桥本甲状腺炎合并甲状腺癌的危险因素回归分析

目的 探讨桥本甲状腺炎（HT）合并甲状腺癌的危险因素。方法 采用回顾性病例对照研究,选取59 例HT 合并甲状腺癌患者为病例组,按照1∶2比例选取118 例HT 合并甲状腺良性结节或单纯HT 患者为对照组,对相关因素进行单因素和多因素logistic 回归分析。结果 单因素分析显示甲状腺疾病家族史、碘摄入情况、辐射接触史、甲状腺自身抗体和合并单发结节为HT 合并甲状腺癌的影响因素。经多因素分析家族史、高碘摄入、辐射接触史为HT 合并甲状腺癌的危险因素,其OR 值（95%CI）分别为2.141（1.664~2.755）、2.479（1.895~2.936）和4.596（3.693~4.997）。结论 HT 合并甲状腺癌发病机制有待于进一步研究,应针对危险因素(家族史、碘摄入情况、辐射接触史)采取措施进行早防早治。     

急性髓系白血病患者化疗后引起医院感染的相关因素分析

目的分析急性髓系白血病(AML)患者化疗后住院期间引起感染的相关因素,并探讨其预防措施。方法 166例AML患者接受化疗554例次,回顾性分析所有患者的病历资料,对其年龄、中性粒细胞绝对值、粒细胞缺乏持续时间与医院感染发生率的关系进行分析。结果年龄60岁者医院感染发生率明显高于年龄60岁者(75.6%vs.32.9%,P0.05)。ANC最低值0.5×109/L者医院感染发生率明显高于ANC最低值0.5×109/L者(89.0%vs.53.0%,P0.05)。粒细胞缺乏持续时间7d者医院感染发生率明显高于粒细胞缺乏持续时间≤7d者(95.7%vs.79.2%,P0.05)。结论年龄、中性粒细胞缺乏及持续时间是导致AML患者化疗后医院感染的危险因素,针对这些危险因素采取有效预防措施对降低AML患者化疗后医院感染率十分必要。     

乳腺癌化疗相关性肝损伤的研究进展

【摘要】 乳腺癌是目前世界上女性最常见的恶性肿瘤之一。化疗作为乳腺癌患者全身治疗的重要组成部分常引发患者肝功能损伤。肝损伤反过来又会影响乳腺癌的治疗与预后。本文就乳腺癌化疗相关性肝损伤的发生机制、诊断、危险因素及防治原则进行综述,对预测其发生、指导其防治具有重要意义。     

IgE myeloma associated with plasma cell leukaemia

A patient presented with plasma cell leukaemia and was found to have an IgE secreting multiple myeloma. IgE myeloma is very rare with only 18 cases recorded. However, this case is the fifth recorded of IgE myeloma associated with plasma cell leukaemia. Since plasma cell leukaemia only occurs in 1.6% of all cases of myeloma, it seems certain that this is a significant association.     

Kaposi's sarcoma associated with hairy cell leukaemia

The case is described of a patient with hairy cell leukaemia who later developed Kaposi''s sarcoma. This association has not been reported before and the coexistence of hairy cell leukaemia with another tumour is very rare. The implications of this unusual association are briefly discussed.     

含去甲氧柔红霉素化疗方案治疗急性淋巴细胞白血病的疗效观察

目的观察含去甲氧柔红霉素化疗方案治疗急性淋巴细胞白血病（ALL）的疗效及副作用。方法收集2005年1月-2008年8月我科收治的初治急性淋巴细胞性白血病31例,按照诱导方案分成去甲氧柔红霉素IOLP组及柔红霉素DOLP组。比较两组CR率及化疗毒副作用发生率。结果IOLP组及DOLP组CR率为（94．44％＆76．92％,P〈0．05）。两组不良反应发生率类似,恶心、呕吐及腹泻发生率10LP组低于DOLP组。IOLP组骨髓抑制时间较DOLP组长。结论去甲氧柔红霉素联合化疗治疗ALL能达到较好的缓解率,骨髓抑制时间较长。     

Primary malignant neoplasms associated with chronic lymphocytic leukaemia

The relationship between chronic lymphocytic leukaemia (CLL) and primary malignant neoplasms was evaluated using data from the Hematology Division in Beilinson Medical Center and the Israel Cancer Registry. The study population consisted of 81 patients diagnosed between 1962 and 1984. A total of 16 patients were found to have 21 malignant neoplasms in addition to their CLL. Excluding patients with nonmelanoma skin tumours, a 1.7 increased risk (statistically not significant) for developing second malignant neoplasms in CLL patients was detected. The only tumour which occurred significantly more than expected subsequent to CLL diagnosis was brain cancer. The coexistence of multiple cancers in the same patient was diagnosed in four of the patients. The results of this study further support the hypothesis that patients with CLL are prone to develop second neoplasms.     

甲地孕酮减轻胃癌化疗相关性呕吐的临床观察

目的研究甲地孕酮在胃癌化疗中减轻呕吐的作用。方法对第一周期化疗中发生Ⅲ、Ⅳ度呕吐的40例胃癌患者进行研究,于第二周期化疗时加用甲地孕酮160 mg/d,观察用药后呕吐症状的变化。结果呕吐程度减轻,甲地孕酮总有效率为65%,其中对Ⅲ、Ⅳ度呕吐的有效率分别为52%、86.6%。结论甲地孕酮具有减轻胃癌化疗性呕吐的作用,对重度呕吐的效果更明显。     

宫颈癌调强放射治疗同步化学药物治疗骨髓抑制的相关因素分析

目的  探讨调强放射治疗（IMRT）同步化学药物治疗（以下简称化疗）宫颈癌过程中出现严重骨髓抑制的相关因素。方法  回顾性分析126例IMRT同步化疗的宫颈癌患者资料。纳入分析的因素包括年龄、肿瘤临床分期、体力状况、放化疗前血细胞计数、治疗前肌酐水平、放疗前是否接受化疗、是否有骨髓抑制、盆腔外照射总量、盆腔骨髓平均剂量、骨髓剂量体积（V30,V40和V50）及同步化疗方案与化疗周期。结果  单因素分析显示,3、4度骨髓抑制与放疗前是否接受化疗、是否有骨髓抑制、盆腔骨髓平均剂量、V40及V50有关（P <0.05）。多因素分析显示,盆腔骨髓平均剂量[■=1.004（95%CI：1.001,1.007）]、V40（<41% vs ≥41%）[■=0.123,（95%CI：0.031,0.487）]和V50（<9% vs ≥9%）[■=0.040,（95%CI：0.013,0.128）]与3、4度骨髓抑制相关。结论  盆腔骨髓V40<41%和V50<9%是宫颈癌患者同步放化疗（CCRT）3、4度骨髓抑制发生率降低的相关因素。盆腔骨髓平均剂量是骨髓抑制发生率增高的相关因素,盆腔骨髓平均剂量越高,骨髓抑制发生率越高。严格控制盆腔骨髓放疗照射的体积及剂量,能减少宫颈癌患者骨髓抑制的发生,是顺利完成IMRT同步化疗的保障。

     

肺癌化疗患者发生肺部感染危险因素的Meta分析

目的 系统评价肺癌患者化疗后发生肺部感染的危险因素。方法 系统检索中国知网、万方、维普、PubMed、Embase和the Cochrane Library从建库至2022年10月公开发表的有关肺癌患者化疗后发生肺部感染的危险因素的病例对照研究和队列研究。由2名研究者独立进行文献筛选、资料提取和质量评价,采用RevMan5.3软件进行Meta分析。结果 共纳入15篇文献,3960例肺癌化疗患者。Meta分析结果显示,年龄≥60岁、吸烟史、饮酒史、高血压、糖尿病、肺不张、低蛋白血症、TNM分期为Ⅲ～Ⅳ期、中央型肺癌、小细胞肺癌、侵入性操作、化疗前卡氏功能状态评分<80分、联合使用化疗药物、化疗时间>2周、化疗后白细胞计数≤3.0×10⁹/L、化疗后白蛋白<30g/L和住院天数>20d均是肺癌患者化疗后肺部感染的危险因素(P<0.05)。结论 肺癌化疗患者发生肺部感染的危险因素较多,应依据其相关危险因素采取预防与控制措施,减少肺部感染的发生。     

Acute myeloblastic leukaemia associated with solitary plasmacytoma of the ilium

A 72 year old man developed acute myeloblastic leukaemia two years after he had been treated with local curative therapy and chemotherapy for a solitary plasma cytoma of the ilium.     

Immunotherapy with chemotherapy in the maintenance of remission in acute myeloblastic leukaemia.

Thirteen patients with acute myeloblastic leukaemia or one of its variants in remission have been given maintenance treatment with a combination of chemotherapy and immunotherapy. Chemotherapy was given for one week in four, and immunotherapy was given during the intervening three weeks. The immunotherapy consisted of BCG vaccine given by Heaf gun, and snap-frozen pooled allogeneic irradiated leukaemic cells. The median duration of survival was 147 weeks, and the median duration of the first complete remission was 76 weeks. It is difficult to compare these results with other figures reported, but they add to the evidence which suggests that immunotherapy is of value in the maintenance treatment of patients with this disease. Further controlled trials are necessary.     

Palmar-plantar erythema associated with combination chemotherapy.

We report three cases of a distinctive palmar-plantar erythema associated with the treatment of non-Hodgkin''s lymphoma and acute myeloid leukaemia. The rash is characterized by a painful, sharply demarcated, intense erythema of the palms and/or soles followed by bulla formation, desquamation and healing. The eruption is self limiting in nature and did not adversely affect prognosis. Treatment need be neither altered nor stopped; only symptomatic measures are required.     

Recent experience with intensive combination chemotherapy for treatment of childhood acute lymphoblastic leukaemia

Forty-eight children with acute lymphoblastic leukaemia (ALL) who presented to the Oncology Department of Our Lady’s Hospital for Sick Children, Crumlin, Dublin over a 52 month period were treated using a schedule modified from the BFM-81 protocol. All patients achieved remission within four weeks. With a minimum follow up period of 18 months, actuarial disease free survival was 68% and overall survival 75%. Mean hospital stay throughout the treatment period was 31 days. While these results represent an improvement in overall survival compared with historical controls, careful selection of risk categories will be the major aim of future studies so that more appropriate treatment can be instituted for high risk patients while minimising therapy for low risk disease.     

GSTP1多态性与乳腺癌新辅助化疗缓解和毒性反应差异相关

Background  Although chemotherapy is one of the most important treatments of breast cancer, it is limited by significant inter-individuval variations in response and toxicity. The metabolism of epirubicin (EPI) and cyclophosphamide (CTX) is mainly mediated by cytochrome P450s (CYPs) and glutathione S-transferases (GSTs). It has been well-known that the activities of these enzymes are polymorphic in population due to their genetic polymorphisms. The aim of this research was to examine the effects of genetic polymorphisms in CYP3A, GSTP1 and MDR1 genes on treatment response and side-effects of breast cancer patients receiving EPI/CTX chemotherapy.

Methods  One hundred and twenty patients with stage II or III invasive breast cancer were recruited and treated with three to four cycles of EPI 80 mg/m² and CTX 600 mg/m² every two weeks. The AJCC TNM staging system (sixth edition) was used to evaluate the pathological response of primary tumor and axillary lymph nodes. The genotypes of gene polymorphisms were determined by using PCR-restriction fragment length polymorphism methods.

Results  Patients carrying GSTP1 ¹⁰⁵Ile/Val or ¹⁰⁵Ile/Ile genotype were more likely to have good response (OR, 0.40; 95% CI, 0.16−0.96; P=0.024) and light toxicity (OR, 0.35; 95% CI, 0.13−0.78; P=0.006) than those carrying ¹⁰⁵Val/Val genotypes. The response to the treatment was not correlated with estrogen receptor, progesterone receptor and Her2/neu status of tumors. No correlation was found between toxicity effect and patient’s age, tumor staging, menopause status, and dose intensity of the drugs.

Conclusion  GSTP1 polymorphism was associatiated with the chemotherapy response or adverse effects of EPI and CTX regimens.

     

Incomplete Reiter's syndrome following chemotherapy of acute myeloid leukaemia

Reiter's syndrome and other reactive arthritides have been described following infection with various organisms although they can occur in unusual circumstances without an obvious infectious precipitant. We have recently witnessed two attacks of reactive arthritis and keratoderma blenorrhagica occurring in an HLA B27 adult male following chemotherapy on two separate occasions with the same drugs for acute myeloid leukaemia. No attacks occurred before or following the cessation of these drugs. This supports the view that in Reiter's syndrome a common pathogenic pathway is triggered by an 'arthritogenic factor' which in this case appears to have been chemical.