三氧化二砷联合全反式维甲酸治疗急性早幼粒细胞白血病的初步观察

目的　观察三氧化二砷 (As2 O3 )联合全反式维甲酸 (ATRA)治疗急性早幼粒细胞白血病(APL)的疗效和不良反应。方法　As2 O3 联合ATRA治疗初治和复发APL患者 2 0例 (可评价的患者 18例 )。治疗方法如下 :As2 O3 (0 .1%溶液 ) 10ml加入 5 0g L葡萄糖溶液 5 0 0ml静脉点滴 ,持续 4～ 6h ,1次 d ;ATRA 2 5mg·m- 2 ·d- 1 ,分 2～ 3次服用。结果　 17例患者获得完全缓解 (CR) ,CR率 94.4%。 14例初治患者均获得CR ,4例复发患者中 3例取得CR。均在 30d内达CR。没有发现明显的不良反应。结论　ATRA联合As2 O3 治疗APL患者不仅能获得好的疗效 ,而且能缩短达CR的时间。     

203例慢性淋巴细胞白血病患者预后相关因素分析

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.     

单个细胞凝胶电泳与染色体不稳定综合征

介绍单个细胞凝胶电泳（SCGE）的原理及详细操作步骤。概括染色体不稳定（断裂）综合征中的常见疾病的临床特点，阐述各种疾病染色体不稳定的详细机制，以此说明SCGE用于染色体不稳定（断裂）综合征诊断的可能。简要总结SCGE在临床上的其他应用。     

203例慢性淋巴细胞白血病患者预后相关因素分析

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.     

43例淋巴母细胞淋巴瘤患者临床特点及疗效分析

Objective To investigate the clinical features and treatment outcomes of different regimens in Chinese patients with lymphoblastic lymphoma(LBL). Methods Forty-three patients with LBL were retrospectively analysed, of which 30 were T-LBL, and 13 B-LBL. Results ①Most patients were young men with a median age of 21, and 63.0％ of the T-LBL patients had mediastinal masses. ② Treatment outcome could be assessed in 37 cases, of which the response rate (RR) was 81.1％ and complete remission (CR) rate was 67.6％. The RR and CR rates in patients treated with regimens for ALL (ALL-like group) and those treated with regimens for NHL(NHL-like group) were 94.4％ , 68.4％ and 83.3％ , 52.6％ , respectively. ③The estimated median overal survival(OS) and progression free survival (PFS) of hematopoietic stem cell transplantation (HSCT) group were significant longer than those of ALL-like group(P =0.018, P=0.025) and NHL-like group(P = 0. 016, P = 0. 011). The OS at 5 years in NHL-like group, ALL-like group and HSCT group were (14.4 ± 9.4) ％ , (20.2 ± 12.7) ％ and (79.5 ± 13.1) ％, respectively. Conclusion ①LBL is more common in young men, with less involvement of peripheral blood. Compared with B-LBL, T-LBL often has a mediastinal mass and serious cavity effusion. ② Intensive treatment regimens for ALL should be used in LBL. HSCT at CR1 can improve outcome obviously.     

注射用重组人血清白蛋白-人粒细胞集落刺激因子(Ⅰ)融合蛋白在健康受试者的耐受性研究

目的评价重组(酵母分泌型)人血清白蛋白-人粒细胞集落刺激因子(Ⅰ)融合蛋白在健康受试者的耐受性和安全性。方法将26例健康受试者(男女各半)按先后顺序入组,进行4个剂量组试验(150,300,500,650μg·kg^-1),每组分别入组4,6,8,8例。根据体重计算给药剂量,受试者于给药当天上臂三角肌部位皮下注射给药1次。用药后观察药物不良事件(AE),定时进行实验室检查、心电图检查。结果共25例受试者发生AE,共145例次。150,300,500及650μg·kg^-1剂量组的AE分别为13,11,56和65例次。其中134例次考虑与研究药物相关。常见的AE有骨痛、单核细胞计数升高、血碱性磷酸酶升高、头痛、高尿酸血症、血乳酸脱氢酶升高、脾肿大、肌肉疲劳。研究中未出现AE导致的用药暂停、受试者退出或试验提前中止。未发生严重不良事件(SAE)。未发生剂量限制性毒性。结论注射用重组(酵母分泌型)人血清白蛋白-人粒细胞集落刺激因子(Ⅰ)融合蛋白在中国健康受试者中单次给药150,650μg·kg^-1剂量范围内有较好的安全性,本临床试验未探索到健康人群的最大耐受剂量。     

56例结性外周T细胞淋巴瘤的治疗和预后分析

目的:探讨结性外周T细胞淋巴瘤(FTCL)的疗效和预后因素.方法:回顾分析1998年5月～2008年2月期间收治的56例结性PTCL,比较不同治疗方法的疗效,探讨预后因素.结果:外周T细胞淋巴瘤非特指型(FTCL-U)37例(66.1%),系统性间变大细胞淋巴瘤(ALCL)12例(21.4%),血管免疫母细胞淋巴瘤(AITL)7例(12.5%).CHOP化疗组25例(51.0%),强化治疗组12例(24.5%),自体造血干细胞移植(ASCT)12例(24.5%).完全缓解(CR)率为71.4%,中位随访11.9个月,3年总生存率为20.0%.化疗组和ASCT组3年总生存率分别为15.8%和38.2%(P=038).预后不良因素包括一般状况差(ECOG≥2分)、结外受累≥2个部位、乳酸脱氢酶升高、血小板<150×109/L、骨髓侵犯、Ann Arbor分期Ⅳ期、国际预后指数(IPI)≥3个危险因素以及未获得CR.多因素分析发现是否获得CR(RR,9.924;95%CI,2.412～40.832;P<0.001)是唯一独立预后因素.结论:结性PTCL化疗反应率较高,但远期疗效很差;取得CR后进行ASCT可以提高结性PTCL的疗效.     

203例慢性淋巴细胞白血病患者预后相关因素分析

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.     

263例慢性淋巴细胞白血病临床与实验室检查分析

目的 探讨慢性淋巴细胞白血病(CLL)的临床和主要实验室检查特点.方法 回顾性分析263例CLL患者的临床及实验室检查资料.结果 患者中位发病年龄为60岁,男女比例为2.17:1.35.4%的患者因查体或其他疾病检查发现,多处于疾病早期.乏力倦怠和淋巴结肿大是患者就诊最常见的原因,后者也是最常见的体征(54.8%).CLL患者常合并感染、结缔组织病和继发肿瘤,但发生自身免疫性溶血性贫血(AIHA)的概率较小,为1.5%.初诊患者外周血白细胞多在(10～100)×109/L,97.1%的患者淋巴细胞比例在0.50以上.骨髓增生活跃,99.4%的患者骨髓淋巴细胞比例在0.300以上.骨髓病理检查以弥漫性浸润为主(72.2%).细胞免疫表型CD5阳性细胞率为85.1%,CD25阳性细胞率为78.9%.CLL患者常合并免疫球蛋白降低,以IgM降低最常见.常规染色体检查不易发现异常.结论CLL多发于老年人,男性多见,临床特征和免疫表型有一定特点.