体外药物敏感试验对ⅢA期非小细胞肺癌新辅助化疗的临床预测价值探讨

目的 探讨体外药物敏感试验对ⅢA期非小细胞肺癌新辅助化疗的临床价值. 方法 64例ⅢA期非小细胞肺癌患者,其中32例应用MTT法检测癌细胞对抗癌药的敏感性,根据药敏结果对患者进行新辅助化疗,无敏感药物者按经验方案化疗:另外32例同期患者按经验方案化疗,观察实验与临床结果的相关性. 结果 应用体外药敏试验评估体内用药效果的敏感性为81.8%(18/22),特异性为70.0%(7/10),总预测准确率为78.1%(25/32).阳性预测值为85.7%(18/21),阴性预测值为63.6%(7/11).药敏阳性组与经验组临床疗效比较差异有显著性(X2=8.14,P<0.05),药敏组与经验组两组手术切除率比较差异显著(X2=4.27,P<0.05). 结论 应用体外药物敏感试验指导ⅢA期非小细胞肺癌新辅助化疗具有重要的临床意义.     

改良MTT法检测胃肠癌体外化疗药物敏感性

目的 探讨胃肠癌对常用化疗药物的敏感性。方法 应用改良ＭＴＴ法进行了化疗药物的体外药敏试验。结果 病人对所测化疗药物以中度敏感为主,不同病例对同一药物的敏感性不同,有其各自的耐药谱。结论 根据体外药敏试验实行个体化用药方案,可提高临床化疗疗效。     

体外药物敏感实验为依据的恶性脑胶质瘤个体化化疗初步研究

目的:建立胶质瘤细胞体外原代培养模型,利用MTT法进行体外药物敏感实验,为临床化疗方案的设计提供理论指导,实施个体化化疗.方法:32例术后病理证实为胶质瘤(WHO Ⅲ级)的新鲜标本,制备肿瘤单细胞悬液进行体外原代培养,与7种抗肿瘤药物在临床血浆峰值浓度(PPC)条件下作用72小时,MTT法标记存活的肿瘤细胞,用酶标仪检测光密度值(OD),计算出抑制率(IR),检测不同肿瘤个体对化疗药物的敏感和耐药情况,从而指导临床个体化化疗方案的制定.另选取同期符合上述入选标准的20例间变型星形细胞瘤患者作为对照组,按照VM-26加DDP方案经验化疗,化疗4个疗程结束后,复查影像学,按照WHO肿瘤疗效评价标准评价治疗效果,分为稳定(SD),进展(PD),缓解(PR).结果:32例临床标本的原代培养及药敏试验,其PPC下的抑制率(IR％)＞50％者,DDP有20例；VCR有9例；VM-26有12例；VP-16有17例；Procarbazine有7例；BCNU有6例；Taxol有3例；其敏感性依次为:DDP＞VP- 16＞VM-26＞VCR＞ Procarbazine＞BCNU ＞Taxol.根据体外药物敏感实验结果制定个体化化疗方案治疗29例,肿瘤缓解率为47.2％,对照组为29.4％,2组x2检验统计P＜0.05.结论:7种常用的抗肿瘤药物均有耐药的情况,进行化疗药物的敏感测定可以避免耐药药物的使用.根据体外药物敏感实验结果制定个体化化疗方案化疗与对照组相比近期疗效较满意.     

FA方案治疗复发难治性成人急性淋巴细胞白血病的临床研究

[目的]观察氟达拉滨联合大剂量阿糖胞苷(FA)方案治疗复发难治性成人急性淋巴细胞白血病(ALL)的临床疗效及不良反应。[方法]22例难治性ALL患者,根据病程分为4个组。1个月为1个疗程,氟达拉滨30mg/m2/d,阿糖胞苷2.0g/m2/d静脉滴注共3d。将所有的患者按发病情况进行分组,比较FA方案针对不同临床情况的ALL患者的治疗情况。[结果]从完全缓解(CR),部分缓解(PR),总缓解(OR)(CR+PR),无效(NR)4个指标对四组的临床疗效做整体评价。对于第1疗程化疗缓解但是早期复发者效果好于≥2次复发的患者,用FA治疗疗效有差异P﹤0.01。FA方案对于早期复发和晚期复发患者疗效不同。对于晚期复发者效果更好。[结论]FA方案对成人难治复发ALL的治疗缓解率相对较高,不良反应可以接受,是成人难治复发性AL首选治疗方案之一。     

FCMR方案联合沙利度胺及局部放疗治疗难治复发套细胞淋巴瘤临床观察

目的 探讨FCMR方案(氟达拉滨+环磷酰胺+米托蒽醌+利妥昔单抗)联合沙利度胺及局部放疗治疗难治复发套细胞淋巴瘤(MCL)的临床效果.方法 13例经CHOP方案治疗后无效或复发的MCL患者,7例采用FCMR方案联合沙利度胺及局部放疗治疗(FCMR组),6例采用常规化疗(常规化疗组).结果 FCMR组中完全缓解3例,部分缓解3例,无效1例.2年生存5例.7例患者未出现严重不良反应.常规化疗组仅2例部分缓解,无一例完全缓解.结论 FCMR方案联合沙利度胺及局部放疗治疗难治复发的MCL效果较满意,不良反应可耐受,值得临床借鉴.     

急性白血病患者化疗后继发感染性休克的临床研究

目的探讨急性白血病(AL)患者化疗后继发感染性休克的临床特点、病原菌分布及耐药性,为临床防治提供参考。方法分析1210例住院治疗的AL患者继发感染性休克的临床资料。结果 1210例AL患者5763次住院化疗后共发生感染性休克45例,均为应用强化疗方案后,其中30例(66.7%)发生于复发难治再次诱导缓解治疗,死亡18例(40.0%),其中复发难治再次诱导治疗15例(83.3%);检出病原菌主要是大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌等革兰阴性杆菌,耐药率高;通过抗休克、抗感染治疗,AL得到完全或部分缓解患者感染性休克可以得到有效控制。结论感染性休克多出现在复发难治AL再次诱导缓解化疗、强化疗方案治疗后,对此类患者要高度警惕继发感染性休克;及时积极有效的抗感染、抗休克治疗是控制感染性休克的关键。     

应用体外化疗药物敏感检测技术指导卵巢肿瘤个体化化疗的可行性研究

目的:探讨应用ATP-肿瘤化学敏感检测(ATP-TCA)技术指导卵巢肿瘤患者的临床个体化化疗的可行性。方法:采用ATP-TCA法检测11例卵巢肿瘤手术标本对8种联合化疗方案的敏感性。结果:11例标本中有10例成功进行了ATP-TCA检测,ATP-TCA的可评价率为91%;所测标本的体外敏感率较高的是:DDP+ADM、PTX+DDP、VCR+ACTD、DDP+VCR+BLM、PTX+CBP,强敏感率均达60%以上;上皮性卵巢癌最为敏感化疗方案的是CAP,其体外有效率达83.3%(5/6)。结论:ATP-TCA法是一种敏感、客观的肿瘤药敏检测技术,是开展卵巢肿瘤个体化化疗的一种重要的体外药物筛选方法。     

沙利度胺联合常规化疗方案治疗急性白血病的临床疗效及对患者免疫水平的影响

目的 探讨沙利度胺联合常规化疗方案治疗急性白血病的临床疗效及对患者免疫水平的影响.方法 将60例急性白血病患者随机分为研究组(n=30,沙利度胺+常规化疗)和常规组(n=30,常规化疗),比较两组的疾病缓解率、免疫水平及不良反应情况.结果 研究组疾病缓解率为93.33％,高于常规组的70.00％(P<0.05).治疗后...     

药物敏感试验对泌尿生殖道支原体感染治疗作用

目的探讨泌尿生殖道支原体感染的临床治疗防止耐药支原体菌株产生的有效方法。方法186例患者分为A、B两组,A组97例为泌尿生殖道感染,未做过药敏试验,经验用药后临床症状不减轻而就诊者;B组89例初诊支原体感染患者;两组患者均经支原体培养确诊并做药敏试验,根据药敏试验结果用药治疗1个疗程(14 d),随访观察治疗效果。结果临床分离的支原体菌株对3大类9种药物的耐药率:四环素类、喹诺酮类药物两组间差异无统计学意义;大环内酯类药物A组患者耐药率显著高于B组;按药敏试验结果治疗1个疗程,A组97例患者中,痊愈率77.3%,显效率(以痊愈、显效患者计)88.7%;B组89例患者中,痊愈率85.4%,显效率96.6%,两组间差异无统计学意义(P>0.05)。结论不规范用药可导致支原体耐药率上升,根据药敏试验结果用药治疗支原体感染效果好、疗程短。     

急性白血病患者乳酸脱氢酶水平变化及临床价值

目的检测急性白血病患者及正常人的血清乳酸脱氢酶水平,分析其临床价值。方法采用国际标准酶法测正常人(对照组)和急性白血病患者化疗前(化疗前组)、化疗后完全缓解者(CR组)及缓解后复发者(复发组)的乳酸脱氢酶水平,并进行比较。结果急性白血病患者化疗前及缓解后复发者乳酸脱氢酶水平明显升高,与对照组比较有统计学意义。完全缓解后乳酸脱氢酶水平下降,与对照组比较无统计学意义。复发时,血清乳酸酶水平又升高。结论乳酸脱氢酶能反映体内肿瘤细胞的负荷,且临床操作方便,有助于临床医生对病人病情的判断及随访。     

人脑星形细胞瘤原代细胞体外化疗药物敏感性实验研究

目的应用偶氮噻唑蓝比色法(MTT),检测常用化疗药物卡莫司丁(BCNU)、替尼泊甙(VM26)、多柔比星(ADM)、顺铂(CDDP)、环磷酰胺(CTX)单用及联合应用对人脑星形细胞瘤(AT)细胞的敏感性,比较不同类型(高分级,低分级,原发,复发)星形细胞瘤细胞对化疗药物敏感性的差别,以期对AT术后化疗提供合理、个性化的用药依据。方法 44例不同类型人脑星形细胞瘤细胞(术后病理证实为AT),在CO2培养体系中进行体外原代培养,差速贴壁法将其分离纯化,应用免疫荧光技术检测脑胶质纤维酸性蛋白(GFAP)对其鉴定;在分离纯化鉴定后的AT细胞中,加入不同浓度的化疗药物进行干预,MTT法测光密度值(OD值),计算敏感率。结果 38例AT标本成功进行了体外培养,培养成功率86%,高分级AT培养成功率最高;五种药物对AT细胞的抑制范围差异性很大,敏感性均不同;不同作用机制的药物联合应用对AT的敏感率高于其单一药物,单用与联合间有显著性差异(P<0.05);高分级及复发AT细胞对单一药物的敏感率均高于低分级及原发AT细胞,高分级与低分级间、原发与复发间差异有统计学意义(P<0.05),而联合用药时,高分级与低分级间、原发与复发间均无差异性(P>0.05)。结论 AT细胞可在体外成功地培养、纯化及鉴定,培养成功率与肿瘤病理类型密切相关;不同肿瘤个体对药物敏感性差异很大,联合用药可提高药物的敏感性,化疗药物对高分级及复发AT的敏感性比对低分级及原发的高;临床上应根据药敏结果,选择敏感性药物,行个体化化疗,以提高疗效,最大限度地减少副反应及肿瘤复发。     

CD_9及P_(170)在白血病诊治中的表达及其临床意义

目的探讨CD9及P170在白血病患者中的表达与分型、疗效、预后的关系。方法采用SAP法检测了53例白血病患者CD9及P170的表达。结果①淋系白血病(T-ALL、B-ALL及CLL)CD9表达较高,阳性率达52%,与对照组(5.5%)比较差异显著(P<0.01),其中B-ALL表达CD9(73%)高于T-ALL(28%)及CLL(33%)(P<0.05)。②髓系白血病CD9的表达率为59%,特别高表达于M3(82%)、M5(88%)及CML(67%),与对照组比较差异显著(P<0.01)。③白血病NR或复发组P170表达(83%)明显高于CR或PR组(15%)及对照组(11%)(P<0.01)。④白血病CD9及P170的表达之间无相关性(r=0.038,P>0.05)。结论CD9可作为M3及B-ALL的一个鉴别诊断指标,了解白血病P的表达对判断预后及选择化疗方案具有一定指导价值。     

Prognostic significance of age and karyotype in the treatment of acute myeloid leukemia: results at our center

INTRODUCTION: Treatment outcome in patients with acute myeloid leukemia are determined by prognostic factors. AIM AND METHODS: Between January 1996 and December 2001 160 patients were treated with newly diagnosed acute myeloid leukemia. Treatment results were analysed according to the age and cytogenetics. Different types of induction and postremission protocols were applied. The median age was 42.2 +/- 12.8 (16-60) years. RESULTS: Complete remission was reached in 113 (70.6%) patients. 25/160 (15.6%) individuals were refractory to treatment, 22/160 (13.8%) patients died within one month. One hundred and ten out of 113 who went into remission were given postremission therapy. Twelve out of 50 relapsed patients achieved a second complete remission. The complete remission rate and cumulative survival of patients below the age of forty years were significantly higher than of those above the age of 40 years. Four fifths of refractory patients as well as nearly all patients with secondary leukemia were older than 40 years. Similarly to studies published in the literature, the expected survival was the best in patients who had a favourable cytogenetics. In contrast, all patients who fell into the unfavourable cytogenetic group died within three years. Intensification of the postremission treatment resulted in an improved survival. CONCLUSION: Classification of acute myeloid leukemia and careful determination of prognostic factors are necessary at the time of diagnosis. This predicts outcome, as well as provides means for application of individualized therapy.     

老年急性白血病临床特点及个体化治疗分析

目的对老年急性白血病的临床特点及个体化治疗进行分析。方法选取老年急性白血病患者80例,按照第一次诱导缓解中化疗药物的用量将患者分为标准或亚标准计量组(A组)和小剂量组(B组),对两组患者的治疗效果进行综合评价。结果A、B两组患者完全缓解(CR)率分别为22.5%和45.0%,总有效率分别为57.5%和80.0%,平均生存时间分别为(175.6±20.3)d和(203.9±29.4)d,平均骨髓抑制持续时间分别为(22.4±6.3)d和(12.5±4.6)d,以上差异均具有统计学意义(P<0.05);不良反应发生率分别为92.0%和88.0%,差异无统计学意义(P>0.05)。结论老年急性白血病患者对化疗的耐受性较差,早期的死亡率比较高,生存时间短,需要对患者实施个体化治疗。     

中医药在急性白血病巩固治疗期的应用研究

目的探讨中医药在急性白血病巩固治疗期的应用研究。方法选取我病区收治的158例急性白血病完全缓解患者按随机化原则分为2组。对照组79例给予单纯西医治疗,观察组79例给予中西医结合治疗,对比两组患者的治疗效果。结果观察组患者治疗中骨髓抑制13.3%、胃肠道反应13.3%、发热20.0%、感染6.7%等毒副作用的发病率明显小于对照组的骨髓抑制26.7%、胃肠道反应33.3%、发热33.3%、感染33.3%,两组比较差异有统计学意义（P〈0.05）。结论急性白血病患者巩固化疗期间加用中医药联合治疗可以有效地缓解化疗药物的毒性作用,提高患者的化疗缓解率、生活质量以及化疗耐受生,具有较好的临床应用意义,值得推广应用。     

Randomized, double-blind, controlled study of glycyl-glutamine-dipeptide in the parenteral nutrition of patients with acute leukemia undergoing intensive chemotherapy

OBJECTIVE: Glutamine has stimulatory effects on lymphocytes and mucosa cells in vitro and, when given with parenteral nutrition, has been shown to improve the clinical course of patients after bone marrow transplantation and in the critically ill. This study investigated the clinical and immunologic effects of parenteral glycyl-glutamine supplementation in patients with acute leukemia receiving intensive conventional chemotherapy without bone marrow transplantation. METHODS: A randomized, double-blind, controlled study compared a standard glutamine-free parenteral nutrition with a glycyl-glutamine-supplemented parenteral nutrition (Glamin, Baxter, Erlangen, Germany) containing 20 g of glutamine in adult patients with acute myeloid leukemia undergoing myelosuppressive chemotherapy. Clinical end points included the duration of neutropenia and the incidence and duration of neutropenic fever. To analyze the effects of glutamine on immunocompetent cells, CD4+ and CD8+ T cells and HLA-DR expression on monocytes were assessed by flow cytometry throughout the treatment course. RESULTS: Fifty-four adult patients entered the study and were randomized. In 45 of 127 chemotherapy cycles, parenteral nutrition was given, and 40 cycles (20 with and 20 without glutamine) were evaluated for comparison. The median durations of neutropenia were 18 d (range, 9-29 d) in the glutamine group and 22.5 d (range, 13-48 d) in the control group (P = 0.052), whereas the median durations of neutropenic fever were 5.5 d (range, 0-13 d) and 5 d (range, 0-31 d), respectively (P = 0.74). Using Kaplan-Meier analysis and controlling for the type of chemotherapy, we found a significantly faster neutrophil recovery in patients receiving glutamine than in the control group (P = 0.040) in patients receiving a high-dose cytarabine regimen. There was no significant difference in the recovery of CD4+ or CD8+ lymphocytes or monocyte activation between groups. CONCLUSION: In patients with acute myeloid leukemia requiring parenteral nutrition, glycyl-glutamine supplementation could hasten neutrophil recovery after intensive myelosuppressive chemotherapy. However, no impact of glutamine on neutropenic fever or other criteria of immunologic recovery was detected.     

Evaluación económica de rituximab en combinación con fludarabina y ciclofosfamida en comparación con fludarabina y ciclofosfamida en el tratamiento de la leucemia linfática crónica

Objectives

We evaluated the cost-effectiveness of rituximab added to the chemotherapy regimen of fludarabine plus cyclophosphamide (R-FC) versus fludarabine plus cyclophosphamide (FC) for the treatment of patients with previously untreated or relapsed/refractory chronic lymphocytic leukemia (CLL).

Methods

Two Markov models were built, using published results on progression-free survival (PFS) in patients receiving first- or second-line therapy with R-FC vs FC, rates of disease progression and mortality rates in Spain. Patient-elicited utilities were applied to PFS and progressed health states. The cost of drugs, supportive care, and quality-adjusted life years (QALY) were estimated over a 10-year period. Univariate and probabilistic (Monte Carlo) sensitivity analyses were performed.

Results

The addition of rituximab to chemotherapy in first- and second-line therapy increased life-years gained (LYG) and QALYs compared with chemotherapy. The incremental cost per LYG and QALY gained was €20,703 and €19,343 for first-line treatment and was €23,183 and €24,781 for second-line treatment.

Conclusion

In patients with previously untreated or relapsed/refractory CLL, the addition of rituximab to the FC regimen increased life expectancy and quality-adjusted life expectancy. In both types of patient, the treatment was cost-effective.     

口腔念珠菌病患者口内菌株分型及药敏观察

摘要:目的　探讨口腔念珠菌病患者口内菌株分型及体外药物敏感性。方法　采用CHROMagar念珠菌培养基进行菌株分离鉴定,采用丹麦Rcsco公司的纸片扩散法（Neo-Sensitabs抗真菌药敏纸片）测定两性霉素B（AMB）,氟康唑（FCZ）,5-氟胞嘧啶（5-FC）,伊曲康唑（ITC）,酮康唑（KTC）5种抗真菌药的体外药敏情况。结果　实验组和对照组口腔念珠菌检出率分别为 70.00%,20.00%,其中白色念珠菌分别占69.05%,50.00%,5种药物对口腔念珠菌的体外试验敏感性均在90%以上。结论　口腔念珠菌病仍以白色念珠菌感染为主,治疗时应进行真菌常规菌种鉴定及药敏试验以指导临床用药。     

卡前列素氨丁三醇治疗难治性产后出血90例临床观察

目的观察卡前列素氨丁三醇(欣母沛)治疗难治性产后出血的临床价值和安全性。方法选择因宫缩乏力性产后出血患者90例,在常规治疗(缩宫素、米索前列醇片等)无效后,宫颈注射或宫体注射卡前列素氨丁三醇,观察阴道出血减少情况及药物的不良反应。结果 90例患者中81例效果显著(90.00%),8例有效(8.89%),1例无效(1.11%),子宫收缩痛15例(16.67%),恶心、呕吐、腹泻9例(10.00%)。结论卡前列素氨丁三醇对难治性宫缩乏力性产后出血疗效显著,安全。     

两性霉素B治疗血液病合并真菌性败血症的护理体会

目的 探讨血液病合并真菌性败血症时应用两性霉素B过程中的并发症及其护理,以提高其在应用过程中的安全性。方法 对异基因造血干细胞移植3例(SAA 2例、ALL1例)和白血病化疗后7例(CLL2例、M55例),出现真菌性败血症时应用长程(1～3个月)的两性霉素B治疗,总剂量为1750～3115 mg,观察其疗效和并发症,且对并发症采用药物预防和护理。结果 9例患者治愈,1例自动出院,绝大部分患者在治疗的早期有畏寒和寒颤,半数患者出现低钠和低钾血症、恶心、呕吐消化道症状,少数患者出现肝肾功能的轻度损害和一过性的心律失常、低血压和静脉炎 经(?)应的药物和护理处理后均能控制。结论 预防和早期发现并发症并予有效的治疗和护理是两性霉素(?)用药的关键。