康艾注射液治疗化疗后白细胞减少症临床研究

目的:观察康艾注射液注射液治疗恶性肿瘤化疗后白细胞减少症的临床疗效。方法:收集石家庄市中医院肿瘤科住院患者共计115例,随机分为治疗组58例和对照组57例,对照组给予地榆升白片联合利可君升白治疗,治疗组用康艾注射液60 m L溶于质量分数5%葡萄糖溶液或生理盐水250 m L中静脉滴注,观察两组患者白细胞、中医证候、卡氏评分变化情况,评价临床疗效。结果:治疗组在改善患者中医证侯、提高卡氏评分及临床疗效方面有明显优势,与对照组比较,差异有统计学意义(P0.05);在升高白细胞方面,与对照组比较,差异无统计学意义(P0.05)。结论:康艾注射液对化疗后白细胞减少症有较好疗效,且能够明显改善患者临床症状,提高患者生存质量。     

ω‐3 Fatty Acids Reduce Chemotherapy‐Induced Hematological Toxicity by Bone Marrow Stimulation in Mice

Background: ω‐3 Fatty acids exert several benefits during chemotherapy, such as preventing intestinal mucosal damage and improving response to chemotherapy. However, little is known about the effect of ω‐3 fatty acids on chemotherapy‐induced hematological toxicities. Methods: Mice that had consumed either an ω‐3–rich or an ω–3‐poor diet for 2 weeks were intraperitoneally administered cisplatin. The resultant changes in blood cell count, bone marrow cell count, and cytokine levels in bone marrow supernatant were analyzed. The effect of ω‐3 fatty acids on human peripheral blood mononuclear cells (PBMCs) exposed to cisplatin was also examined. Results: Although peripheral blood cell counts decreased after cisplatin treatment in both groups of mice, the decrease in white blood cell count was significantly lower in mice that consumed the ω‐3–rich diet. The decrease in bone marrow cells after cisplatin treatment was also reduced in mice that consumed the ω‐3–rich diet. Levels of stem cell factor (SCF) and fibroblast growth factor 1 (FGF‐1) were significantly higher in bone marrow supernatants from mice that consumed the ω‐3–rich diet. The rate of apoptosis in PBMCs (after exposure to cisplatin) cultured in medium containing ω‐3 fatty acids was significantly lower than in PBMCs cultured in control medium. Conclusion: ω‐3–Rich diets reduced chemotherapy‐induced leukopenia in mice. This may be the result of increased numbers of bone marrow cells due to higher levels of SCF and FGF‐1 in the bone marrow.     

Agranulocytosis during antibiotic therapy: Drug sensitivity or sepsis?

Forty-three patients reviewed from the literature and five cases of agranulocytosis during antibiotic therapy studied by the author are presented. Time required to develop agranulocytosis with antibiotics was <19 days in comparison to >40 days required with nonantibiotic drugs. In all, agranulocytosis occurred concomitantly with drug treatment and became normal as treatment was discontinued. Retrospective rechallenge studies suggest that agranulocytosis may be dose related. In all cases PMNs were almost completely deleted and marrows were devoid of granulocyte precursors. In contrast, leukopenia secondary to overwhelming sepsis displayed persisting granulocytes in peripheral blood and marrow. While leukagglutinins were not found in nine cited cases, four serums were toxic to test PMNs as measured by suppression of postphagocytosis respiratory burst. Clindamycin directly suppressed development of CFU-G in one sensitive patient but not in 16 normal controls. The hazard of antibiotics in suppressing granulocytopoiesis is emphasized by these observations. © 1993 Wiley-Liss, Inc.     

Benign familial leukopenia and neutropenia in different ethnic groups

Benign hereditary leukopenia-neutropenia has been reported in several ethnic groups, including Yemenite Jews, Blacks of South African extraction, West Indians and Arab Jordanians. The subjects with BFL were shown not to have an increased incidence of infections, and their response to infection did not differ from subjects having normal white blood cell counts. This study entails the report of two additional unrelated ethnic groups with familial neutropenia - Black Beduin and Falashah Jews. The familial nature of the phenomenon was confirmed. The suggested mechanism of this type of neutropenia is a defect in release of mature WBC from the bone marrow to the peripheral circulation. All ethnic groups thus far reported have tanned or dark skin. The significance of this common feature has still to be elucidated.     

Severe leukopenia and thrombocytopenia secondary to quinidine

A case of severe thrombocytopenia and leukopenia secondary to quinidine is presented. The white cell count and platelet count returned to normal within five days after initiation of corticosteroid therapy and cessation of quinidine. Of interest is the fact that the patient had developed a purpuric rash twelve months earlier after drinking gin and tonic.     

参脉注射液联合利血生治疗化疗后白细胞减少症

目的:观察参脉注射液联合利血生治疗化疗后白细胞减少症的临床疗效.方法:将符合病例入选标准的60例患者随机分为观察组、对照组各30例.两组均给予利血生片、维生素C、维生素B口服,观察组同时给予参麦注射液(每次20mL,1次/d,静脉滴注)治疗.两组疗程均为4周,治疗结束后观察临床疗效及白细胞变化情况.结果:显效率观察组36.67％,对照组20.00％,两组差异显著(P＜0.05);总有效率观察组76.67％,对照组66.67％,两组差异显著(P＜0.05).两组白细胞计数情况治疗后1周均迅速降低,与治疗前比差异显著(P＜0.05);治疗后2周两组白细胞计数继续下降,与治疗前比差异显著(P＜0.05);治疗后3周均有所回升,但观察组[(3.58±0.4) ×109/L]较对照组[(2.82±0.6)×109L]改善更为显著(P＜0.05);治疗后4周观察组为(4.58±0.B5) ×109/L,已接近正常,与对照组[(3.20±0.74)×109/L]相比差异显著(P＜0.05).结论:利血生片联合参麦注射液治疗化疗后白细胞减少症临床疗效显著.     

氯吡格雷致白细胞及血小板减少

1例64岁男性患者因冠心病、急性前间壁心肌梗死给予阿司匹林300mg,1次/d、氯吡格雷75mg,1次/d,静脉滴注150万U尿激酶,并给予硝酸异山梨酯、美托洛尔、洛伐他汀。1个月后阿司匹林减量至100mg,1次/d,氯吡格雷剂量不变。7个月后患者出现发热、咽痛,血常规示WBC1.6×109/L,PLT82×109/L。停用氯吡格雷,其他治疗不变,7d后白细胞及血小板计数恢复正常。继续使用阿司匹林、美托洛尔及洛伐他汀,随访1年无复发。     

生脉散对小鼠免疫和造血功能影响

目的观察古方生脉散口服液对小鼠免疫和造血功能的影响。方法用注射给予环磷酰胺的方法形成小鼠白细胞减少症模型,生脉散灌胃给药,以外周血白细胞、骨髓有核细胞数、淋转指数、网织红细胞以及细胞肿瘤因子（TNF）、白细胞介素-6（IL-6）为观察指标。结果病理模型小鼠外周血白细胞、网只红细胞、骨髓有核细胞数明显减少,淋转指数下降,TNF、IL-6活性降低,生脉散可促进上述各指标的恢复及升高（P〈0.05,P〈0.01）。结论生脉散口服液有显著改善机体免疫功能和刺激骨髓造血功能的作用。     

左归丸对环磷酰胺诱导小鼠白细胞降低的保护作用及其机制

目的探讨左归丸对环磷酰胺诱导小鼠白细胞降低的保护作用及其可能机制。方法♂昆明种小白鼠120只,随机分为5组,每组24只。空白对照组和模型组给予NS,治疗组分别给予左归丸1.8、3.65、.4 g.kg-1(Ⅰ~Ⅲ组),ig,连续10 d;于d 4~6空白对照组给予NS,模型组和Ⅰ~Ⅲ组给予环磷酰胺50 mg.kg-1,ip,qd。各组小鼠中的12只于给药前1 d及d 71、1、15尾静脉取血计数WBC,其余12只小鼠于d 11检测骨髓有核细胞计数(BMC)、脾脏指数和胸腺指数、脾集落形成单位(CFU-S)、血清粒细胞集落刺激因子(G-CSF)和白细胞介素6(IL-6)活性。结果试验d 7时各组小鼠的WBC均明显低于空白对照组,在d 11、15时,治疗的WBC最高比模型组分别提高93%和40%(P<0.01)。d 11时,治疗组的BMC、脾脏指数、CFU-S、G-CSF最高比模型组分别提高92%、83%、85%、45%和45%(P<0.01)。结论左归丸对环磷酰胺所致的白细胞降低具有保护作用,该作用可能与升高血清G-CSF活性有关。     

国内氯氮平引起白细胞减少和粒细胞缺乏文献回顾

目的 :了解常用抗精神病药氯氮平在我国应用引起白细胞减少和粒细胞缺乏的情况。方法 :依托北京 7家图书馆 ,对《中华 (神经 )精神科杂志》等 9种精神科杂志 ,《(中国 )新药与临床杂志》等 3种药学杂志逐年进行手工检索 ,收集国内自 1979年至 2 0 0 2年 11月公开发表的有关氯氮平引起白细胞减少和 或粒细胞缺乏的文献 10 7篇 ,其中个案报道 39篇 ,进行整理分析。结果 :白细胞减少发生率为 3 92 % (12 4 3 3174 9) ,粒细胞缺乏的发生率为 0 2 1% (92 4 330 2 )。收集到的 6 2例个案报道中 ,死亡 2 1例 (33 87% ) ,粒细胞缺乏发生者的平均年龄 (34 12± 12 39)岁 ,平均剂量 (318 33± 14 5 81)mg d。在 4 7例有发生距用药时间记录的病例中 ,4 2例发生在 90天内 (89 36 % ) ,2例的应用时间分别长达 5年半和 10年 ,由其余 4 5例得到的平均发生时间为 (4 6 4 7±2 6 4 0 )天。 6 2例中有 7例指明了与其他精神药物联用 ,4例死亡 (5 7 14 % )。结论 :应用氯氮平发生白细胞减少和粒细胞缺乏的风险较高 ,用药前 3个月是粒细胞缺乏的相对高发期 ,长期应用或联用其他精神药物仍有一定风险 ,建立定期的血象监测等措施十分必要