组,正常对照组、模型对照组、贞芪扶正胶囊组、升白胶囊大剂量组、升白胶囊小剂量组,每组12只。经低能X射线照射制备小鼠白细胞减少症模型,造模成功后各组分别给予相应药物灌胃。造模后第8d、第14d取血及股骨进行检测。观测小鼠外周血象、骨髓有核细胞数(BMNC)和骨髓DNA的含量。结果与正常对照组比较,模型对照组白细胞(WBC)数、BMNC数及骨髓DNA含量显著降低(P﹤0.01);与模型对照组比较,贞芪扶正胶囊组与升白胶囊大剂量组第8d、第14dWBC数及升白胶囊小剂量组第14dWBC数显著升高(P﹤0.01);与模型对照组比较,贞芪扶正胶囊组、升白胶囊大剂量组BMNC数及骨髓DNA含量显著升高(P﹤0.01或P﹤0.05),升白胶囊小剂量组骨髓DNA含量显著升高(P﹤0.05)。结论升白胶囊对低能X射线照射所致小鼠白细胞减少有显著升高作用,其机制与促进骨髓造血功能有关。     

Graves病合并白细胞减少症中医治疗进展

Graves病合并白细胞减少症是Graves病严重的并发症之一。祖国医学将其归属于"瘿病"、"虚劳"等范畴。现代医学认为本病的病因主要与免疫异常、遗传因素、药物毒物作用等方面相关。临床治疗主要采用中药治疗(辨证施治、专方专药)、中西医结合治疗等。中医药治疗Graves病合并白细胞减少症具有一定的优势和特色,可提高临床疗效,今后应进一步加强中医药及中西医结合治疗研究。     

重组人粒细胞刺激因子治疗抗痨药物引起的白细胞减少50例疗效观察

目的：观察重组人粒细胞刺激因子治疗抗痨药物引起的白细胞减少的疗效。方法：将患者随机分为治疗组与观察组,观察白细胞计数的变化。结果：治疗组3天有效率为64％,7天有效率为32％,无效率为4％,治疗组总有效率为96％;观察组3天有效率为4％,7天有效率为64％,无效率为32％,观察组总有效率为68％,治疗组显著高于观察组（P〈0．001）。结论：重组人粒细胞刺激因子能迅速提高由抗痨药物引起的白细胞减少,缩短抗痨药物停用时间,提高临床疗效。     

Granulocytopenia in Cohen syndrome

Cohen syndrome is an autosomal recessive disorder characterized by mental retardation, microcephalia and typical craniofacial features, myopia and chorioretinal dystrophy. As some patients were reported to have leucopenia, we collected the haematological data of 26 Finnish Cohen patients. They all had experienced periods of isolated granulocytopenia from an early age. Granulocytopenia was mild to moderate, non-cyclic and never fatal. Most patients suffered from prolonged or repeated gingival or skin infections. We restudied 16 patients. Bone marrow examination revealed in all patients a normo- or hypercellular marrow, with a left-shifted granulopoiesis in 8/16 patients. The response to adrenaline stimulation was subnormal in 12/14 and to hydrocortisone in 8/16 patients, but administration of rhG-CSF caused granulocytosis in the three patients studied. No bone marrow malignancies were seen.     

Automated leucocyte differentials in 292 patients with leucopenia: an evaluation of the Abbott CELL-DYN 3500 (CD3500) haematology analyser

Summary The widespread use of intensive therapies and the need to haematologically monitor patients on a frequent basis means that the proportion of blood samples with moderate to severe leucopenia is significant and increasing. From a laboratory perspective, particularly because of the need to spend significant amounts of time in obtaining manual differentials from stained smears with low leucocyte numbers, these clinical trends have created additional pressures on what is often a limited manpower resource. Moreover in such situations, differentials obtained from examination of only 20 or 50 cells are not uncommon and the statistical consequences of this will be clearly apparent. Currently, there is general user confidence for automated leucocyte differentials for blood samples with normal WBC parameters, but there has been some reluctance to extend this to samples with leucopenia. In order to explore this further, we examined the efficiency of a modern automated five-part differential analyser (Abbott CELL-DYN 3500) in an unselected series of 292 samples with leucopenia (WBC count range range; 0.28–2.48 × 10⁹/l). Of these, 49 were from leucopenic sero-positive HIV patients with the remaining 243 samples originating from haematological oncology clinics, patients receiving radiotherapy for non-haemopoietic malignancies, and from patients with various chronic diseases. Morphologically, 204 of these samples did not show any blast cells or NRBC, 48 had blast cells but no NRBC, 29 had NRBC but no blasts, and the remaining 11 showed both blasts and NRBC. For 277 cases with less than 5% blasts, there was an excellent correlation between the manual and CD3500 automated differential, with no obvious bias between manual and automated subpopulation estimates at any percentage level. Linear regression analyses comparing absolute neutrophil, eosinophil, lymphocyte and monocyte counts for these same samples further revealed impressive correlations (r > 0.92) for all leucocyte populations and the absolute neutrophil count in particular (r = 0.986). Manual and CD3500 leucocyte differential comparisons for 11 cases with > 5% blasts showed good correlations for absolute neutrophil and eosinophil counts although, when the blast cell percentage was high, correlations for lymphocyte and monocyte counts were less consistent (an operator alert in the form of a ‘Blast Flag’ was, however, given in 10/11 of these particular cases). Four additional cases where manual differentiation between lymphoid cells and monocytes was recorded as difficult also showed consistently good correlations for manual vs automated neutrophil and eosinophil estimates. Not surprisingly, and essentially as a result of the low confidence noted for the manual differential itself, correlations for lymphoid and monocytic cells were relatively poor. In conclusion, this study has demonstrated that the CD3500 provides reliable and accurate absolute neutrophil and eosinophil counts in leucopenic samples irrespective of the presence of blasts or NRBC. These observations are particularly important in terms of monitoring patients who are liable to develop neutropenia as a result of chemotherapy and radiotherapy, and provide evidence that the routine use of automated leucocyte differentials may be confidently extended to the analysis of leucopenic samples.