利妥昔单抗对B细胞非霍奇金淋巴瘤患者体液免疫的影响*

Objective To investigate the effect of Rituximab (RTX) on humoral immunity of patients with B cell Non-Hodgkin lymphoma (B-NHL). Methods Eighty-six B-NHL patients who were diagnosed with B-NHL in The Second Affiliated Hospital of Anhui Medical University were analyzed retrospectively. Patients were divided into observation group and control group. Patients in the observation group received RTX combined with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimen, and patients in the control group received CHOP treatment. CD20+B lymphocytes, serum immunoglobulin as well as major subtypes were compared before and after treatment, and the incidence of infection was recorded. Results After 4 courses of treatment, CD20+ B lymphocytes occurred in peripheral blood of 14% (9/64) patients in the observation group, while the number was 100% (16/16) in control group. The levels of serum immunoglobulin, IgG, IgA and IgM in the observation group decreased significantly after chemotherapy, while no significant difference in Ig, IgG, IgA or IgM were witnessed before and after treatment in the control group. Incidence of hypo-immunoglobulinemia was significantly increased in the observation group after 4 courses of treatment compared with control group. Infection rate in the observation group was 45.71% and 81.25% of which were grade1-to 2 events. Incidence of infection in patients with low immunoglobulin increased significantly compared with those with normal immunoglobulin. Conclusions RTX treating B-NHL destroys the humoral immunity and increases the incidence of infection. Dynamical measurement of serum immunoglobulin and its major subtypes is necessary for prevention of infectious complications when receiving RTX.     

地西他滨联合维奈克拉与地西他滨联合CAG方案治疗老年初治急性髓系白血病的临床疗效比较

［摘要］　目的　比较地西他滨联合维奈克拉与地西他滨联合CAG方案治疗老年初治急性髓系白血病（AML）的临床疗效。方法　选择长江大学附属荆州医院2016年5月至2022年2月收治的不适合接受强化化疗的老年初治AML患者29例。根据患者选择治疗方案意愿将其分为维奈克拉组（地西他滨+维奈克拉,17例）与CAG组（地西他滨+CAG方案,12例）。比较两组的临床疗效及预后情况。结果　患者随访时间为8.1～70.3个月,中位随访时间为27.7个月。截至随访结束,29例患者中有8例存活,均为维奈克拉组,其中5例患者仍处于缓解阶段,行巩固治疗;3例为缓解后复发患者。19例死亡（维奈克拉组9例,CAG组10例）,2例失访。维奈克拉组的完全缓解（CR）率、形态学完全缓解而血细胞计数未完全恢复（CRi）率、复合完全缓解（CR+Cri）率及总反应率（ORR）均高于CAG组,但差异无统计学意义（P>0.05）。维奈克拉组的中位总生存期（OS）为10.73个月,CAG组的中位OS为8.57个月,两组生存预后差异无统计学意义（P>0.05）。维奈克拉组的中位无进展生存期（PFS）为7.93个月,CAG组的中位PFS为5.77个月,两组复发情况差异无统计学意义（P>0.05）。29例患者中有27例（维奈克拉组16例,CAG组11例）出现了3～4级血液学不良反应。维奈克拉组与CAG组中位粒细胞缺乏时间分别为24 d和25 d,中位血小板恢复时间分别为20 d和18 d,差异均无统计学意义（P>0.05）。两组感染、出血发生率比较差异无统计学意义（P>0.05）。结论　地西他滨联合维奈克拉和地西他滨联合CAG方案对老年初治AML患者均有较好的临床疗效,且安全性良好。     

再生障碍性贫血转骨髓异常增生综合征患者1例诊疗过程分析及文献复习

目的 探索再生障碍性贫血(AA)患者向骨髓增生异常综合征(MDS)转化的危险因素,并探讨诊疗过程.方法 收集1例由AA转化的MDS患者临床资料,并通过相关文献加以分析总结.结果 患者为45岁男性,6年前曾行血常规、骨髓细胞学及骨髓病理等检查明确诊断为AA.治疗上首先给予雄激素等促进造血但效果不佳,4个月后加用环孢素,治疗1年后患者就诊,此时血常规结果提示血红蛋白(Hb)及白细胞(WBC)较前已有所恢复,但由于血小板(PLT)一直无明显提升.为排除其他疾病可能,再次行骨髓细胞学检查但未发现异常.在随后的2年多随访时间里,虽然该患者定期检测环孢素浓度并规范调整治疗,但WBC和PLT始终未见好转,Hb甚至有下降趋势,而患者网织红细胞比例一直处于较高水平且逐渐升高.因此考虑患者的原发病可能已转化,故再次行骨髓细胞学检查,结果发现骨髓中三系均存在病态造血,最终患者诊断为MDS(AA继发).结论 对于长期口服免疫抑制剂治疗但效果不佳的AA患者,尤其是重度AA患者,应积极监测患者外周血及骨髓情况,若疾病转化则应尽早处理,有条件者也可考虑行造血干细胞移植治疗,避免其向其他克隆性疾病转化.同时,由于AA患者存在向MDS转化的风险,在做骨髓检查时可以通过MDS的流式细胞术(FCM)积分系统早期判断患者原发病是否已转化.     

CircBACH1调节miR-140-5p/MDM2轴对多发性骨髓瘤细胞增殖、凋亡和化疗敏感性的影响

目的 探讨CircBACH1对多发性骨髓瘤（MM）细胞增殖、凋亡和化疗敏感性的影响以及在此过程中对miR-140-5p/MDM2轴的调节机制。方法 收集MM组和正常对照组骨髓浆细胞，将人MM细胞系U266细胞分为未转染（Control）组、si-NC组、si1-CircBACH1组、si2-CircBACH1组、si-CircBACH1+anti-miR-NC组、si-CircBACH1+anti-miR-140-5p组。实时荧光定量PCR检测细胞中CircBACH1、miR-140-5p、鼠双微体2(MDM2)mRNA的表达；CCK-8法检测细胞增殖活性；流式细胞术检测细胞凋亡及对硼替佐米的敏感性；Western blot检测细胞中B细胞淋巴因子2(Bcl-2)、Bcl-2相关X蛋白（Bax）、裂解的胱天蛋白酶（cleaved caspase）-3蛋白的表达；双萤光素酶报告基因实验验证CircBACH1、miR-140-5p、MDM2三者的靶向关系。结果 与正常对照组相比，MM组的骨髓浆细胞及U266细胞中CircBACH1、MDM2 m RNA表达升高，miR-140-5p表达降低...