异基因外周血造血干细胞移植治疗白血病

５例白血病患者接受ＨＬＡ相合异基因外周血干细胞移植。外周血干细胞动员采用供者连续皮下注射Ｇ－ＣＳＦ（１０μｇ／ｋｇ）５天，于第５天和第６天用ＣＳ３０００Ｐｌｕｓ血细胞分离机分离单个核细胞（ＭＮＣ）。患者平均输入ＭＮＣ６．０×１０８／ｋｇ，ＣＤ３４＋细胞２２．６×１０６／ｋｇ，ＣＤ３＋细胞４１２×１０６／ｋｇ，ＣＤ４＋细胞２０５×１０６／ｋｇ和ＣＤ８＋细胞１６２×１０６／ｋｇ。移植后造血重建迅速，中性粒细胞绝对计数＞０．５×１０９／Ｌ和血小板计数＞２０．０×１０９／Ｌ的平均时间分别为１３．４天和１１．４天。５例均未发生急性ＧＶＨＤ，２例发生慢性ＧＶＨＤ。供者对大剂量Ｇ－ＣＳＦ耐受良好     

异基因外周血造血干细胞移植后巨细胞病毒间质性肺炎

目的：探讨异基因外周血造血干细胞移植(Allo-PBSCT)后间质性肺炎（IP）的病因,危险因素及防治方法。方法;将Allo-PBSCT患者分为更昔洛韦（GCV）预防组18例和对照组（未预防组）22例,比较两组巨细胞病毒南性肺炎（CMV－IP）的发生率。结果：对照组Allo-PBSCT患者中并发CMV－IP5例,预防组无1例发生CMV－IP。发生CMV－IP的高危因素为女性供者,合并移植物抗宿主病（GVHD）。4例治愈,1例治疗无效死亡。结论：Allo-PBSCT后CMV感染是IP的主要病因,IP的发生与GVHD严重程度及妇性供者密切相关,GCV能有效预防和治疗CMV－IP。     

Allogeneic peripheral blood stem cell transplantation for leukemia

Objective To observe engraftment kinetics, the incidence and severity of graft-versus-ho st disease (GVHD), and clinical outcome on 40 recipients undergoing allogeneic p eripheral blood stem cell transplantation (allo-PBSCT).Methods From June 1997 to May 1999, forty leukemia patients with a median age of 35 year s underwent allo-PBSCT. PBSC were mobilized with G-CSF at a dose of 5 μg/kg s.c. every 12 hours for 5 days. A median of 7.7 (2.0-16.8)×10 (6) CD34(+) cells/kg was infused into the recipients. Busulfan-cyclophosphamid e (BU-CY) was used as the conditioning regimen. All patients received cyclospo rine A and either methotrexate (n=34) or methylprednisolone (n=6) for GVHD p rophylaxis. Results Engraftment of neutrophils and platelets was achieved at a median of 13 days (9 -28 days) and 12 days (7-60 days) respectively. Patients receiving ≥4×10 (6) CD34(+) cells/kg or given G-CSF post transplant had significantl y accelerated neutrophil and platelet engraftment. Acute GVHD occurred in 17 of 40 patients (42.5%), with grade Ⅱ-Ⅳ acute GVHD in 10 patients (25%). Chron ic GVHD developed in 21 (9 extensive, 12 limited) out of 30 evaluable patients ( 21/30, 70%) with a median follow up of 380 days (180-900 days). Transplan t related mortality was 17.5% and the relapse rate was 10%. The probability of leukemia free survival at 3 years was 72.5%.Conclusion Allo-PBSCT can provide rapid hematopoietic reconstitution without an increased incidence of acute GVHD, but may be associated with a high risk of chronic GVHD .     

Cytomegalovirus interstitial pneumonitis following allogeneic peripheral blood stem cell transplantation

Objective： To explore the risk factors and prophylaxis and treatment of cytomegalovirus interstitial pneumonitis （CMV-IP） after allogeneic peripheral blood stem cell transplantation （allo-PBSCT）. Methods： 43 patients who received allo-PBSCT were allocated to either a Gancyclovir（GCV）-prophylaxis group （n=19） or a non-GCV prophylaxis group （n=24）. A comparison was made of the incidence of CMV-IP in patients given or not given prophylactic gancyclovir. Results： 9 patients in non-GCV prophylaxis group developed late CMV-IP （P〈0.05）. Graft-versus-host-disease （GVHD） may be associated with a high risk of CMV-IP. 5 cases of CMV-IP were successfully treated with GCV, but 3 cases died of CMV-IP. The most common adverse event of GCV was neutropenia, but was reversible. Conclusion： CMV infection was a major cause of interstitial pneumonitis after allo-PBSCT, which correlated strongly with the severity of GVHD. Gancyclovir was shown to be effective in both prophylaxis and treatment of CMV-IP.     

Detection and clinical significance of thrombomodulin in both plasma and tissue extracts of cancer patients

Thrombomodulin?is the endothelial cell surface glycoprotein that converts thrombin from a procoagulant protein into the activator for protein C. Thrombin plays an important role in the adhesion of cancer cells to endothelial cells through fibrin formation and platelet activation, and thrombin stimulates tumor cell bindings to endothelial cells[1]. In this article, the changes of TM were studied in both plasma and tissue extracts of cancer patients for evaluating its clinical significance. P…     

骨髓涂片有核细胞量减少的真实性研究

目的研究骨髓涂片有核细胞的假阳性和假阴性减少,提高对涂片评估有核细胞量不足的认识。方法用骨髓穿刺针抽吸髓液涂片272例,随后同步以活检术获取组织块置于载玻片上制成印片,组织块入Bouin液固定,以骨髓印片和切片为对照,评估涂片对检查有核细胞量的价值。结果272例骨髓涂片有核细胞减少和增多级别均显著低于骨髓印片和切片(P<0.05~<0.01)。以印片和切片为对照,124例涂片有核细胞减少中,58.9%和66.1%为假阳性减少,常见误诊疾病为再生障碍性贫血、造血减低;而印片和切片细胞量增加中,涂片仍有26%和36%为假阴性减少,常见疾病或结论为脾功能亢进、真性红细胞增多症、特发性血小板增多症等;印片和切片细胞减低者中,涂片符合率(91.2%和97.9%),以及涂片细胞增加者中,印片和切片符合率(95%和100%)均高。涂片诊断细胞量真性减少疾病或结论(再生障碍性贫血和造血减低)的假阳性分别为29.0%和37.1%,诊断真性增加疾病(脾功能亢进、特发性血小板增多症、真性红细胞增多症等)假阴性率为22.6%和21.8%,诊断指标性能评价均不佳。结论骨髓涂片评估有核细胞量差,常造成假阳性和假阴性结果,建议将印片作为常规项目以弥补涂片的不足。     

11例肾小管性酸中毒误诊分析

１１例肾小管性酸中毒误诊分析杭州市浙江医科大学附属第二医院（３１０００９）周松吉，黄连生肾小管性酸中毒（ＲＴＡ）是指一组由于肾小管远端排泌Ｈ”或近端重吸收ＨＣＯ３障碍引起的慢性代谢性酸中毒综合征，是肾小管病变中较常见的疾病。多数学者认为它是常染色体显...     

急性髓细胞白血病端粒酶活性及临床意义

目的：探讨端粒酶活性在急性髓细胞白血病（ＡＭＬ）发生中的作用。方法：采用端粒重复序列扩增文件酶标法（ＴＲＡＰ－ＥＬＩＳＡ）,对３２例ＡＭＬ和非恶性血液系统疾病骨髓细胞端粒酶活性检测。结果：端粒酶活性在初发ＡＭＬ患者高于非恶性血液系统疾病患者（Ｐ〈０．０１）,ＡＭＬ初发期患者高于完全缓解期患者（Ｐ〈０．０５）,端粒酶生与体内白血病细胞数之间无显著相关性。结论：端粒酶活性的观察有助于疗效的判断。     

异基因外周血干细胞移植治疗白血病的临床研究

目的　探讨异基因外周血干细胞移植（allo-PBSCT）的植活情况,移植物抗宿主病（GVHD）的发生率和临床结果。方法　回顾性分析1997年6月至1999年5月在我院实行的40例allo-PBSCT的临床资料。以粒细胞集落刺激因子(G-CSF)5μg/kg,12h1次,皮下注射动员外周血造血干细胞;输入CD     

60例高血压病患者头痛的分析

据统计成年人高血压病患病率平均为 7.8% [1 ] ,其早期临床症状常不明显 ,多以头痛为最主要表现 ,约 80 %出现不同程度的头痛 [2 ] ,头痛多为持续性后头、颈项痛或 /和搏动性前头、双颞部痛 ,头痛的程度和形式与高血压程度有明显关系 [3] 。由于人们往往对其认识不足或警惕性不高 ,没有经常规范地检测血压 ,而被长期误诊为颈椎病和偏头痛性血管性头痛 ,延误治疗。现将我院收治 6 0例高血压病患者的头痛作一分析。1　一般资料本组 6 0例中 ,男 34例 ,女 2 6例 ;年龄 4 2～ 6 9岁 ,平均5 5岁 ;病程 3～ 8年。临床常以头痛、头晕、颈项强硬酸痛…