血小板计数对细菌性肝脓肿患者预后判定的临床价值

目的:研究血小板计数对细菌性肝脓肿患者预后判定的临床价值.方法:经肝脏CT或MRI平扫加增强和肝脏穿刺确诊的细菌性肝脓肿(平均直径为6.54 cm)患者(n=112),入院后每天1次血常规,3天1次B超,应用血小板的动态检测研究细菌性肝脓肿患者的预后.结果:血小板计数1 wk内达到最高值≥400×109/L共43(38.39%)例,＜400×109/L共22(19.64%)例,＞1 wk达到最高值≥400×109/L共29(25.89%)例,＜400×109/L共18(16.07%)例.血小板计数1 wk内达到高峰值的患者预后明显优于＞1 wk的患者(P＜0.05),≥400×109/L的患者预后明显优于＜400×109/L的患者(P＜0.05).结论:血小板计数可作为衡量细菌性肝脓肿预后的重要指标之一.     

FLT3-ITD突变高等位基因比率在急性髓系白血病中的预后意义

目的:探讨FLT3-ITD突变高等位基因比率在急性髓系白血病(AML)患者中的预后意义.方法:筛选100例检测到FLT3-ITD等位基因比率的AML初诊患者的临床资料,对其临床特征及预后因素进行统计学分析.结果:100例患者初诊时中位白细胞计数为80.1×109/L(2×109/L～326×109/L),中位骨髓原始细...     

骨髓增生异常综合征-难治性中性粒细胞减少1例及文献复习

目的:总结1例骨髓增生异常综合征-难治性中性粒细胞减少(MDS-RN)患者的诊疗体会.方法:对1例MDS-RN患者进行形态学、细胞化学、染色体核型分析,并用流式细胞术检测免疫表型,同时进行融合基因多重PCR扩增.结果:患者血常规示白细胞0.86×109/L,中性粒细胞绝对值0.25×109/L,红细胞3.86×1012...     

超声引导经皮脾内注射鱼肝油酸钠治疗肝硬变性脾功能亢进13例

1材料和方法 1.1材料男11例,女2例,年龄14岁～61岁,肝功能A级4例,B级6例,C级3例.都有食管静脉曲张.脾脏肋下3 cm～10 cm.常有出血症状、体征18例次.血小板(Pt)数(21～64)×109/L,白细胞(WBC)计数(2.4～3.4)×109/L,血红蛋白(Hb)70 g/L～135 g/L,骨髓穿刺检查排除了血液病,且骨髓中出现相应的外周血细胞系的幼稚细胞过度增生.     

异体输血感染恶性原虫报告1例

<正>患者,男,28岁,软件工程师,河南巩义市人,在南京工作。2013年5月27日,因持续高热至江苏省中医院就诊。入院查体:急性病容,脸色苍白,体温39.8℃。血常规检查:血红蛋白86 g/L,红细胞计数3.2×1012/L,白细胞计数7.2×109/L,血小板计数18×109/L,外周血中可见原始单核细胞和幼稚单核细胞为34%。骨髓细胞学检查:骨髓增生活跃,可见幼稚单核细胞和早幼粒细胞为57%。临床诊断为急性单核细胞性白血病,于当日入院开始化疗。患者住院化疗期间出现严重贫血,血红蛋白最低降至60g/L,     

淋巴细胞绝对数减少在非霍奇金淋巴瘤中的临床意义

目的:探讨非霍奇金淋巴瘤(NHL)患者初发时淋巴细胞绝对数(ALC)与其临床特征的相关性,并探讨其预后参考价值。方法:回顾性分析2007年1月-2010年10月间我院新确诊的210例NHL患者的临床特征,结合随访资料,分析不同ALC水平与NHL患者各临床特征及其预后的相关性。结果:在本组NHL病例中,中位年龄58岁,结外淋巴瘤占有一定比例(47.1%)。ALC中位数为1.2(0.1～13.9)×109/L,25%～75%的置信区间分界值为(0.7～1.8)×109/L。我们发现,ALC<1.2×109/L时,其与患者的年龄、性别、淋巴瘤类型、临床分期、IPI预后指数、骨髓浸润、贫血等临床特征并无显著相关性,但常伴有LDH水平的升高,且表现B症状,而此类患者临床缓解率相对较低,死亡率较高(P<0.05)。继续以ALC<1.0×109/L作为分界点时,除上述特点外,年龄差异开始具有统计学意义,ALC减少更多见于老年淋巴瘤患者(P<0.01)。最后以ALC<0.7×109/L作为临床分界点时,ALC减少的NHL患者除了涵盖上述临床特点外,T细胞淋巴瘤所占比例也明显升高(P<0.01),此类患者临床分期更晚,IPI积...     

小剂量利妥昔单抗治疗原发性干燥综合征继发血小板减少四例疗效观察

目的 初步评价小剂量利妥昔单抗治疗原发性干燥综合征(pSS)继发血小板减少的疗效与安全性.方法 4例pSS继发血小板减少患者,2例为难治性血小板减少,2例为糖皮质激素依赖性血小板减少,静脉滴注利妥昔单抗100 mg,每周1次,共2次,同时联合泼尼松1～2 mg·kg-1·d-1治疗.观察血小板和外周血B细胞的变化.结果 4例患者治疗前血小板水平为(3 ～39)×109/L,小剂量利妥昔单抗治疗后,血小板于1～2周内上升,3～8周内恢复至(107～241)×109/L,维持缓解27 ～52周.12周内泼尼松减为3.75 ～7.50 mg/d并维持.1例患者于第27周时复发,血小板降至47×109/L,再次静脉滴点利妥昔单抗100 mg,4周后血小板升至81 x 109/L.4例患者外周血B细胞降至(0.007 ～0.010)×109/L,但未达清除状态.输注过程中均无严重不良反应发生.结论 小剂量利妥昔单抗可用于治疗pSS继发血小板减少,减少糖皮质激素用量,部分清除B细胞.     

溃疡性结肠炎合并自身免疫性溶血性贫血一例

患者男,26岁.2004年8月无明显诱因出现腹泻,解黏液脓血便4～6次/d,轻度里急后重感,自服抗生素效果不佳.2005年2月初,患者发现面色发黄,尿呈深黄色,就诊外院.查血象:WBC 14.6×109/L,Hb 66 g/L,红细胞压积0.21,红细胞平均体积(MCV)130.0 fl(正常值80～94 fl),红细胞平均血红蛋白含量(MCH)40.9 Pg(正常值20～32pg),红细胞平均血红蛋白浓度(MCHC)314 g/L(正常值320～360 g/L),PLT 295×109/L,网织红细胞(Ret)0.40.     

急性早幼粒细胞白血病分化综合征临床特征及对预后的影响研究

目的探讨急性早幼粒细胞白血病(APL)分化综合征(DS)的临床特征和影响预后的因素。方法收集中山大学附属第一医院2003—2010年收治的97例APL患者,采用维甲酸或维甲酸联合三氧化二砷(ATO)双诱导治疗,初诊者诱导分化治疗后WBC≥5×109/L联合化疗,完全缓解后采用ATO联合常规化疗巩固治疗方案。结果27例(27.83%)并发DS,出现DS中位时间为诱导分化治疗第6(2～24)天,其中24例(88.89%)发生在第1、2周。27例DS均给予地塞米松治疗,其中12例暂时停用诱导分化剂患者DS症状均缓解,15例继续使用者2例(7.41%)病情恶化死亡。中位随访37个月,DS组与未并发DS组患者无病生存(LFS)差异无统计学意义(P=0.269)。分析与DS发生的相关因素表明DS更多见于初诊WBC>10×109/L患者(χ2=4.994)。结论初诊WBC>10×109/L患者易并发DS,DS主要发生在诱导分化治疗前2周,DS对长期预后无影响。     

系统性红斑狼疮合并中枢神经系统感染的临床特点分析

目的 分析系统性红斑狼疮(SLE)合并中枢神经系统(CNS)感染的临床特点及相关危险因素.方法 对18例诊断为SLE合并CNS感染的患者和随机抽取的36例SLE患者的临床资料进行回顾性分析.结果 CNS感染组与对照组在大剂量激素冲击(22%与3%,P<0.05),1年内日平均激素用量[(35±18)mg/d与(24±17)mg/d,P<0.05],外周血白细胞[(4.4±3.4)×109/L与(6.7±2.9)×109/L,P<0.05]、淋巴细胞计数[(0.7±0.6)×109/L与(1.5±0.7)×109/L,P<0.01]和临床转归(病死率22%与0,P<0.05)方面的差异有统计学意义.结论 SLE患者合并CNS感染的临床表现不典型.大剂量激素冲击治疗,日平均激素剂量大以及外周血白细胞、淋巴细胞减少是SLE患者发生CNS感染的危险因素.     

Spectrum of anemia associated with chronic liver disease

Anemia of diverse etiology is a common complication of chronic liver diseases. The causes of anemia include acute or chronic gastrointestinal hemorrhage, and hypersplenism secondary to portal hypertension. Severe hepatocellular disease predisposes to hemorrhage because of impaired blood coagulation caused by deficiency of blood coagulation factors synthesized by hepatocytes, and/or thrombocytopenia. Aplastic anemia, which is characterized by pancytopenia and hypocellular bone marrow, may follow the development of hepatitis. Its presentation includes progressive anemia and hemorrhagic manifestations. Hematological complications of combination therapy for chronic viral hepatitis include clinically significant anemia, secondary to treatment with ribavirin and/or interferon. Ribavirin- induced hemolysis can be reversed by reducing the dose of the drug or discontinuing it altogether. Interferons may contribute to anemia by inducing bone marrow suppression. Alcohol ingestion is implicated in the pathogenesis of chronic liver disease and may contribute to associated anemia. In patients with chronic liver disease, anemia may be exacerbated by deficiency of folic acid and/or vitamin B12 that can occur secondary to inadequate dietary intake or malabsorption.     

The protean manifestations of hemorrhagic fever with renal syndrome. A retrospective review of 26 cases from Korea

Twenty-six cases of hemorrhagic fever with renal syndrome from 1981 to 1986 were retrospectively reviewed to determine the scope of clinical presentation and the unique complications of the illness. The diagnosis was confirmed by detection of Hantaan virus antibody in 25 cases and by characteristic autopsy findings in 1 case. The illness could be classified into three distinct clinical subgroups. Fever was universally present. Two patients presented with intractable shock and diffuse hemorrhage and died within 6 days from multi-organ system failure, mimicking the clinical picture of overwhelming sepsis. Eighteen patients presented with acute renal failure with an illness lasting a mean of 21 days (range, 10 to 36 days). Resolution of thrombocytopenia heralded recovery of renal function. At discharge, the serum creatinine level was normal in 13 patients; 5 patients had evidence of minimal renal dysfunction. Acute pulmonary edema requiring hemodialysis and retroperitoneal hemorrhage were the major complications in this subgroup. Six patients had an undifferentiated febrile illness with normal renal function. Fever, thrombocytopenia, abnormal urinalysis, hypertransaminasemia, and a benign clinical course characterized the third clinical pattern. The recent availability of serodiagnostic methods to detect Hantavirus group antibody facilitates the diagnosis of hemorrhagic fever with renal syndrome. Application of this test in the described clinical settings will identify unsuspected cases, broaden the knowledge of the geographic distribution of Hantavirus infection, and increase physician awareness of its protean manifestations.     

Two cases of hemorrhagic fever with renal syndrome in northern Greece

Two cases of hemorrhagic fever with renal syndrome were diagnosed in woodcutters presumably exposed to wild rodents and their urine in a forest in northern Greece. The disease was characterized by acute renal insufficiency without hemorrhagic manifestations. One patient required hemodialysis, but both recovered without sequelae and developed a fourfold increase in titer of antibody to Hantaan virus, as determined by an immunofluorescence test. These are the first reported cases of hemorrhagic fever with renal syndrome in Greece.     

Hemorrhagic fever with renal syndrome: four decades of research

Hemorrhagic fever with renal syndrome is an acute infectious illness characterized by fever, hemorrhage, and renal failure. Research over the last 40 years has led to the discovery and characterization of the causative viruses, detailed knowledge of the epidemiology of the disease, development of sensitive diagnostic assays, and improvements in patient management, which in turn have led to significant reductions in mortality. Considerable progress has also been made in elucidating the pathophysiology of the disease, although much more needs to be learned. Recent data show that hemorrhagic fever with renal syndrome has a wider geographic occurrence than previously thought. This syndrome must be considered in the differential diagnosis of acute renal failure of unknown cause.     

Experience with extrarenal manifestations of hemorrhagic fever with renal syndrome in a tertiary care hospital in South Korea

Reports on the clinical entity of hemorrhagic fever with renal syndrome (HFRS) have focused on acute renal failure. Data on the extrarenal manifestations are limited primarily to case reports. In this study, protean extrarenal manifestations involving the major organs occurred in one-third of patients with HFRS during various stages (i.e., febrile phase through diuretic phase). Pancreatobiliary manifestations and major bleeding occurred in 11% and 10% of patients, respectively. Cardiovascular and central nervous system manifestations developed during the febrile or oliguric phase, whereas pancreatobiliary manifestations and major bleeding were detected even in the diuretic phase. Thus, close monitoring of and additional knowledge about various extrarenal manifestations are needed.     

以急性胰腺炎为主要特征的肾综合征出血热3例

肾综合征出血热以急性胰腺炎为主要特征表现较少,表现特殊,易造成误诊.本3例患者临床表现均以腹痛为主,查血尿淀粉酶明显增高,CT及彩超胰腺肿大,易误诊为"急性胰腺炎".后经感染科会诊结合流血病学,临床特征与实验室检查才得以确诊.临床医生需开阔思路,在临床诊治过程中遇到类似病例不排外为肾综合征出血热.     

艾滋病合并马尔尼菲青霉菌病120例实验室结果分析

目的探讨艾滋病（AIDS）合并马尔尼菲青霉菌病（PSM）患者的实验室检测结果特点,为临床诊断提供可靠依据,达到早期诊断和早期治疗的目的。方法对120例艾滋病合并马尔尼菲青霉菌病患者的实验室资料进行分析。结果艾滋病合并马尔尼菲青霉菌病患者易发生机会性感染,常见病原体依次为真菌、细菌、病毒;血常规血红蛋白偏低,女性100%贫血,男性71.7%贫血;白细胞较低,平均值为5.6×10^9/L,〈4×10^9/L占50%（60/120）;流式细胞计数CD4＋细胞明显降低,平均值为26×10^6/L,〈50×10^6/L占88.3%（106/120）。被调查病例中CD4＋细胞〈50×10^6/L时,易发生病原微生物机会性感染。结论大多数艾滋病合并马尔尼菲青霉菌病患者,CD4＋细胞明显降低,出现不同程度的贫血和白细胞降低,常发生机会性感染,常出现两种或多种病原体合并感染,病原体依次为真菌、细菌、病毒。     

Clinical characteristics and risk factors for concurrent bacteremia in adults with dengue hemorrhagic fever

To better understand the clinical characteristics of concurrent bacteremia (dual infection) in patients with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) and identify predictive risk factors for dual infection, 100 patients with DHF/DSS (7 with a dual infection and 93 with DHF/DSS alone [controls]) were enrolled in this study. A patient with DHF/DSS who lacked three or more of the five most frequently observed manifestations other than fever in controls or showed disturbed consciousness was defined as one with unusual dengue manifestations. Patients with a dual infection were older, and tended to have prolonged fever, higher frequencies of acute renal failure, gastrointestinal bleeding, altered consciousness, unusual dengue manifestations, and DSS. Acute renal failure (odds ratio [OR] = 51.45, P = 0.002), and prolonged fever (> 5 days) (OR = 26.07, P = 0.017) were independent risk factors for dual infection. Clinicians should be alert to the potential for concurrent bacteremia when treating patients with DHF/DSS who are at risk for dual infection and manage them accordingly.     

Key differentiating features between scrub typhus and hemorrhagic fever with renal syndrome in northern China

Both scrub typhus and hemorrhagic fever with renal syndrome (HFRS) are severely epidemic in northern China and often present with acute undifferentiated fever. To correctly distinguish the two diseases at an early stage, we collected and compared clinical and routine laboratory data of 46 patients with confirmed scrub typhus and 49 patients with confirmed HFRS presenting to the outpatient departments of three town hospitals in northern China. Most patients with HFRS but none of the patients with scrub typhus had hemorrhagic manifestations. Retro-orbital pain, lumbar back pain, flank tenderness, proteinuria, and occult blood in urine often occurred in patients with HFRS. However, skin eschar, regional lymphadenopathy, and maculopapular rash were more commonly found in patients with scrub typhus. In addition, platelet counts in patients with HFRS were significantly lower than in patients with scrub typhus. These findings will be useful for physicians to distinguish scrub typhus from HFRS.     

伴血细胞减少系统性红斑狼疮34例骨髓细胞形态学分析

目的 了解伴血细胞减少的系统性红斑狼疮(SLE)骨髓细胞形态学变化.方法 对34例外周血细胞减少的SLE患者(WBC<4×109/L, 或Hb<100 g/L, 或Pt<100×109/L)的骨髓涂片进行回顾性细胞形态学检查,并与26例特发性血小板减少性紫癜(ITP)、18例骨髓增生异常综合征的难治性贫血(MDS-RA)患者以及14例健康对照者综合分析.结果 34例SLE患者中24例(70.6%)骨髓发育不良,包括红系多核(三核或更多)10例(29.4%),巨幼样变8例(23.5%), Pelger-Hüet样畸形12例(35.3%),多核巨核细胞8例(23.5%),小型巨核细胞10例(29.4%). 结论在伴血细胞减少的SLE患者中能观察到骨髓多系细胞发育不良,这些改变说明骨髓可能是SLE侵犯的靶器官之一.