白细胞介素6和hepcidin在弥漫大B细胞淋巴瘤中的表达及其与贫血的相关性

目的：研究白细胞介素6（IL-6）和hepcidin在弥漫大B细胞淋巴瘤（DLBCL）患者中的表达及其在贫血发生中的作用。方法收集诊断时伴或不伴贫血的45例DLBCL患者,在诊断时抽取外周血标本,分别检测IL-6、hepcidin、血清铁蛋白和血红蛋白（Hb）浓度等。以24名健康志愿者作为对照。结果DLBCL患者的血浆hepcidin及IL-6水平分别为（347±171）μg／L、0.27 ng／L（0～9.61 ng／L）,与健康对照者的（175±92）μg／L、0相比,差异均有统计学意义（均P＜0.001）。在高乳酸脱氢酶（LDH）（P＝0.003）、有B症状（P＝0.040）和年龄校正的国际预后指数（IPI）评分＞1（P＝0.010）的患者中血浆hepcidin水平升高,差异均有统计学意义。在男性（P＝0.003）、肿瘤分期Ⅲ～Ⅳ期（P＝0.008）和IPI评分＞1（P＝0.004）的DLBCL患者中IL-6水平升高,差异均有统计学意义。 hepcidin水平与血清铁蛋白高度相关（r＝0.77,P＜0.001）,与IL-6弱相关（r＝0.31,P＝0.030）,与Hb无相关性（r＝-0.12,P＝0.300）。IL-6表达水平与Hb呈负相关（r＝-0.35,P＝0.009）。多因素分析提示,IL-6可以预测贫血（P＝0.03）,而hepcidin不能预测贫血（P＝0.89）。结论 DLBCL患者血浆hepcidin常高表达,但IL-6水平升高在DLBCL患者贫血的发生中起主要作用。     

复方丹参注射液联合伊马替尼治疗急性淋巴细胞白血病临床研究

目的：观察复方丹参注射液联合伊马替尼对急性淋巴细胞白血病患者造血及免疫功能的影响。方法：选择70 例急性淋巴细胞白血病患者为研究对象,按随机数字表法分为对照组和观察组各35 例。对照组给予化疗+伊马替尼治疗,观察组在对照组基础上给予复方丹参注射液治疗。比较2 组临床疗效,检测治疗前后血白细胞（WBC）、红细胞（RBC）、血小板（BPC） 计数和血红蛋白（Hb） 水平的变化,检测外周血T 淋巴细胞亚群（CD3+,CD4+,CD8+及CD4+/CD8+） 水平的变化。结果：治疗前,2 组外周血WBC、RBC、BPC 计数及Hb 水平比较,差异无统计学意义（P＞0.05）。治疗后,2 组外周血RBC、BPC 计数及Hb 水平较治疗前上升,WBC 计数较治疗前下降（P＜0.05）;且观察组WBC、RBC 及Hb 高于对照组（P＜0.05）。治疗前,2 组CD3+、CD4+、CD8+及CD4+/CD8+水平比较,差异无统计学意义（P＞0.05）。治疗后,2 组CD3+、CD4+及CD4+/CD8+水平较治疗前降低（P＜0.05）,但是观察组降低程度小于对照组（P＜0.05）。结论：复方丹参注射液联合伊马替尼治疗急性淋巴细胞白血病具有较好的疗效,可以有效改善患者骨髓造血功能和免疫功能。     

Therapeutic effects of combined cytokines on hematopoietic injuries induced by 4.5 Gy γ-rays irradiation in beagles

Objectivc To observe the therapeutic effects of combined cytokines on hematopoietic injuries induced by 4.5 Gy60 Co γ-rays irradiation in beagles,and to provide experimental evidences for the clinical treatment of extremely severe myeloid acute radiation sickness(ARS).Methods 16 beagles were given 4.5 Gy60 Co γ-rays total body irradiation,and then randomly assigned into irradiation control group,supportive care group and cytokines group.In addition to supportive care,recombinant human granulocyte colony-stimulating factor (rhG-CSF),recombinant human interleukin-11(rhIL-11)and recombinant human interleukin-2(rhIL-2)were administered subcutaneouly to dogs in cytokines group.Peripheral blood hemogram was examined once every two days.Bone marrow and peripheral blood were collected to proceed colony cultivation 4 d pre-irradiation and 1 and 45 d post-irradiation.Conventional histopathological sections of sternum were prepared to observe the histomorphology changes. Results After irradiation,the population of all kinds of cells in peripheral blood declined sharply.WBC nadir Was elevated(1.04×109/L,but 0.28×109/L and 0.68×109/L for the irradiation control group and the supportive care group separately),the duration of thrombocytopenia was shortened (24 days,but 33 days for the supportive care groug) and red blood cell counts were maintained in the range of normal values after cytokincs treatment in combination.The colony forming efficiency of haemopoietic stem cells(HSCs)in bone marrow and peripheral blood decreased obviously 1 d post irradiation,but recovered to the level of that before irradiation 45 d post irradiation after supportive care and cytokines treatment.Hematopoietic cells disappeared in bone marrow of animals in irradiation control group,but hematopoietic functions were recovered after cytokines were administrated.Conclusions RhG-CSF.rhIL-11 and rhIL-2 used in combination could elevate WBC nadir,accelerate the recovery of leukocytes,platelets and red blood cells and promote the proliferation,differentiation and maturity of HSPCs left in the body after 4.5 Gy γ-rays total body irradiation,eventually restore the hematopoietic function.Hence,combination of rhG-CSF,rhIL-11 and rhIL-2 could serve as better therapeutic strategy to treat extremely severe myeloid ARS.     

Experimental therapeutic effect of combined cytokines on beagle dogs exposed to 4.5 Gy γ-rays

Objective To evaluate the effects of combined administration of recombinant human interleukin-11(rhIL-11),recombinant human G-CSF(rhG-CSF)and recombinant human interleukin-2 (rhIL-2)on acute radiation sickness(ARS)beagles.Methods Sixteen beagle were irradiated with 4.5 Gy60 Co γ-rays to establish ARS models,and were divided into irradiation control group,supportive care group and combined cytokines treatment group.After irradiation irradiation control group was given no treatment,the dogs in supportive care group received purely symptomatic treatment,while combined cytokines treatment group received rhIL-11 50μg/(kg·d)and rbG-CSF 10μg/(kg·d)subcutaneously(0-14 d)and rhIL-2 1×1 06 U/d(29-43 d)besides symptomatic treatment.Manifestation and characteristics of ARS beagles were observed,and the survival time were recorded.At last,post-mortem examination and histological examination were performed.Results All animals underwent nausea,diarrhea and fever.After irradiation,all animals in irradiation control group died in two weeks,and the mean survival time was 12.7 d,while only one died at 33 d in supportive care group.All dogs in combined cytokine group survived at 45 day after exposure,and their haematopoiesis and gastrointestinal tract were recovered.Conclusions Combination of rhIL-11 + rhG-CSF + rhIL-2 treatment could be significantly effective on ARS beagles irradiated by 4.5 Gy60 Co γ-rays,which could accelerate injured haemotopoiesis and intestinal tract recovery,increase the survival rate and improve the life quality of animals.     

细胞因子联合治疗对急性放射病比格狗造血干/祖细胞的影响

目的 探讨重组人粒细胞集落刺激因子(rhG-CSF)和重组人白细胞介素11(rhIL-11)联合治疗对重度骨髓型急性放射病(ARS)比格狗干/祖细胞数量和质量的影响.方法 用4.5Gy60Coγ射线照射比格狗建立重度骨髓型ARS模型,随机分为三组:A组5犬,不予任何治疗;B组5犬,予输血、抗感染等对症治疗;C组6犬,在B组基础上加用rhG-CSF和rhIL-11 3周.观察外周血CD34+细胞数和骨髓中CD34+细胞的比例、骨髓涂片骨髓增生程度、骨髓和外周血造血祖细胞集落数及端粒酶活性.结果 与A、B组比较,C组外周血CD34+细胞数照射后早期增高(P<0.05),骨髓CD34+细胞比例各个时间点差异无统计学意义(P>0.05);照射后45d,C组骨髓增生程度、外周血红细胞集落形成单位(CFU-E)、骨髓混合细胞集落形成单位(CFU-Mix)和骨髓端粒酶活性均明显高于B组(P<0.05).结论 联合使用细胞因子可保护部分造血干/祖细胞的增殖能力,保持端粒酶较高的活性,促进CD34+的早期释放,有利于骨髓造血功能较快恢复.     

rhG-CSF和rhIL-11联合治疗极重度骨髓型急性放射病比格狗疗效观察

目的观察重组人粒细胞集落刺激因子（rhG-CSF）和重组人白介素-11（rhIL-11）联合治疗极重度骨髓型急性放射病（ARS）比格狗的治疗效果,为临床救治提供依据。方法用4.5Gy-（60）Coγ射线照射比格狗建立极重度骨髓型ARS模型,随机分成照射对照组、综合对症组和细胞因子组。照射对照组不给予任何治疗,综合对症组给予包括输血、抗感染等对症治疗,细胞因子组在综合对症治疗基础上给予rhG-CSF和rhIL-11治疗3周,然后观察各组的血象变化、输血量、抗生素使用时间和动物的存活率等。结果照射后3组动物血象中各类细胞都呈急剧下降,细胞因子组治疗后血象基本恢复正常。细胞因子组的平均输血量和输血时间均显著少于综合对症组（P〈0.01）,抗生素使用时间也较短（P〈0.05）。照后45d观察期内,存活率照射对照组为0%,综合对症组为80%,细胞因子组为100%,3组存活率有显著差异（P〈0.01）。结论综合对症基础上联合rhG-CSF和rhIL-11治疗极重度骨髓型ARS比格狗,能够促进骨髓造血功能的恢复,刺激血细胞较快地回升,显著减少输血量,缩短抗生素使用时间,并能提高照射狗的存活率。     

Therapeutic effects of combined cytokines on hematopoietic injuries induced by 4.5 Gy γ-rays irradiation in beagles

Objectivc To observe the therapeutic effects of combined cytokines on hematopoietic injuries induced by 4.5 Gy60 Co γ-rays irradiation in beagles,and to provide experimental evidences for the clinical treatment of extremely severe myeloid acute radiation sickness(ARS).Methods 16 beagles were given 4.5 Gy60 Co γ-rays total body irradiation,and then randomly assigned into irradiation control group,supportive care group and cytokines group.In addition to supportive care,recombinant human granulocyte colony-stimulating factor (rhG-CSF),recombinant human interleukin-11(rhIL-11)and recombinant human interleukin-2(rhIL-2)were administered subcutaneouly to dogs in cytokines group.Peripheral blood hemogram was examined once every two days.Bone marrow and peripheral blood were collected to proceed colony cultivation 4 d pre-irradiation and 1 and 45 d post-irradiation.Conventional histopathological sections of sternum were prepared to observe the histomorphology changes. Results After irradiation,the population of all kinds of cells in peripheral blood declined sharply.WBC nadir Was elevated(1.04×109/L,but 0.28×109/L and 0.68×109/L for the irradiation control group and the supportive care group separately),the duration of thrombocytopenia was shortened (24 days,but 33 days for the supportive care groug) and red blood cell counts were maintained in the range of normal values after cytokincs treatment in combination.The colony forming efficiency of haemopoietic stem cells(HSCs)in bone marrow and peripheral blood decreased obviously 1 d post irradiation,but recovered to the level of that before irradiation 45 d post irradiation after supportive care and cytokines treatment.Hematopoietic cells disappeared in bone marrow of animals in irradiation control group,but hematopoietic functions were recovered after cytokines were administrated.Conclusions RhG-CSF.rhIL-11 and rhIL-2 used in combination could elevate WBC nadir,accelerate the recovery of leukocytes,platelets and red blood cells and promote the proliferation,differentiation and maturity of HSPCs left in the body after 4.5 Gy γ-rays total body irradiation,eventually restore the hematopoietic function.Hence,combination of rhG-CSF,rhIL-11 and rhIL-2 could serve as better therapeutic strategy to treat extremely severe myeloid ARS.     

Experimental therapeutic effect of combined cytokines on beagle dogs exposed to 4.5 Gy γ-rays

Objective To evaluate the effects of combined administration of recombinant human interleukin-11(rhIL-11),recombinant human G-CSF(rhG-CSF)and recombinant human interleukin-2 (rhIL-2)on acute radiation sickness(ARS)beagles.Methods Sixteen beagle were irradiated with 4.5 Gy60 Co γ-rays to establish ARS models,and were divided into irradiation control group,supportive care group and combined cytokines treatment group.After irradiation irradiation control group was given no treatment,the dogs in supportive care group received purely symptomatic treatment,while combined cytokines treatment group received rhIL-11 50μg/(kg·d)and rbG-CSF 10μg/(kg·d)subcutaneously(0-14 d)and rhIL-2 1×1 06 U/d(29-43 d)besides symptomatic treatment.Manifestation and characteristics of ARS beagles were observed,and the survival time were recorded.At last,post-mortem examination and histological examination were performed.Results All animals underwent nausea,diarrhea and fever.After irradiation,all animals in irradiation control group died in two weeks,and the mean survival time was 12.7 d,while only one died at 33 d in supportive care group.All dogs in combined cytokine group survived at 45 day after exposure,and their haematopoiesis and gastrointestinal tract were recovered.Conclusions Combination of rhIL-11 + rhG-CSF + rhIL-2 treatment could be significantly effective on ARS beagles irradiated by 4.5 Gy60 Co γ-rays,which could accelerate injured haemotopoiesis and intestinal tract recovery,increase the survival rate and improve the life quality of animals.     

细胞因子联合对4.5Gyγ射线照射比格犬造血损伤的治疗作用

目的 观察细胞因子组合对4.5 Gy γ射线照射比格犬造血系统损伤的治疗效果,为极重度骨髓型急性放射病的临床救治提供实验依据。方法 16只比格犬均给予4.5 Gy ⁶⁰Co γ射线全身照射,随机分为照射对照、综合对症和细胞因子3组。细胞因子组动物在综合对症支持治疗的基础上应用rhG-CSF、rhIL-11和rhIL-2联合治疗。2 d检测1次外周血象,分别于照射前4 d,照射后1和45 d收集骨髓和外周血进行造血细胞集落培养,制备胸骨病理切片观察组织形态学改变。结果 照射后各组动物外周血各类细胞数急剧下降,细胞因子联合治疗可提高白细胞最低值(1.04×10⁹/L,而照射对照组和综合对症组分别为0.28×10⁹/L和0.68×10⁹/L),缩短血小板减少持续时间(细胞因子组24 d,综合对症组33 d),使红细胞维持在正常值范围;照射后1 d骨髓及外周血中造血干细胞集落形成率明显下降,照射后45 d 2个治疗组造血干细胞集落数均恢复为照射前水平;照射对照组动物骨髓造血细胞完全消失,细胞因子治疗使得骨髓造血功能完全恢复,与照射前水平比较差异无统计学意义。结论 rhG-CSF、rhIL-11和rhIL-2联合应用可提高极期时外周血白细胞最低值,加速白细胞、血小板和红细胞恢复,促进4.5 Gy γ射线照射犬体内残留造血干/祖细胞的增殖、分化和成熟,从而加速造血功能的重建。rhG-CSF、 rhIL-11和rhIL-2不失为治疗极重度骨髓型急性放射病的有效措施。