OUTCOMES OF INVASIVE STRATEGY TO PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROMES

To compare the outcomes of an invasive with a conservative strategy in the management of patients with non-ST-elevation acute coronary syndromes. Methods From January 2000 to June 2001,505 patients presenting with unstable angina or non-Q wave myocardial infarction were divided into two groups (conservative vs. invasive) according to management strategy. Patients assigned to an early invasive strategy underwent coronary angiography within 7d of enrollment after intensive antiplatelet, antithrombotic and antiangina therapy and revascularization as appropriate. All patients were followed up at least 6 months. The primary endpoints were cardiac death and acute myocardial infarction. Recurrence angina and readmission were the secondary endpoint. Results There were 194 patients in conservative group and 311 patients in invasive group. Overall, coronary angiography was performed in 100% and 56%, and revascularization in 93% and 52% in the invasive and conservative groups, respectively. During a mean of 11 5. 7 months ( range 6 ~ 24 months) of follow-up, the occurrence of primary endpoint was significantly lower in the invasive group than that in the conservative group (3.9% vs8. 2% , P =0. 036). The rate of recurrent angina (48% vs 17% , P =0. 001 ) , readmission (41% vs 13% , P =0. 001 )and revascularization ( 12% vs 35%, P =0. 001 ) was also significantly lower in patients assigned to invasive strategy. Conclusion The study indicates that the early invasive approach may be the preferred strategy in patients with unstable angina or non-Q wave myocardial infarction.     

TH17细胞在小鼠皮肤急性移植物抗宿主病中的作用

目的 观察TH17细胞在小鼠皮肤急性移植物抗宿主病(aGVHD)中的作用.方法 将小鼠分为3组:单纯照射组(照射组,60Co照射1次)、异基因骨髓移植组(移植组,60Co照射后进行异基因骨髓移植)和常山酮组(60Co照射后进行异基因骨髓移植,移植前1 d予TH17抑制剂常山酮腹腔注射),每组10只.移植后观察皮肤aGVHD发生情况并进行临床和病理评分.移植后6 d流式细胞仪检测血中TH1/TH17、γ干扰素(IFN-γ)及白细胞介素17(IL-17)变化.结果 小鼠在移植后6 d出现典型的系统性aGVHD表现,常山酮组小鼠系统性aGVHD较移植组重.常山酮组小鼠皮肤aGVHD临床表现和病理评分较移植组轻;常山酮组TH1/TH17中位数为17.57,移植组TH1/TH17中位数为5.31,两组比较差异有统计学意义(P<0.05).照射组IL-17低于移植组[(1.47±0.18)pg/ml比(2.81±0.19)pg/ml,P<0.05],常山酮组未测到.对照组、移植组、常山酮组IFN-γ分别为(3.86±0.32)、(42.97 ±0.42)、(9.89±0.51)pg/ml,各组间比较差异均有统计学意义(均P<0.05).结论 阻断TH17能够减轻小鼠皮肤aGVHD但加重系统性aGVHD.

Abstract：

Objective To explore the functions of TH17 cell in cutaneous graft-versus-host disease (GVHD). Methods A model of acute GVHD (aGVHD) was established with a major histocompatibility complex class Ⅰ /Ⅱ -disparate allogeneic bone marrow transplantation( BMT). Bone marrow monocytes and splenic T cells from donor C57/BL6 were enriched. The recipient BABL mice were irradiated ( Co source)with 7. 5 Gy total body irradiation (TBI) and injected with 5 × 106 marrow monocytes and 5 × 105 T cells.The experimental mice were divided into 3 groups: lethal total body irradiation (TBI); allogeneic bone marrow transplantation (BMT) and recipients of holafugine ( HF). The symptoms of aGVHD were observed daily and detailed histopathologic analyses of recipient skin were performed at Day 6 post-transplantation.And Tri-color flow cytometry ( FCM) was performed at Day 6 post-transplantation to measure the levels of interleukin (IL)-17, interferon (IFN)-γ and TH1/TH17. Results Clinical GVHD symptoms were observed in recipient mice. The administration of HF to lethally irradiated recipients led to very modest GVHD-induced cutaneous changes manifested predominantly by fur loss. However, the experimental animals receiving only allogeneic BMT showed significant fur loss and pathologic skin conditions. Consistent with the clinical evaluations, the histopathologic results demonstrated significantly increased pathologic cutaneous lesions in recipients undergoing only BMT. The median ratios of TH1/TH17 cells were 17. 57 and 5. 31 in the HF and BMT groups respectively. The difference had statistical significance (P < 0. 05). The serum levels of IL-17 were(1.47 ±0. 18)and(2. 81 ±0. 19)pg/ml in the TBI and BMT groups respectively(P <0. 05). But IL-17 could not be detected in the HF group. The serum levels of IFN-γ were (3. 86 ±0. 32) ,(42. 97 ± 0. 42) and (9. 89 ± 0. 51) pg/ml in the TBI, BMT and HF groups respectively. The inter-group differences had statistical significance (P <0. 05). Conclusion An absence of TH17 cell may alleviate the cutaneous GVHD but exacerbate the systemic GVHD.     

The Effects of PDTC on Interleukin-1β-induced Nitric Oxide Production in Chondrocytes

In order to find new drugs to inhibit nitric oxide （NO） production, the effects of pyrrolidine dithiocarbamate （PDTC）, a nuclear factor-kappa B （NF-κB） inhibitor, on recombinant human interleukin-1β （rhIL-1β）-induced NO production in chondrocytes were investigated. Rat chondrocytes were isolated and cultured, divided into control, P0, P1, P2, P3 and P4 groups. The chondrocytes in the P0, P1, P2, P3 and P4 groups were treated with different concentrations of PDTC （0, 3, 10, 30, and 50 p.mol/L respectively） for 1 h and then incubated with 5 U/mL rhIL-1β for 24 h. NO assay kit and RT-PCR were used to detect the NO content and the iNOS mRNA expression in the chondrocytes The expression level of iNOS mRNA in control, P0, P1, P2, P3 and P4 groups was 0.02±0.01, 1.24±0.13, 1.21±0.14, 0.61±0.11, 0.40±0.09, 0.21±0.06, and the relative content of NO was 15.8±2.7, 100±14.8, 92.6±9.3, 68.3±14.2, 27.5±9.8, 19.8±3.6, respectively. In the P0, P1, P2, P3 and P4 groups, the expression of iNOS mRNA and NO production were significantly increased as compared with those in the control group. As compared with the P0 group, the expression of iNOS mRNA and NO content in control group were lower. In the P2, P3 and P4 groups, PDTC could significantly inhibit the expression of iNOS and NO production induced by rhIL-1β in a concentration-dependent manner. It is suggested that PDTC can inhibit NO production and iNOS mRNA expression induced by IL-1β, which may provide an alternative method for the treatment of osteoarthritis.     

Smoking control hindered by realities in China

Background Calcified coronary lesions carry the risk of suboptimal stent expansion, subsequently leading to restenosis. The effectiveness of sirolimus-eluting stents （SES） for the treatment of calcified lesion has not been fully investigated. In the present study, therefore, we evaluated the effectiveness of SES implantation for the treatment of calcified coronary lesions.Mothods A total of 333 consecutive patients with 453 lesions were enrolled in this study. They were divided into two groups according to whether the lesion treated with SES was calcified or not; no calcification group （n=-264） and calcification group （n=-189）. Lesions treated with SES were subjected to quantitative coronary angiography （QCA） immediately and 8 months following stenting. Results Baseline clinical, demographic or angiographic characteristics were well balanced in both groups. Angiographic follow-up at 8 months, the in-stent restenosis and in-segment restenosis rates were not significantly different between the two groups; instent restenosis： 3.8% vs 4.2%; P=0.081; in-segment restenosis： 8.7% vs 10.6%, P=0.503. The target lesion revascularization （TLR） was also not significantly different between the two groups; 4.9% vs 6.9%, P=0.378. In addition, the in-stent late loss was similar in both groups; （0.16±0.40） mm vs （0.17±0.33） mm, P〉0.05. Meantime, overall thrombosis rates were also similar in both groups; 1.6% vs 1.6%, P〉0.05. Conclusion Although calcified coronary lesion was hard to stent, successful percutaneous coronary intervention with SES stenting for calcified lesions was conferred by the similar favorable results that were seen when comparing non-calcified and calcified coronary lesions.     

Effects of simulated weightlessness on tight junction protein occludin and Zonula Occluden-1 expression levels in the intestinal mucosa of rats

This study investigated the tight junction(TJ) protein expression of the intestinal mucosa in a rat tail-suspension model under simulated weightlessness.Twenty-four Wistar rats were randomly divided into three groups:CON group(n=8),control;SUS-14 d group(n=8),tail-suspension for 14 days;SUS-21 d group(n=8),tail-suspension for 21 days.Occludin and Zonula Occluden-1(ZO-1) expression levels were determined by immunohistochemical analysis and mRNA fluorescent quantitative PCR.Plasma levels of diamine oxidase(DAO) and d-lactate were determined using enzymatic spectrophotometry.Immunohistochemical results for occludin and ZO-1 showed disruption of the TJs in the intestinal mucosa in SUS-14 d and SUS-21 d groups.The expression levels of occludin and ZO-1 in SUS-21 d group were lower than those in SUS-14 d group,and significantly lower than those in CON group(Occldin:0.86±0.02 vs 1.01±0.03 vs 1.63±0.03 and ZO-1:0.82±0.01 vs 1.00±0.02 vs 1.55±0.01,P<0.01).Moreover,the levels of plasma DAO and d-lactate in SUS-21 d group were higher than those in SUS-14 d group,and significantly higher than those in CON group(DAO:27.58±0.49 vs 20.74±0.49 vs 12.94±0.21 and d-lactate:37.86±0.74 vs 28.26±1.01 vs 17.76±0.91,P<0.01).There were significant negative correlations between occludin or ZO-1 expression levels and DAO(r2=0.9014,r2=0.9355,P<0.01) or d-lactate levels(r2=0.8989,r2=0.9331,P<0.01).Occludin and Zo-1 were reduced in intestinal mucosa both in mRNA and protein levels in the rat tail-suspension model.The significant negative correlations between expression levels of TJs and plasma levels of DAO or d-lactate support the hypothesis that intestinal permeability is increased due to a decrease in TJ protein expression during tail-suspension from 14 days to 21 days.     

Anti-Müllerian hormone,antral follicle count and folliclestimulating hormone for predicting the number of oocytes retrieved in IVF/ICSI cycles

Objective To evaluate the efficacy of anti-Müllerian hormone(AMH), antral follicle count(AFC) and follicle-stimulating hormone(FSH) for predicting the number of oocytes retrieved in in-vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)cycles.Methods In this retrospective study, a total of 122 infertile women were divided into two groups: group A, 35 years(n=71); group B, ≥35 years(n=51). AMH and FSH were determined on 2-5 d of the early menstrual cycle. AFC was tested on the second day of the menstrual cycle before the start of stimulation.Results Group B had higher FSH levels compared with group A(8.2±3.5 IU/L vs 6.8±2.4 IU/L, P0.05). However, levels of AMH and AFC in group B were lower than those of group A(AMH: 4.2±3.5 μg/L vs 2.7±2.7 μg/L; AFC: 9.0±3.9 vs 5.4±3.3, P0.05). The number of oocyte retrieved in the two groups was not significantly different(11.5±6.8 vs 9.6±6.9, P0.05). The level of AMH was more strongly correlated with the number of oocytes retrieved than that of AFC or FSH level. The strengths of the correlation degrees were AMH level, AFC, and FSH level in turn(r=0.600, 0.511,-0.369).Conclusion AMH would be a useful predictor for ovarian response.     

Gastrointestinal tract

<正>209328 Fast track surgery in elective operation for colorectal carcinoma/Yang Dongjie(杨东杰,Dept Gastrointest Pancreas Surg,1st Affil Hosp,Sun Yat-sen Univ,Guangzhou 510080)…∥Chin J Gen Surg.-2009,24(6).-477～479Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery.Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups:fast-track group(35 cases) and conventional care group(35 cases).Results Sixty-two patients finished the study,32 cases in fast-track group and 30 cases in conventional care group.The median and average time to the first passage of flatus(2±1 vs.4±2,P<0.01),the first passage of stool (3.8±1.6 vs. 6.4±2.5,P=0.000 7),resumption of normal diet[(4±2)vs.(8.2±2.2),P<0.01]and the length of postoperative stay (6±1 days vs. 11.7±3.8 days,P<0.01)were much shorter in the fast-track group than in the conventional care group.The preoperative incidence of thirst (2/32 vs.23/30,P<0.01),hunger (5/32 vs.20/30,P<0.01) and postoperative infectious complications (2/32 vs.8/30,P=0.04)were much lower in the fast-track group than in the conventional care group.Conclusion Fast track surgery in patients undergoing elective colorectal resetion was safe and effective.12 refs,1 tab.     

128-slice Dual-source Computed Tomography Coronary Angiography in Patients with Atrial Fibrillation: Image Quality and Radiation Dose of Prospectively Electrocardiogram-triggered Sequential Scan Compared with Retrospectively Electrocardiogram-gated Spiral

Objective To evaluate the image quality (IQ) and radiation dose of 128-slice dual-source computed tomography (DSCT) coronary angiography using prospectively electrocardiogram (ECG)-triggered sequential scan mode compared with ECG-gated spiral scan mode in a population with atrial fibrillation. Methods Thirty-two patients with suspected coronary artery disease and permanent atrial fibrillation referred for a second-generation 128-slice DSCT coronary angiography were included in the prospective study. Of them, 17 patients (sequential group) were randomly selected to use a prospectively ECG-triggered sequential scan, while the other 15 patients (spiral group) used a retrospectively ECG-gated spiral scan. The IQ was assessed by two readers independently, using a four-point grading scale from excellent (grade 1) to non-assessable (grade 4), based on the American Heart Association 15-segment model. IQ of each segment and effective dose of each patient were compared between the two groups. Results The mean heart rate (HR) of the sequential group was 96±27 beats per minute (bpm) with a variation range of 73±25 bpm, while the mean HR of the spiral group was 86±22 bpm with a variationrange of 65±24 bpm. Both of the mean HR (t=1.91, P=0.243) and HR variation range (t=0.950, P=0.350) had no significant difference between the two groups. In per-segment analysis, IQ of the sequential group vs. spiral group was rated as excellent (grade 1) in 190/244 (78%) vs. 177/217 (82%) by reader1 and 197/245 (80%) vs. 174/214 (81%) by reader2, as non-assessable (grade 4) in 4/244 (2%) vs. 2/217 (1%) by reader1 and 6/245 (2%) vs. 4/214 (2%) by reader2. Overall averaged IQ per-patient in the sequential and spiral group showed equally good (1.27±0.19 vs. 1.25±0.22, Z=-0.834, P=0.404). The effective radiation dose of the sequential group reduced significantly compared with the spiral group (4.88±1.77 mSv vs. 10.20±3.64 mSv; t=-5.372, P=0.000). Conclusion Compared with retrospectively ECG-gated spiral scan, prospectively ECG-triggered sequential DSCT coronary angiography provides similarly diagnostically valuable images in patients with atrial fibrillation and significantly reduces radiation dose.     

Intravenous Contrast Material Administration at High-pitch Dual-source CT Coronary Angiography: Bolus-tracking Technique with Shortened Time of Respiratory Instruction Versus Test Bolus Technique

Objective To investigate the feasibility of acquiring the similar homogeneous enhancement using bolus-tracking techniques with shortened respiratory time in prospectively electrocardiogram-gated high-pitch spiral acquisition mode (Flash mode) coronary computed tomography angiography (CCTA) compared with test bolus technique. Methods One hundred and eighty-four consecutive patients with mean heart rate ≤65 beats per minute undergoing CCTA were prospectively included in this study. The patients were randomly divided into two groups. Patients in the group A (n=92) instructed to shorten respiratory time received CCTA using bolus-tracking technique with high-pitch spiral acquisition mode (Flash mode), while those in the group B (n=92) underwent CCTA with test bolus technique. The attenuation in the ascending aorta, image noise, contrast-to-noise ratio and radiation doses of the two groups were assessed. Results There were no significant differences in the mean attenuation values in the ascending aorta (483.18±59.07 HU vs. 498.7±83.51 HU, P=0.183), image noise (21.4±4.5 HU vs. 20.9±4.3 HU, P=0.414), contrast-to-noise ratio (12.1±4.2 vs. 13.8±5.1, P=0.31) between the groups A and B. There were no significant differences in the radiation dose of dynamic monitoring scans (0.056±0.026 mSv vs. 0.062±0.018 mSv, P=0.068) and radiation dose of angiography (0.94±0.07 mSv vs. 0.96±0.15 mSv,P=0.926) between the two groups, while 15 mL less contrast material volume was administered in the group A than the group B. Conclusion Bolus-tracking technique with shortened time of respiratory in Flash mode of dual-source CT yields the similar homogeneous enhancement with less contrast material in comparison to the test bolus technique.     

Is adjunctive balloon postdilatation necessary with drug-eluting stents? One center experience in Chinese patients

Background With the advent of drug-eluting stents （DES） and much lower rates of target vessel revascularization （TVR）, whether adjunctive balloon postdilatation can further optimize outcome is still unknown. The present study was to compare the outcomes of postdilatation with un-postdilatation following deployment of DES. Methods From April 2004 to September 2006, 6479 consecutive Chinese patients who underwent DES implantation, including 1769 with postdilatation （1454 male, （57.9 ± 10.8） years old） and 4710 without postdilatation （3819 male, （57.9 ± 10.6） years old） were analyzed. Clinical and angiographic follow-up was performed at 7 months. Results Compared with the un-postdilatation group, the postdilatation group had more complex lesions and larger relevant vessel diameter （RVD）. In the postdilatation group, in-stent residual restenosis was significantly improved right after the procedure （（16.80±5.88）% vs （19.60±6.07）%; P=0.000）. There was no statistical difference in the major adverse cardiac events （MACE） rate between the groups （2.9% vs 3.3%; P=0.420）, and there were also no statistical differences in death, acute myocardial infarction （AMI） and target lesion revascularization （TLR） rates in the two groups （0.1% vs 0.4%, P=0.127; 1.7% vs 1.3%, P=0.229; and 1.5% vs 2.0%, P=0.206, respectively）. The in-stent thrombosis rate was almost the same in both groups （0.5% vs 0.5%; P=1.000）. Seven months angiographic follow-up results showed that both in-stent and in-segment restenosis rates were lower in the postdilatation group （8.8% vs 15.6%, P=0.000; and 10.5% vs 17.3%, P=0.000）, and so were instent and in-segment late loss （（0.32±0.12） mm vs （0.49±0.13） mm, P=0.000; and （0.24±0.08） mm vs （0.36±0.09） mm, P=0.001 ）. Conclusion Postdilatation after DES deployment was safe and could reduce the restenosis rate, especially for more complex lesions.     

两种重组人粒细胞集落刺激因子动员异基因造血干细胞移植供者的随机临床观察

目的 比较两种重组人粒细胞集落刺激因子(rHuG-CSF)惠尔血和特尔津,对造血干细胞移植供者的动员疗效.方法 异基因造血干细胞移植(allo-HSCT)患者52例,人类白细胞抗原(HLA)配型全相合的同胞供者52例,随机采用两种rHuG-CSF特尔津和惠尔血分别进行供者造血干细胞动员,对供者千细胞动员参数及患者移植后造血重建等进行比较研究.结果 惠尔血组和特尔津组外周血白细胞计数高峰时间均为第4天(38.9±3.0)×109/L和(37.8±2.9)×109/L(P>0.05).惠尔血和特尔津两种动员剂对供者外周血造血干细胞参数的影响,其结果分别为采集物MNC计数(4.8±0.7)×108/kg vs(5.1±0.4)×108/kg;CD34+(1.6±0.3)×106/kg vs(1.9±0.7)×106/kg;惠尔血和特尔津两种动员剂对供者骨髓血造血干细胞参数有诸多方面的影响,其结果分别为采集物MNC计数(3.8±0.5)/L vs(3.9±0.7)/L;CD34+(1.3±0.7)×106/kg vs (1.5±0.4)×106/kg(均P>0.05).特尔津和惠尔血两种动员剂对造血干细胞移植后造血重建的影响,其结果分别为移植后中性粒细胞植活时间(14.6±0.9)d vs(15.2±1.6)d;血小板的植活时间(18.1±0.8)d vs(17.0±1.9)d(P>0.05);两种动员剂对造血干细胞移植供者不良反应无显著差异.结论 惠尔血和特尔津两种动员剂分别对供者外周血及骨髓的造血干细胞动员动力学,以及对患者造血重建影响均无显著性差异.特尔津能可靠用于造血干细胞供者的动员及患者移植后造血重建.     

供者调控T细胞对异基因造血干细胞移植后造血与免疫重建、移植物抗宿主病发生及生存的影响

目的 研接受不同数量供者CD4 CD25 调控T细胞(TReg)移植对异基因造血干细胞移植(allo-HSCT)患者移植物抗宿主病(GVHD)的发生和造血与免疫重建的影响.方法 对30例接受allo-HSCT患者采用流式细胞仪测定移植物中的TReg值和移植后患者不同时间点外周血T淋巴细胞亚群及TReg.按移植供者TReg绝对数是否大于或等于10.0×10/kg为标准分为高TReg移植组和低TReg移植组,比较两组患者移植后造血与免疫重建、TReg重建、GVHD发生及无病生存率有无差异.结果 高TReg组的白细胞(WBC)和血小板(PLT)重建时间分别为 (8.62±2.29)d和 (12.69±5.74)d,低TReg组分别为 (8.88±2.71)d和 (15.18±6.71)d(P值分别为0.778和0.613),两组间WBC和PLT重建时间无显著性差异.高TReg组患者移植后 15 dCD4 CD3 ,CD45RO CD4 T细胞重建, 30dCD3 、CD4 CD3 T细胞重建明显快于低TReg组患者(P值分别为0.039、0.024、0.014、0.020).高TReg组患者移植后 15 dCD4 CD25 TReg重建, 180 d与低TReg组相比明显加快(P值分别为0.013、0.005).高TReg组和低TReg组患者急性GVHD发生率分别为61.54%(8/13)和94.12%(16/17),两组统计有显著性差异(P=0.027),移植的供者TReg数与急性GVHD的发生程度呈负相关(rs=0.393,P=0.032).高与低TReg组无病生存率分别为(60.40±16.10)%和(72.00±2.00)%,无显著性差异(P=0.818).结论 供者TReg能促进allo-HSCT后免疫重建及CD4 CD25 TReg重建,降低移植后急性GVHD的发生率.     

社区获得性肺炎患者血清及血小板γ-谷氨酰转肽酶活性和总抗氧化力水平的变化

目的观察社区获得性肺炎（CAP）患者血清及血小板γ-谷氨酰转肽酶（GGT）活性和总抗氧化力（T-AOC）水平的变化。方法以徐州医学院附属医院呼吸科2010年9月至2011年9月收治的90例CAP患者和30例体检健康者为研究对象。CAP患者根据外周血血小板计数分为继发血小板增多组（血小板计数〉300×10^9／L）40例和血小板不增多组（血小板计数≤300×10^9／L）50例。检测研究对象的血清GGT、T-AOC及血小板GGT、T．AOC的水平。结果CAP患者人院时血清GGT活性和血小板GGT活性[（45．6±25．4）U／L;（179．9±41．3）mU／10^9pit]均较对照组[（17．9±3．7）U／L;（49．5±8．0）mU／10^9pit]高;血清T—AOC入院时[（12．6±1．6）U／mL]比对照组[（17．8±2．1）U／mL]低;血小板T-AOC入院时[（61．6±21．5）mU／10^9plt]高于对照组[（48．6±9．9）mU／10^9plt];血小板T-AOC出院时[（40．7±14．2）mU／10^9plt]比入院时[（61．6±18．3）mU／10^9plt]和对照组[（48．6±9．9）mU／10^9plt]均低,差异均有统计学有意义（P〈0．05）。血清T．AOC血小板增多组[（12．9±1．1）U／mL]比血小板不增多组[（12．3±1．7）U／mL]高;血小板T—AOC血小板增多组[（53．0±12．0）mU／10’plt]比血小板不增多组[（68．6±19．7）U／10^9plt]低,血清GGT血小板增多组[（52．5±31．6）U／L]比血小板不增多组[（39．7±15．8）U／L]高,血小板GGT血小板增多组[（166．4±39．3）mU／10^9plt]比血小板不增多组[（190．6±39．9）mU／10^9plt]低,差异均有统计学意义（P均〈0．05）。人院时血小板计数与血小板T-AOC、GGT呈负相关,相关系数分别为-0．316（P=0．003）,-0．308（P=0．002）。结论在炎症反应过程中血小板活化与氧化应激有关;血小板在炎症反应过程及维持氧化抗氧化平衡中发挥作用。     

生脉注射液对创伤失血性休克大鼠免疫功能的影响

目的探讨生脉注射液对创伤失血性休克大鼠T淋巴细胞及其亚群的影响,为揭示生脉注射液调理创伤后免疫功能紊乱机制提供依据。方法制作创伤失血性休克大鼠模型。将30只SD大鼠随机分为3组,分别为正常对照组（A组）、创伤失血性休克组（B组）、生脉注射液治疗组（C组）,每组各10只。3组大鼠分别于实验开始后第3天处死。全自动血液生化仪检测大鼠血常规,流式细胞仪检测T淋巴细胞及其亚群（CD3^＋、CD4^＋、CD8^＋）含量。结果大鼠创伤失血性休克后,机体出现过度的炎症反应和免疫功能低下状态,B组与A组比较,白细胞含量显著升高[（8.890±0.387）×10^9/L vs（4.230±0.856）×10^9/L,P=0],中性粒细胞比例显著升高[（26.15±2.97）%vs（16.00±4.53）%,P=0],淋巴细胞比例显著下降[（68.57±5.23）%vs（76.617±4.9）%,P=0.001]。应用生脉注射液治疗后,C组与B组比较,白细胞明显下降[（6.29±0.758）×10^9/L vs（8.89±0.387）×109/L,P=0],中性粒细胞比例显著下降[（20.29±3.09）%vs（26.15±2.97）%,P=0.001],同时,淋巴细胞比例显著上升[（74.85±4.12）%vs（68.57±5.23）%,P=0.007]。创伤失血性休克后,B组与A组相比,大鼠CD3^＋、CD4^＋T淋巴细胞数量显著降低[CD3＋：（31.17±4.00）vs（41.97±2.50）,P=0;CD4^＋：（10.49±1.42）vs（15.51±3.48）,P=0.003],CD4^＋/CD8^＋比值降低[（0.97±0.09）vs（1.19±0.07）,P=0],CD8＋含量变化差异无统计学意义[（17.75±5.94）vs（17.34±3.77）,P=0.997]。大鼠处于免疫功能抑制状态,在生脉注射液治疗后,C组与B组比较,CD3^＋、CD4^＋T细胞数量显著升高[CD3^＋：（36.64±5.73）vs（31.17±4.00）,P=0.001;CD4^＋：（10.49±1.42）vs（13.94±2.02）,P=0.008],CD4^＋/CD8^＋比值有所升高[（1.12±0.03）vs（0.97±0.09）,P=0.001]。结论创伤失血性休克大鼠出现炎症反应和T淋巴细胞免疫功能下降,应用生脉注射液能明显提高创伤失血性休克大鼠T淋巴细胞的免疫功能,降低炎症反应。     

氨氯地平对轻中度高血压患者血小板参数的影响

目的探讨氨氯地平治疗对轻中度高血压患者血小板4项参数的影响。方法采用全血细胞自动分析仪检测60名原发性1、2级高血压患者治疗4周前后血小板4项参数指标：血小板计数（PLT）、平均血小板体积（MPV）、血小板分布宽度（PDW）和血小板压积（PCT），统计分析其数据变化。结果治疗前2级高血压组与1级高血压组比较，血小板参数PLT、MPV和PDW均有不同程度增高（P〈0．05）。氨氯地平治疗能使治疗后上述4项指标较治疗前均降低，PLT：1级组（183．3±29．8）×10^9／L比（153．3±25．7）×10^9／L（P〈0．05），2级组（224．1±33．3）×10^9／L比（184．4±33．3）×10^9／L（P〈0．05）；MPv：1级组9．9±1．5比8．1±0．9fL（P〈0．05），2级组13．1±1．6比9．7±1．1 fL（P〈0．05）；PDW：1级组15．0±1．4比13．2±1．4fL（P〈0．05），2级组16．4±1．1比14．1±1．2fL（P〈0．05）：PCT：1级组0．20％±0．03％比0．18％±0．02％（P〈0．05），2级组0．21％±0．03％比0．19％±0．03％（P〈0．05）。结论氨氯地平治疗能降低血小板4项参数，改善血压升高所致的前血栓状态。     

不同强度预处理方案用于系列不明急性白血病异基因造血干细胞移植的疗效比较

目的 分析两种不同强度预处理方案对系列不明急性白血病(ALAL)异基因造血干细胞移植(allo-HSCT)的疗效.方法 回顾性分析南方医科大学附属南方医院血液内科2002年3月至2010年8月38例ALAL患者临床资料.标准清髓性预处理方案为全身放疗+环磷酰胺或白消安+环磷酰胺;超强预处理方案为氟达拉滨+阿糖胞苷+全身放疗+环磷酰胺.移植物抗宿主病(GVHD)预防在人白细胞抗原(HLA)全相合相关移植患者用环孢素A(CsA)+甲氨蝶呤(MTX),HLA不相合相关移植及无关移植患者采用CsA+MTX+抗胸腺细胞球蛋白和(或)霉酚酸酯.COX模型分析影响长生存的因素.结果 19例患者接受标准预处理方案;19例接受超强预处理方案.移植后38例患者均获造血重建,5年累计总体总生存(OS)和无病生存(DFS)率分别为35.5%和25.7%;标准预处理组和超强预处理组5年0s率分别为20.2%与48.1%(P=0.233)、DFS为6.5%与43.1%(P:0.031).38例患者移植后5年白血病累计复发率为58.9%,标准预处理组和超强预处理组分别为87.6%和30.4%(P=0.003).COX单因素分析显示:超强预处理及慢性GVHD为DFS的保护因素(P=0.001、0.031).结论 在allo-HSCT中应用超强预处理能改善ALAL患者的生存及减少复发,移植物抗白血病效应对ALAL患者具有一定疗效.

Abstract：

objective To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT)in the conditionings of different intensities for acute leukemias of ambiguous lineage(ALJAL). Methods A total of 38 ALAL patients were treated with two conditionings of different intensities in our hospital from March 2002 to August 2010. The standard conditioning included TBI+Cy or Bu+Cy,intensified conditioning included Fludarabine+Ara-C+TBI+Cy. Cyelosporine A(CsA)and methotrexate (MTX) were administered in patients with human leukocyte antigen-matched sibling donor. And CsA, MTXplus antihuman thymocyte globulin and/or mycophenolate were used in all patients with HLA-A-mismatched related donor and unrelated donors transplants for graft-versus-host disease(GVHD)prophylaxis. COX regression was used to evaluate the prognostic factors of ALAL Results Among 38 ALAL patients,19received the standard conditioning while another 19 the intensified conditioning. All patients achieved hematopoietic reconstitution. The 5-year overall survival(OS)and the disease-free survival(DFS)were 35. 5%and25. 7%respectivelv. The 5-year OS rates were 20. 2%and48. 1%(P=0. 233)and DFS 6. 5%and 43. 1%(P=0. 031)in the standard and intensified conditioning groups respectively. The 5-year cumulative relapsing incidence was 58. 9%in all patients and 87. 6% vs 30. 4% in the standard and intensifted conditioning groups respectively(P=0. 003). Through a COX regression model for univariate analysis, the intensified conditioning and chronic GVHD were protective factors for DFS (P = 0. 001,0. 031 ). Conclusions The intensified conditioning in ALAL patients undergoing allo-HSCT may improve the long-term patient survival and decrease the relapse of leukemia. The graft versus leukemic effect has some efficacy in ALAL patients undergoing allo-HSCT.     

重组人白介素-11治疗血液恶性肿瘤化疗后血小板减少的临床观察

目的 观察重组人白细胞介素-11(rhIL-11)治疗血液肿瘤化疗后血小板减少症的临床疗效和毒副反应.方法 应用自身对照方法,对22例血液肿瘤患者分为第1周期(对照期)单用化疗、第2周期(观察期)化疗后加rhIL-11,rhIL-11的用量1.5mg/d,连续6～15d,观察血小板最低值、持续天数及不良反应.结果 观察...     

重组人血小板生成素与重组人白介素-11促进白血病患者异基因造血干细胞移植后血小板恢复的疗效比较

目的比较重组人血小板生成素(rhTPO)与重组人白介素-11(rhIL-11)对促进白血病患者异基因造血干细胞移植术后血小板恢复的临床疗效及安全性。方法将114例行异基因造血干细胞移植的白血病患者分为IL-11组、TPO组和空白组,分别为36例、56例和22例,IL-11组及TPO组从移植后第6天开始分别给予rhIL-11 1.5 mg/d及rhTPO 15 000 u/d皮下注射,至血小板上升至100×109/L停药,如使用14 d未达正常亦停用。空白组患者不应用任何升血小板药物,血小板自然恢复。监测血常规并观察记录患者用药后的不良反应及30 d内血小板悬液输注量。结果IL-11组、TPO组和空白组血小板由最低恢复至≥20×109/L的中位时间分别为+13(8～20)d、+12(6～25)d和+19.5(12～32)d,IL-11组、TPO组的恢复时间均快于空白组(P值分别为0.003,0.001),但IL-11组和TPO组两组没有统计学差别(P=0.640);IL-11组、TPO组和空白组血小板由最低恢复至≥50×109/L的中位时间分别为+16.5(10～39)d、+15(11～48)d和+29(15～49)d,IL-11组、TPO组的恢复时间均快于空白组(P值分别为0.002,0.001),IL-11组和TPO组两组亦没有统计学差别(P=0.357);IL-11组、TPO组和空白组血小板由最低恢复至≥100×109/L的中位时间分别为+25(13～69)d、+18(14～48)d和+43(19～64)d,IL-11组、TPO组的恢复时间均快于空白组(P值分别为0.001,0.004),TPO组较IL-11组缩短7 d,两组差异有统计学意义(P=0.033)。+30 d内IL-11组、TPO组及空白组输注血小板悬液的中位数量分别为2(0～6)个治疗量、2(0～4)个治疗量和4(1～4)个治疗量,IL-11组和TPO组的血小板悬液输注量均少于空白组(P值分别为0.005,0.003),但该两组之间差异无统计学意义(P=0.499)。TPO组的不良反应发生率3.6%明显低于IL-11组的77.8%(P<0.001)。结论 rhTPO及rhIL-11均能够促进白血病患者异基因造血干细胞移植术后血小板计数的恢复,有效减少血小板悬液的输注量,降低移植出血相关风险;rhTPO较rhIL-11能缩短血小板升至正常的时间,从而提高患者对移植并发症的耐受性;rhTPO较rhIL-11的不良反应更少,具有良好的安全性,值得临床进一步推广应用。     

造血干细胞移植后硬皮病样慢性移植物抗宿主病的临床表现

目的探讨异基因造血干细胞移植（allo-HSCT）后硬皮病样慢性移植物抗宿主病（ScGVHD）的发病率、危险因素。方法 对我院2012 年1 月~2014 年12 月之间进行allo-HSCT 的259 例患者发生ScGVHD 的情况进行回顾性分析。结果134 例 （51.7%）发生慢性移植物抗宿主病（cGVHD）,其中22例为硬皮病型,即ScGVHD在移植患者中的发病率为8.49%（22/259）、在 cGVHD患者中的发病率为16.4%（22/134）。ScGVHD出现的中位时间为移植后12.5（4~28）月。单因素分析结果提示预处理方 案是否含全身照射（TBI）（P=0.031）、GVHD预防方案是否含霉酚酸酯（MMF）（P=0.046）、cGVHD（P=0.008）的发生、供者淋巴 细胞回输（DLI）（P=0.001）均与ScGVHD的发生具有相关性。多因素分析确定cGVHD[相对危险度（RR）=3.512,95%可信区间 （CI）=1.235~9.987,P=0.018]和DLI（RR=5.217,95% CI=1.698~16.029,P=0.004）为ScGVHD 发病的独立危险因素。结论 ScGVHD是移植后一种较为少见的并发症,移植物抗宿主病（GVHD）和DLI是其发病的独立危险因素。     

150例异基因造血干细胞移植治疗恶性血液病的疗效分析

目的：分析异基因造血干细胞移植（allo-HSCT ）治疗恶性血液病的疗效及安全性,探讨移植相关并发症及影响预后的因素。方法回顾性分析2010年6月至2015年6月贵州医科大学附属医院造血干细胞移植中心行 allo-HSCT 的150例恶性血液病患者的病历资料。按照供者类型不同,将其分为同胞全相合移植组（n＝52）和单倍体移植组（n＝98）。所有患者均采用改良白消安／环磷酰胺（BU ／CY）为预处理方案,单倍体移植组加用兔抗人胸腺细胞免疫球蛋白（ATG）,移植物抗宿主病（GVHD）的预防采用短疗程甲氨蝶呤＋环孢素 A ＋吗替麦考酚酯,对150例患者疗效、安全性及移植相关并发症进行分析。结果150例患者经血型、染色体或 DNA 多态性检测证实均达到完全供者细胞植入,同胞全相合移植组平均中性粒细胞及血小板重建时间为移植后12 d 和16 d ,单倍体移植组平均中性粒细胞及血小板重建时间为移植后13 d 和16 d 。150例患者中,59例（39．3％）患者出现口腔黏膜溃疡,47例（31．3％）患者移植后100 d 内发生细菌和（或）真菌感染,41例（27．3％）患者移植后100 d 内发生巨细胞病毒感染,48例（32．0％）患者发生急性 GVHD ,43例（28．7％）患者发生慢性 GVHD 。随访1～60个月,中位随访时间23个月。115例（76．7％）患者无病存活,其中同胞全相合移植组38例（73．1％,38／52）,单倍体移植组77例（78．6％,77／98）。35例（23．3％,35／150）患者死亡,其中同胞全相合移植组死亡14例（26．9％,14／52）,单倍体移植组死亡21例（21．4％,21／98）。死因分析发现,12例（8．0％）因移植相关并发症死亡,其中5例（3．3％）因严重感染,7例（4．7％）因急性 GVHD ;23例（15．3％）患者因原发病复发死亡。两组患者生存率及死亡率比较差异无统计学意义（P＞0．05）。结论 allo-HSCT 治疗恶性血液病安全有效,单倍体移植的疗效与安全性接近全相合移植,急性 GVHD 和感染是严重影响移植疗效和预后的危险因素,需早期预防。