细胞衰老诱导的抑制性细胞因子累积对DLBCL细胞功能的影响

目的 探讨细胞衰老在弥漫大B细胞淋巴瘤(DL-BCL)细胞抵抗化疗中的作用及机制.方法 将入组的DL-BCL患者分为初诊(ND)组、完全缓解(CR)组、复发/难治(r/r)组.分别应用HE染色和β-半乳糖苷酶染色法检测淋巴结反应性增生患者、r/r DLBCL患者淋巴结组织衰老情况;用β-半乳糖苷酶染色法检测ND、r/r组DLBCL患者外周血中的衰老情况;用10、20、40 nmol/L的阿霉素(DOX)反复诱导DLBCL细胞株LY8衰老,构建衰老模型;CCK-8法检测衰老模型细胞增殖情况;流式细胞术检测衰老模型细胞凋亡情况;ELISA法检测DLBCL患者血清和衰老模型上清液中细胞因子表达.结果 r/r组DLBCL患者淋巴结组织及外周血中的衰老细胞明显增多且血清中白细胞介素(IL)-6、IL-8、IL-10、IL-35、转化生长因子-β1(TGF-β1)等促炎性和免疫抑制性细胞因子分泌增加;使用40 nmol/L DOX成功诱导LY8细胞衰老,衰老细胞比例24.77％.对对照组及DOX诱导组进行功能检测,结果提示衰老组细胞增殖率低于对照组但高于10 nmol/L和20 nmol/L DOX组(P＜0.05);凋亡率高于对照组但低于10 nmol/L和20 nmol/L DOX组(P＜0.05).同时,各组IL-2、IL-6、IL-8、IL-10、TGF-β1分泌量差异有统计学意义(P＜0.05),与对照组比较,衰老组细胞上清液中IL-2、IL-6、IL-8、IL-10、IL-35、TGF-β1等各种促炎和免疫抑制性细胞因子分泌增加.结论 细胞衰老通过诱导抑制性细胞因子累积促进DLBCL细胞凋亡抵抗.     

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.     

有创通气的急性呼吸窘迫患者发生急性肾损伤的危险因素分析

目的:探讨有创机械通气的急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）患者发生急性肾损伤（acute kidney injury，AKI）的危险因素。方法:回顾性分析2019年01月至2019年12月泰州市人民医院重症医学科收治的有创机械通气的ARDS患者的临床资料，根据患者是否发生AKI，分为AKI组和非AKI组。比较两组患者的临床特征和实验室指标；分析影响有创机械通气的ARDS患者发生AKI的危险因素；绘制Kaplan-Meier生存曲线，比较两组患者的生存率。结果:共120名有创机械通气的ARDS患者，其中57名发生AKI，发生率为47.5%。降钙素原、基础肌酐增高，pH值降低和意识障碍是有创机械通气的ARDS患者发生AKI的独立危险因素。120例患者中57名死亡，总住院病死率38.3%。Kaplan-Meier生存曲线表明，AKI组生存率低于非AKI组，差异有统计学意义（ P<0.001）。 结论:有创机械通气的ARDS患者AKI发生率高，可明显增加患者住院病死率。降钙素原、基础肌酐增高，pH值降低和意识障碍是有创机械通气的ARDS患者发生AKI的独立危险因素。