田间作业致有机磷农药中毒与口服中毒的临床比较

目的 探讨田间作业中毒和口服有机磷农药中毒在临床表现及治疗上的差异.方法 回顾性分析我院2007年7月至2010年7月收治的85例中、重度急性有机磷农药中毒患者的临床资料,按中毒途径分为口服组(51例)和非口服组(34例),比较不同途径中毒后的临床表现、治疗特点及预后.结果 口服组中度中毒患者的肌颤肌痉挛和共济失调的发生率(86.4%、90.9%)均明显高于非口服组(50.0%、55.0%),差异有统计学意义(P＜0.05,P<0.01);口服组重度中毒患者的肺水肿、肌颤肌痉挛及昏迷的发生率(100.0%、89.7%、93.1%)均明显高于非口服组(71.4%、64.3%、50.0%),差异有统计学意义(P<0.05 ).非口服组解毒时间[中度:(35.0±6.2)h、重度:(45.0±11.1)h]较口服组[中度:(49.0±7.7)h、重度:(77.0±10.3)h]明显缩短,差异有统计学意义(P＜0.05).治疗后24、48、72 h,中、重度非口服组胆碱酯酶活力明显高于口服组,差异有统计学意义(P<0.05或P<0.01);中、重度非口服组的氯磷定用量、阿托品化用量及阿托品总量明显低于口服组,差异有统计学意义(P＜0.05或P<0.01).结论 田间作业有机磷农药中毒在临床表现上与口服中毒不尽相同,且治疗的阿托品及氯磷定用量相对较少,胆碱酯酶活力恢复较快.

Abstract：

Objective To investigate the differences of clinical manifestation and therapy of organophosphorus pesticide poisoning (OPP) between oral exposure and occupational exposure in field work. Methods From July 2007 to July 2010, 85 patients with acute severe OPP were treated in a hospital, which were divided into oral poisoning group (51 cases) and non-oral poisoning group (34 cases). The differences of clinical manifestations, curative effects and prognosis between two groups were compared. Results The rates of myoclonus and ataxia in cases with moderate poisoning of oral poisoning group were 86.4% and 90.9%, which were significantly higher than those (50.0% and 55.0% ) of non-oral poisoning group (P<0.05 or P< 0.01). The rates of myoclonus, lung fluid and coma in cases with severe poisoning of oral poisoning group were 100.0%, 89.7% and 93.1%, respectively, which were significantly higher than those (71.4%, 64.3% and 50.0%) of non-oral poisoning group (P<0.05). The mean detoxification hours in cases with moderate poisoning and cases with severe poisoning of non-oral poisoning group were (35.0±6.2) and (45.0±11.1) hours which were significantly lower than those [(49.0±7.7) and (77.0±10.3) hours] in cases with moderate poisoning and cases with severe poisoning of oral poisoning group (P<0.05). In 24, 48 and 72 h after treatment, the cholinesterase (ChE) activities of non-oral poisoning group were higher than those of oral poisoning group (P< 0.05 or P<0.01). The used doses of pyraloxime methylchloride (PAM-Cl) or atropine and the used total dose of atropine in non-oral poisoning group were lower than those in oral poisoning group (P<0.05 or P<0.01). Conclusions The clinical manifestation of non-oral poisoning group is different from the clinical manifestation of oral poisoning group due to the high morbidity of OPP occurred at field site in summer. The used doses of atropine and PAM-Cl are less and the ChE activity recovers quickly for non-oral poisoning group.     

急性淋巴细胞白血病患儿骨髓间充质干细胞对K562细胞株药物耐受性的影响

Objective To study the effect of acute lymphoblastic leukemia (ALL) children bone marrow mesenchymal stem cells (MSCs) on the resistance of K562cell atd mechanism in vitro.Method MSCs were obtained from AL children bone marrow after derivation, cultivation and identification.The coculture of MSCs and K562 and K562 suspension were established.Effects of MSCs on the growth of K562 cells were investigated in vivo.The two kinds of cells treated with different concentration of adriamycin (ADM) and the rate of apoptosis was evaluated by flow cytometry.Cell cycle was determined by flow cytometry.RT-PCR was used to detect Bcl-2 and Bax in K562 cells.Result Compared with the cell growth curve of K562 alone, the K562 cell co-cultured with MSCs grew slower and the exponential phase of growth was not obvious.The apoptosis index of the K562 cells co- clutured with MSCs was (9.19 ±0.53)% examined by flow cytometry, and that of the K562 cells alone was 4.00 ± 0.37% respectively( P ＜ 0.05 ).The percentage of cells at G0/G1 phase was (50.2 ± 2.26) % and that at S phase was (37.03 ± 3.50) % in the group of K562 alone, but those of the K562 cells co - cultured with MSCs were (80.95 ± 3.83) % and ( 17.40 ± 1.50)% respectively( P ＜0.05).The result of RT-PCR suggested expression of Bcl-2/Bax of the K562 cell co-cultured with MSCs was higher than K562 alone.Conclusion ALL children MSCs suppressed the growth of K562 cell in vitro.Adhesion made K562 depress sensitive to ADM.The mechanism was perhaps caused by adhesion with MSCs, K562 cell cycle was changed and related to Bcl-2 gene high level expression.     

血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

急性淋巴细胞白血病患儿骨髓间充质干细胞对K562细胞株药物耐受性的影响

Objective To study the effect of acute lymphoblastic leukemia (ALL) children bone marrow mesenchymal stem cells (MSCs) on the resistance of K562cell atd mechanism in vitro.Method MSCs were obtained from AL children bone marrow after derivation, cultivation and identification.The coculture of MSCs and K562 and K562 suspension were established.Effects of MSCs on the growth of K562 cells were investigated in vivo.The two kinds of cells treated with different concentration of adriamycin (ADM) and the rate of apoptosis was evaluated by flow cytometry.Cell cycle was determined by flow cytometry.RT-PCR was used to detect Bcl-2 and Bax in K562 cells.Result Compared with the cell growth curve of K562 alone, the K562 cell co-cultured with MSCs grew slower and the exponential phase of growth was not obvious.The apoptosis index of the K562 cells co- clutured with MSCs was (9.19 ±0.53)% examined by flow cytometry, and that of the K562 cells alone was 4.00 ± 0.37% respectively( P ＜ 0.05 ).The percentage of cells at G0/G1 phase was (50.2 ± 2.26) % and that at S phase was (37.03 ± 3.50) % in the group of K562 alone, but those of the K562 cells co - cultured with MSCs were (80.95 ± 3.83) % and ( 17.40 ± 1.50)% respectively( P ＜0.05).The result of RT-PCR suggested expression of Bcl-2/Bax of the K562 cell co-cultured with MSCs was higher than K562 alone.Conclusion ALL children MSCs suppressed the growth of K562 cell in vitro.Adhesion made K562 depress sensitive to ADM.The mechanism was perhaps caused by adhesion with MSCs, K562 cell cycle was changed and related to Bcl-2 gene high level expression.     

血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

目的 探讨血液灌流(hemoperfusion,HP)结合连续性静脉-静脉血液滤过(continuous venovenous hemofiltration,CVVH)对于急性百草枯中毒患者的疗效.方法 急性百草枯中毒患者91例随机分成HP组(49例)和HP后给予CVVH治疗组(HP-CVVH组,42例),比较两组患者的病死率、存活时间和死亡原因.结果 HP组病死率为59.2%(29/49),HP-CVVH组为61.9%(26/42),两组比较,差异无统计学意义(χ2=0.070,P=0.791).HP-CVVH组患者中毒至死亡时间为(4.9±3.1)d,明显长于HP组[(3.5±2.0)d],差异有统计学意义(t=2.026,P=0.049).HP组和HP-CVVH组中毒后4 d内死亡构成比分别为62.1%(18/29)和30.8%(8/26),HP组和HP-CVVH组中毒至死亡＞4 d的构成比分别为37.9%(11/29)和69.2%(18/26),差异有统计学意义(χ2=5.388,P=0.020).HP-CVVH组患者出现中毒至低氧血症时间为(4.3±2.5)d,明显长于HP组[(3.2±1.9)d],差异有统计学意义(t=2.033,P=0.047).HP组呼吸衰竭导致死亡的发生率为20.4%(10/49),明显低于HP-CVVH组(40.5%,17/42),差异有统计学意义(χ2=4.365,P=0.037);HP组患者急性肾衰竭的发生率为63.3%(31/49),明显高于HP-CVVH组(40.5%,17/42),差异有统计学意义(χ2=4.712,P=0.030).结论 HP结合CVVH可减少急性百草枯中毒的早期死亡,延长病死患者的存活时间,降低急性肾衰竭的发生率,但无法降低总体病死率.

Abstract：

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

腺苷蛋氨酸治疗白毒伞中毒的初步探索

目的 观察腺苷蛋氨酸(SAMe)治疗白毒伞中毒的临床疗效.方法 回顾性分析12例白毒伞中毒病例资料,按是否使用SAMe治疗分为两组:A组接受洗胃、导泻、补液、利尿、护肝、抗感染及血液净化等治疗;B组在A组治疗的基础上加用SAMe.比较两组病例中毒后第1、3、5及7天肝功能变化及病死率.结果 A组6例患者中毒后2人死亡,病死率为33.3%(2/6),2例死亡病例的天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)在3、5 d持续增加(5 d时＞2000 U/L),在7 d下降;总胆红素(TBIL)则3、5及7 d持续增加.B组6例患者中毒后无死亡病例.SAMe治疗后7 d,TBIL下降,5例ALT升高,3例AST降低.结论 腺苷蛋氨酸可能对降低白毒伞中毒的病死率起到重要作用.

Abstract：

Objective To observe the curative effects of transmetil on Amanita verna poisoning.Methods Twelve cases with Amanita verna poisoning were reviewed. The patients were divided into 2 groups according to usage of transmetil: Group A was treated with traditional protocol (gastric lavage, catharsis,rehydration, diuresis, anti-infection and hemodialysis), Group B was treated with traditional protocol combined with transmetil. The liver function changes on the 1st, 3rd, 5th and 7th day after poisoning and the mortality were compared between 2 groups. Results Two cases in group A (6 patients) died. The mortality of group A was 33.3%. The AST levels continued to increase on the 3rd and 5th day, but decreased on the 7th day. TBIL continued to increased on the 1st, 3rd, 5th and 7th day. None in group B died. The TBIL level dropped at 7 d 5 patients showed an increase in ALT at 7 d and 3 patients showed a decrease in AST at 7 d.Conclusion Transmetil may play an important role in reducing the mortality of Amanita vema poisoning.     

p53基因甲基化和突变与燃煤污染型砷中毒关系研究

目的 探讨燃煤砷污染对人体p53基因甲基化(启动子区及第5外显子)和突变(第5外显子)的影响,分析其与燃煤型砷中毒的关系.方法 在贵州省兴仁县燃煤型砷中毒病区选择112例砷中毒患者,根据病情将其分为轻度中毒组(38例)、中度中毒组(43例)和重度中毒组(31例);根据有皮肤病理学诊断患者(43例)的病理结果,将其分为非癌变组(24例)和癌变组(19例).选择条件相似的非砷暴露村90名居民作为对照组.在知情同意原则下,采集上述观察对象的外周血,应用限制性内切酶-PCR法检测p53基因启动子区及第5外显子甲基化情况,应用PCR-单链构象多态性技术及PCR产物克隆测序技术检测p53基因第5外显子突变情况.结果 p53基因启动子区甲基化阳性率在轻、中、重度组分别为13.16%(5/38)、27.91%(12/43)、45.16%(14/31),与对照组[1.11%(1/90)]比较差异均有统计学意义(χ2值分别为8.679、23.690、41.199,P值均＜0.017);在非癌变组和癌变组分别为25.00%(6/24)和63.16%(12/19),与对照组[1.11%(1/90)]比较差异均有统计学意义(χ2值分别为18.762、57.497,P值均＜0.025).p53基因第5外显子甲基化阳性率在轻、中、重度组分别为55.26%(21/38)、51.16%(22/43)、48.39%(15/31),与对照组[88.88%(80/90)]比较差异有统计学意义(χ2值分别为18.151、23.168、22.420,P值均＜0.017);在非癌变组和癌变组分别为54.17%(13/24)和42.11%(8/19),与对照组[88.88%(80/90)]比较差异有统计学意义(χ2值分别为15.201、22.075,P值均＜0.025).p53基因第5外显子突变率在轻、中、重度组分别为5.26%(2/38)、16.28%(7/43)、25.81%(8/31),中、重度组与对照组(0.00%)比较差异均有统计学意义(χ2值分别为15.465、24.870,P值均＜0.017);在非癌变组和癌变组分别为16.67%(4/24)、31.58%(6/19),与对照组(0.00%)比较差异均有统计学意义(χ2值分别为15.545、30.077,P值均＜0.025).启动子区高甲基化与第5外显子突变相关(列联系数为0.294,P＜0.05);第5外显子低甲基化与第5外显子突变相关(列联系数为0.410,P＜0.05).结论 燃煤砷污染可致人体p53基因启动子区高甲基化、第5外显子低甲基化和突变,上述甲基化改变均与p53基因突变相关联;p53基因甲基化改变可能是砷致p53基因突变以及砷致病或致癌的重要原因之一.

Abstract：

Objective To explore the influence of arsenic pollution caused by coal-burning on methylation(promoter and exon 5 ) and mutation (exon 5 ) of human p53 gene, and to analyze the relationship between methylation, mutation and arsenism. Methods According to the diagnostic criteria of endemic arsenism, 112 patients with arsenism (including 38 mild cases,43 moderate cases and 31 severe cases) were selected in the areas with endemic arsenism from Xingren, Guizhou province. Among the subjects ,43 cases were diagnosed by dermatopathological methods, and they were divided into non-cancerous group (24 cases) and cancerous group ( 19 cases ). 90 controls were selected from the non-arsenic polluted areas. Under the principle of informed consent, blood samples were collected from individuals. The methylation of p53 gene in promoter region and exon 5 were detected by extinction enzyme-PCR,the mutation of p53 gene (exon 5 ) was detected by PCR-SSCP,PCR products cloning and sequencing technology. Results The positive rates of methylation of p53 gene in promoter region were 13. 16% ( 5/38 ), 27.91% ( 12/43 )and 45. 16% (14/31) respectively among mild, moderate and severe arsenism group, which were obviously higher than the rates in the control group (1.11% (1/90), χ2 values were 8.679,23.690, 41. 199,respectively,both P values ＜ 0. 017 ). The positive rates of methylation of p53 gene were 25.00% (6/24)and 63. 16% (12/19)in non-cancerous and cancerous group respectively, which were obviously higher than those in the control group ( 1. 11% (1/90) ,χ2 values were 18. 762,57. 497,respectively,both P values ＜0. 025 ). The positive rates of methylation of p53 gene ( exon 5 ) were 55.26% ( 21/38 ), 51. 16% ( 22/43 )and 48. 39% (15/31)respectively among mild, moderate and severe arsenism group,which were obviously lower than the rates in the control group ( 88. 88% ( 80/90 ), χ2 values were 18. 151 , 23. 168,22. 420,respectively, both P values ＜ 0. 017 ). The positive rates of methylation of p53 gene (exon 5 ) were 54. 17%(13/24) and 42. 11% (8/19) in non-cancerous and cancerous group respectively, which were obviously lower than those in the control group ( 88. 88% (80/90), χ2 values were 15. 201,22. 075, respectively, both P values ＜ 0. 025 ). The mutation rates of p53 gene ( exon 5 ) were respectively 5. 26% ( 2/38 ), 16. 28%(7/43) and 25.81% (8/31 )among mild, moderate and severe arsenism group; while the results in moderate and severe arsenism group were obviously higher than in the control group (0. 00% ,χ2 values were 15.465,24. 870,respectively,both P values ＜ 0. 017). The positive rate of mutation of p53 gene ( exon 5 ) were respectively 16. 67% (4/24) and 31.58% ( 6/19 ) in non-cancerous and cancerous group, which were obviously higher than it in the control group (0. 00%, χ2 values were 15. 545,30. 077, both P values ＜0. 025). The hypermethylation of p53 gene in promoter region was related with the mutation of p53 gene ( exon 5) ( coefficient of association was 0. 294, P value ＜ 0. 05 ); and the hypomethylation of p53 gene (exon 5 ) was related with the its mutation ( coefficient of association was 0. 410, P value ＜ 0. 05 ).Conclusion Arsenic pollution caused by coal-burning can cause the hypermethylation of p53 gene in promoter region, hypomethylation and mutation of p53 gene ( exon 5 ), and the changes of methylation of p53 gene are related with its mutation and might be one of the important etiological factors of arsenic pathogenicity or carcinogenesis.     

降钙素对大白兔糖尿病骨质疏松模型假体骨密度及生物力学的影响

Objective To investigate the influence of calcitonin on bone mineral density and biomechanics around the artificial pros-thesis in ovariectomized diabetic rabbit model. Methods Fourteen femina New Zealand white rabbits at the age of 5 months old were select-ed, which weight 2.24 -2.65kg, averaging 2.26kg. First, the model of rabbit with diabetic osteoporosis was successfully established by the compound method of ovariectomy plus streptozotocin. Osteotomy in the middle part of femur was performed in both groups, fixation of artifi-cial prosthesis was done with 3.0 kirschner wire. After that, Rabbit models with diabetic osteoporosis were randomly divided into experimen-tal group and control group. Rabbits in the experimental group were treated with calcitonin 6U intramuscular injection once every other day. In control group, intramuscular injection of normal saline solution 1.5ml once every three days. Rabbit models of two groups were sacrificed in the 24th week. The BMD of the region of interest (ROI) around the prosthesis were detected before experiment and 8, 16 and 24 weeks after injection. After rabbits were killed, experimental femurs in both groups were complete removal and soft tissues were rejected. Determi-nation of the pull-out and torsion bone biomechanics experiments of prosthesis was done in both groups respectively. Results The BMD of ROI in the experimental group before operation was (0.1863±0.004)g/cm2 and (0.1753±0.005)g/cm2 in 24 weeks after operation, in control group before operation was (0.1865±0.002)g/cm2 and (0.1638±0.005)g/cm2 in 24 weeks after operation. There were significant difference between the two groups(P < 0.05). Biomechanical show that the pull-out strength in the experimental group was (312.68±8.73 )N/cm2 and (205.43±12.45 ) N/cm2 in control group. There were significant difference between the two groups(P < 0.05). The tor-sion strength in experimental group was (80.47±2.51) N/cm2 and (38.52±0.64) N/cm2 in control group. There were significant differ-ence between the two groups(P < 0.05). Conclusion Salmon calcitonin can reduce the bone turnover rate around prosthesis and decrease bone absorption in the rabbit of diabetic osteoporosis models, accelerate the bone formation around prosthesis, and increase the BMD. It can ameliorate the quality of bone around prosthesis, improve its biomechanics property, and increase the holding power between prosthesis and body mass. It is of clinical significance for the prevention and treatment of aseptic loosening artificial prosthesis.     

2005年厦门市三起雪卡毒素中毒情况分析

目的 分析引发2005年厦门3起雪卡毒素中毒的原因及引发中毒的鱼种.方法 采集3起中毒案例中剩余的棕点石斑鱼及市场上其他深海鱼共7份,采用小鼠生物法、雪卡毒素免疫膜试剂盒测定雪卡毒素,同时提取中毒鱼肉组织中的mtDNA,采用PCR技术扩增细胞色素6(Cry b)部分序列片段并直接测序,将结果与CenBank数据库比对.结果 引发中毒的鱼肉中雪卡毒素检测呈阳性,小鼠生物实验毒性为0.11小鼠单位(MU)/g,提取的mtDNA扩增出475 bp大小的Cty b基因片段,与棕点石斑鱼(登录号 AY950695)的Cry b基因相似性达99%.其余6份样品均未检出雪卡毒素.结论 这3起中毒事件均是由于食用了含有雪卡毒素的棕点石斑鱼而引发的食物中毒.

Abstract：

Objective To find out the reason of three eiguatem fish poisoning cases in Xiaman in 2005 and identify the fish species.Methods The grouper implicated in food poisoning and seven other coral reef fishes collected from market were tested by mice bioassay and ciguatoxin-test kit.The mtDNA was extracted from toxic grouper meat,and Cty b gene segment was amplified and the PCR products were sequenced.The sequences were compared with those in the GenBank.Results The result turned out to be positive by the ciguatoxin-test kit,while the toxicity of the toxic grouper implicated in food poisoning was 0.11 mouse unit(MU)/g by mice bioassay.A 475 bp segments of Cty b gene was amplified by PCR and the sequence was 99% homologous with Epinephelus fuscoguttatus(GenBank:AY950695).No ciguatoxin in six grouper species collected from market was detected.Conclusion All three food poisoning cases were caused by consumption of ciguatoxin-carrying groupers.     

急性白血病患儿治疗期人体组成成分的变化

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

重度苯中毒骨髓检查及其临床诊断价值的研究

目的探讨骨髓涂片及活检对重度苯中毒的诊断和鉴别诊断意义.方法对46例重度苯中毒进行骨髓穿刺,取骨髓液及活体组织进行研究.结果 46例有23例骨髓像符合再生障碍性贫血(AA)的典型表现,11例为可疑AA.苯中毒患者的骨髓涂片中粒红比值、巨核细胞数量随着骨髓增生程度降低而降低.结论骨髓活检结合涂片检查对苯中毒的病情及诊断可作较为全面的综合评价.     

骨髓细胞学检查在全血细胞减少症中的诊断价值

目的探讨骨髓细胞学检查在全血细胞减少症中的诊断价值。方法对215例全细胞减少症患者行骨髓细胞学检查。观察骨髓有核细胞的增生程度及有无特殊细胞;观察骨髓的增生程度;观察红细胞、粒细胞、淋巴细胞、巨核细胞、浆细胞及网状细胞是否有减少或增多。结果本组215例全血细胞减少症患者经骨髓细胞学检查测定,其中骨髓增生异常综合征者41例,占19.07%;再生障碍性贫血者97例,占45.12%;白血病者33例,占15.35%;增生性贫血25例,占11.63%;骨髓纤维化者9例,占4.19%;多发性骨髓瘤者4例,占1.86%;骨髓转移癌者4例,占1.86%;诊断不确定者2例,占0.93%。明确诊断率99.07%。结论骨髓组织细胞学检查能较好地反映骨髓组织的结构及细胞分布情况,以便于临床明确诊断,减少误诊。     

苯接触后急性再生障碍性贫血的临床特点及其意义研究

目的探讨苯接触史急性再生障碍性贫血(AAA)的临床特点及意义。方法对1989～2004年我院收治的39例苯接触史AAA患者,按疗效分为有效组、无效组,与7例原发性AAA作比较,分析骨髓造血多项指标,并调查可能引起AAA的过去史。结果有效组患者的骨髓造血指标明显优于无效组及原发组,而无效组与原发组相似。部分苯接触史AAA病例用过氯霉素、解热镇痛药及患有肝炎。结论有效组属于苯中毒AAA,无效组可能为原发性AAA。苯接触史及良好的骨髓造血指标,对治疗有效,可作为苯中毒AAA的诊断依据。骨髓造血指标可判断此类患者的预后。     

Benzene and leukemia

Benzene is known as a severe bone marrow poison. In the last 40 years, however, more than 100 cases of leukemia attributed to benzene have been described besides cases of classical pancytopenia. It is possible that many cases of acute leukemia developing as a terminal stage of an aplastic anemia due to benzene have been missed in the past, when bone marrow puncture was not performed. Benzene leukemia is mostly an acute stem cell or myeloblastic leukemia, sometimes aleukemic; in some cases it has shown a pattern of an erythroleukemia. The Institutes of Occupational Health of Milano and Pavis have collected 25 cases of benzene leukemia, all of them acute. Chronic types of leukemia are also said to occur after exposure to benzene. There may be a latent period extending over several years between cessation of exposure to benzene with more or less pronounced anemia, and the onset of leukemia. Benzene is known to be a mutagenic agent inducing chromosomal aberrations, and this may lead to the development of an abnormal cell clones with selective growth advantage. It is also possible that benzene may activate a latent leukemogenic virus or produce an immunological impairment with proliferation of abnormal cell clones as a result of defective immune surveillance.     

研究环孢菌素A对再障病患骨髓细胞Fas表达及凋亡率的影响

目的：研究环孢菌素A（CsA）对再生障碍病患骨髓细胞Fas表达及凋亡率的影响。方法：从2010年2月-2013年2月,本院共计48例病患被确诊为再障。以数字法随机分成观察组24例和对照组24例,对照组以注射用丹参治疗,观察组在此基础上另以CsA治疗。对比两组疗效,分析CsA对于再障病患骨髓Fas表达情况和对MNC有关凋亡率影响。结果：观察组总有效率为83.33%（20/24）,显著高于对照组的37.50%（9/24）,比较差异有统计学意义（P〈0.05）。两组在治疗前后CD34＋Fas＋的细胞百分率相比,差异无统计学意义。观察组病患骨髓CD34-细胞的Fas表达和对照组相比,差异无统计学意义。观察组治疗后MNC有关凋亡率为（2.27±0.74）%,显著低于治疗前的（6.58±2.33）%,以及对照组治疗后的（2.92±1.20）%,比较差异均有统计学意义（P〈0.05）。结论：细胞Fas异常表达和再障发病情况有一定联系,以CsA治疗再障病患,可明显降低其骨髓MNC凋亡率,疗效显著,值得临床推荐。     

慢性苯中毒患者34例骨髓象的临床观察

目的　通过对慢性苯中毒患者骨髓象分析,了解其临床类型特点。方法　按诊断标准对患者进行分组诊断,３４ 例患者均进行骨髓穿刺,选取材、涂片、染色好的骨髓片计数有核细胞２００ 个,进行分类并观察细胞形态。结果　除２ 例再生障碍性贫血（ 简称再障） 患者外,其他患者均表现骨髓增生活跃或明显活跃,但各组患者粒红比值均数低于正常值均数。骨髓增生异常综合征（ Ｍ Ｄ Ｓ） 患者骨髓中原粒和早幼粒细胞百分率高于正常,分别为５ ．０８ 和７ ．８５（ 正常参考值分别为０ ．６４ 和１ ．５９） ,粒细胞和红细胞有细胞形态异常和核畸形。结论　慢性苯中毒可以导致 Ｍ Ｄ Ｓ,慢性重度苯中毒患者 Ｍ Ｄ Ｓ 发病率高于再障,应考虑将骨髓象检查列为苯中毒诊断的必要项目。     

慢性苯中毒100例骨髓检查报告

100例慢性苯中毒的骨髓象中,轻度增生减低81例,中度增生减低4例,轻度增生明显活跃15例;其中41例有轻重不等的细胞成熟障碍以及中毒性形态异常如毒性颗粒与空泡等。各例如骨髓细胞分类都见到中性分叶粒细胞增加,从正常的10%增加到20～30%;结合周围血液中中性粒细胞计数长期减少,表明慢性苯中毒的骨髓除了造血功能异常外,还有释放障碍。这些情况与一般再生障碍性贫血相似,但慢性苯中毒的骨髓变化较轻。     

Chemical of current interest--benzene

Benzene is one of the world's major commodity chemicals. It is derived from petroleum and coal and is used both as a solvent and as a starting material in chemical syntheses. The numerous industrial uses of benzene over the last century need not be recounted here, but the most recent addition to the list of uses of benzene is as a component in a mixture of aromatic compounds added to gasoline for the purpose of replacing lead compounds as anti-knock ingredients. The best known and longest recognized toxic effect of benzene is the depression of bone marrow function seen in occupationally exposed individuals. These people have been found to display anemia, leucopenia, and/or thrombocytopenia. When pancytopenia, i.e., the simultaneous depression of all three cell types, occurs and is accompanied by bone marrow necrosis, the syndrome is called aplastic anemia. In addition to observing this decrease in humans and relating it to benzene exposure, it has been possible to establish animal models which mimic the human disease. The result has been considerable scientific investigation into the mechanism of benzene toxicity. Although the association between benzene exposure and aplastic anemia has been recognized and accepted throughout most of this century, it is only recently that leukemia, particularly of the acute myelogenous type, has been related to benzene. The acceptance of benzene as an etiological agent in aplastic anemia in large measure derives from our ability to reproduce the disease in most animals treated with sufficiently high doses of benzene over the necessary time period. Unfortunately, despite extensive efforts in several laboratories, it has not been possible to establish a reproducible, reliable model for the study of benzene-induced leukemia. The recent demonstration that several animals exposed to benzene either by inhalation or in the drinking water during studies by Drs. B. Goldstein and C. Maltoni suggests that such a model may be forthcoming. Nevertheless, at this time it is not clear whether bone marrow damage of the type that leads to aplastic anemia is required for the development of leukemia. Most studies of benzene toxicity have involved dosing animals with benzene either by inhalation or by injection, using high doses to ensure a toxic response. Very few studies have concentrated on the oral route of administration and none have concentrated on administering benzene by mouth at the low doses occasionally detected in drinking water.(ABSTRACT TRUNCATED AT 400 WORDS)     

小儿再生障碍性贫血合并骨髓细胞病态造血现象的临床分析

目的 分析小儿再生障碍性贫血合并骨髓细胞病态造血现象.方法 选取资阳市第一人民医院2014年3月至2017年3月收治的40例再生障碍性贫血患儿作为A组,骨髓增生异常综合征患儿38例作为B组,再生障碍性贫血合并骨髓细胞病态造血患儿30例为C组,另选择同时期收治的来院体检的35例健康儿作为对照组,A组、B组及C组患儿采用对应的治疗方法,测定并比较治疗前后CD34+、叶酸及维生素B12的水平.结果 治疗前,A组、B组、C组与对照组相比CD34+、叶酸及维生素B12的水平均较低,C组与A组、B组相比CD34+降低更加显著,A组与B组相比CD34+降低更加显著,差异具有统计学意义(t=2.34~6.57,均P<0.05),A组、B组及C组叶酸及维生素B12的水平分别相比无明显差异(t=0.87~1.01,均P>0.05);治疗后,A组、B组及C组CD34+、叶酸及维生素B12水平均有所升高,但低于对照组,差异具有统计学意义(t=4.90~6.38,均P<0.05).A组、B组及C组治疗后CD34+、叶酸及维生素B12的水平相比无明显差异(t=0.56~0.88,均P>0.05).结论 小儿再生障碍性贫血合并骨髓细胞病态造血的血清学指标具有特殊,建议对患儿的血清叶酸及维生素B12的水平进行合理的检测和针对性治疗.     

Molecular study of Fanconi anemia in Tunisia

Fanconi anemia (FA) is an autosomal recessive rare disease characterized by progressive pancytopenia, congenital malformations and predisposition to acute myeloid leukemia. Fanconi anemia is genetically heterogeneous, with at least eight complementation groups of FA (FAA to FAD2). In order to characterize the molecular defects underlying FA in Tunisia, fourty-one families were genotyped with microsatellite markers linked to known FA gene. Haplotype analysis and homozygosity mapping showed that 92% of these families belong to FAA group. We demonstrated the effectiveness of the molecular analysis for a better selection of bone marrow graft donor and for the evaluation of chimerism after bone marrow transplantation. This study also allows genetic counselling for FA family members.