二氯亚甲基二膦酸盐-明胶微粒治疗模型大鼠免疫性血小板减少性紫癜

目的二氯亚甲基二膦酸盐(Cl2MDP)通过明胶微粒负载靶向免疫性血小板减少性紫癜(ITP)模型的肝脾巨噬细胞,以杀伤巨噬细胞或降低其免疫活性达到治疗ITP的目的。方法抗血小板血清150μL每24 h注射1次建立SD大鼠ITP模型,其血小板计数于实验期间能维持在低于50×109L-1的病理水平。静脉注射Cl2MDP-明胶微粒,以血小板计数和出血时间为指标观察疗效,并观察药物对巨噬细胞的作用。结果Cl2MDP-明胶微粒以剂量依赖关系迅速、有效地升高模型血小板计数到平均约180×109L-1的水平,并维持血小板计数在生理水平不再下降。电镜下可见巨噬细胞变性、坏死等病变。此外,预先注射Cl2MDP-明胶微粒的SD大鼠可避免发生抗血小板血清引起的ITP。结论Cl2MDP-明胶微粒静脉注射后可以有效提高ITP模型的血小板数量至生理水平,这种靶向巨噬细胞的药物输送技术可为治疗ITP提供一种新的方法。     

肝硬化性脾功能亢进的外科治疗

脾功能亢进（脾亢）是肝硬化患者常见的临床综合征之一，表现为脾脏肿大、一种或几种血细胞（主要是血小板、白细胞）减少，其发生率高达50％-64％。肝硬化性脾亢的发生是多因素作用的结果：①肝细胞功能不全被认为是血小板减少的根源；②脾脏对血细胞（血小板为主）的阻留和破坏；③体内产生血小板抗体；④HBV或HCV抑制骨髓造血。以下把当前可选择的脾亢治疗措施和射频消融治疗脾亢的经验作一简单介绍。     

小剂量米非司酮联合射频消融术治疗子宫肌瘤95例疗效观察

目的探讨小剂量米非司酮对子宫肌瘤的疗效。方法 190例患者随机分为试验组95例和对照组,分别使用米非司酮和射频消融术及单纯使用射频消融术进行治疗,术后随访,观察其疗效。结果所有患者均手术成功,术后均未出现阴道大出血、感染等并发症,均无复发。二组月经量减少、痛经、下腹酸痛坠胀、贫血纠正情况及子宫大小比较,差异有统计学意义。结论与单纯手术相比,米非司酮联合射频消融术治疗子宫肌瘤效果更好。     

ITP血小板特异性自身抗体（GPⅡb/Ⅲa和GPIbα）与糖皮质激素和静脉丙种球蛋白临床疗效的关系

目的检测特发性血小板减少性紫癜（ITP）患者体内的抗血小板膜糖蛋白（GPⅡb/Ⅲa和GPIbα）特异性自身抗体,并探讨特异性自身抗体与糖皮质激素和静脉丙种球蛋白（静丙）治疗的临床疗效是否存在针对性,以便得到更经济和个体化的治疗方案,为ITP提出新的分型依据。方法应用改良的单克隆抗体特异性俘获血小板抗原（MAIPA）法检测抗GPⅡb/ⅡIa,GPIbα特异性自身抗体。结果双抗体阳性组与单一抗GPIbα抗体阳性组总疗效比较,差异无显著性（χ^2=0.995,P〉0.05）双抗体阳性组与单一抗GPⅡb/ⅡIa抗体阳性组总疗效比较,差异有显著性（χ^2=17.439,P〈0.01）,后者优于前者;单一抗GPⅡb/ⅡIa抗体阳性组,双抗体阳性组,双抗体阴性组,糖皮质激素治疗与糖皮质激素联合静丙治疗比较,差异无显著性（P〉0.05）。结论血小板特异性自身抗体种类（GPⅡb/Ⅲa和GPIbα）及种类数目与ITP的临床疗效（糖皮质激素、静丙）有一定关系,对临床治疗方案的选择有一定意义。以抗血小板膜糖蛋白（GPⅡb/Ⅲa和GPIbα）特异性自身抗体为ITP进行新的分型依据尚不足,需扩大样本量进一步研究。     

急性免疫性血小板减少症患儿血清IL-33检测及其意义

为研究IL-33在儿童急性免疫性血小板减少症(ITP)发病机制中的作用及意义,我们采用ELISA法检测了37名ITP患儿和37名对照者血清IL-33水平,分析IL-33与患儿就诊时血小板计数及后期疗效的关系。我们发现,ITP患儿血清IL-33较对照者明显增高(P<0.01),且与血小板计数呈负相关(R2=0.10,P=0.05)。血清IL-33水平与治疗效果密切相关,采用IL-33预测ITP患儿疗效,预测敏感性为0.88,特异性为0.81。这些结果提示:IL-33参与了ITP的发病机制,血清IL-33水平可以作为预测患儿疗效的免疫学指标。     

血小板相关抗体检测的应用价值

目的：探讨血小板相关抗体（PAIgG）检测的应用价值。方法：采用流式细胞术分别对42例特发性血小板减少性紫癜（ITP）患者、39例再生障碍性贫血患者及21例其他自身免疫性疾病患者的PAIgG进行检测,并分析其与血小板输注无效率的关系。结果：ITP患者组、再生障碍性贫血患者组及其他自身免疫性疾病患者组PAIgG阳性血小板百分率均明显高于正常对照组（P〈0.01）;PAIgG阳性的ITP患者及再生障碍性贫血患者中的血小板输注无效率均明显高于PAIgG阴性的患者（P〈0.01,P〈0.05）。结论：PAIgG用于ITP诊断敏感性高,特异性差,PAIgG的存在与血小板输注无效存在密切关系,是引起血小板输注无效的重要原因之一。     

等离子射频消融术治疗老年早期声门型喉癌的远期疗效及其对嗓音声学影响

目的　探究等离子射频消融术治疗老年早期声门型喉癌（early glottic cancer,EGC）的远期疗效及其对嗓音声学的影响。 方法 回顾性分析2010年5月~2011年5月河南省人民医院耳鼻咽喉头颈外科收治的95例EGC患者临床资料,根据治疗方案的不同将其分为研究组和对照组,对照组46例行CO2激光切除术,研究组49例行等离子射频消融术治疗,比较两组视觉模拟评分（visual analogue scale,VAS）、临床疗效总有效率、嗓音学指标（基频微扰、标准化噪声能量、振幅微扰）、术后生活质量（躯体疼痛、生理功能、生理职能、总体健康评分）及远期疗效（5年生存率、局部复发率）。 结果 VAS评分研究组较对照组无统计学差异（P>0.05）;总有效率研究组高于对照组（P<0.05）;术后6个月嗓音学指标研究组低于对照组（P<0.05）;术后生活质量评分研究组略高于对照组,差异无统计学意义（P>0.05）;5年生存率、局部复发率研究组较对照组无统计学差异（P>0.05）。 结论 等离子射频消融术治疗老年早期声门型喉癌临床疗效较好,具有嗓音恢复快、术后疼痛感轻的优势,值得临床推广应用。     

经皮微波消融治疗肝硬化脾功能亢进症的临床研究

目的:探讨经皮穿刺微波消融治疗肝硬化脾功能亢进症的安全性、疗效和临床应用前景。方法:2012年8月至2015年4月在超声引导下对50例(29例患者1次微波消融,12例患者重复2次微波消融,9例患者重复3次微波消融)肝硬化脾功能亢进症患者实施经皮穿刺脾脏微波消融治疗,对脾微波消融术过程中的术前及术后观察进行总结。结果:平均手术时间为(2.1±0.9)h,平均消融时间为(1.5±0.6)h;术后3 d外周血小板计数较术前明显下降;术后6个月随访发现患者白细胞以及血小板计数均较术前改善,差异有统计学意义(P0.05),肝肾功能指标、凝血功能、红细胞计数无明显差异(P0.05)。术后白细胞计数指标在Child-Pugh分组和消融次数分组中存在显著差异(P0.05),术后血小板计数指标在消融次数分组和脾大程度分组中存在显著差异(P0.05)。结论:经皮穿刺微波消融治疗肝硬化脾功能亢进症是一项具有临床应用前景的微创治疗方法,对患者白细胞及血小板指标的改善有显著作用。     

免疫性血小板减少性紫癜的发病机制与临床研究进展

免疫性血小板减少性紫癜(Immune thrombocytopenic purpura,ITP)是自身抗体介导的血小板减少综合征,自身抗原的主要成分是血小板一种或多种糖蛋白;细胞免疫也是血小板破坏的一个重要原因.目前ITP的诊断仍是临床排除性诊断,分为原发性与继发性两种.ITP治疗的目的是使患者血小板计数提高到安全水平.肾上腺糖皮质激素仍是ITP的首选药物,静脉输注丙种球蛋白(IVIg)用于控制严重出血与重度血小板减少,脾切除仍是治疗慢性ITP的主要手段.血小板生成素(TPO)类似物可能成为新的治疗方法.对成人慢性ITP患者应常规进行幽门螺杆菌(Hp)筛查,阳性患者应根除Hp.     

植入式心电记录器在心房颤动射频消融术后随访中的应用

目的探讨植入式心电记录器（ILR）在观察心房颤动射频消融术后疗效中的价值。方法收集2010年10月至2012年8月心房颤动射频消融术后复发患者7例,其中男性2例,女性5例;年龄23～67岁,平均年龄51岁。经常规检查未能明确复发原因,根据病情分别选择植入Medtronic公司RevealRDX9528型、Reveal XTTM9529型ILR监测复发时的心电事件,以帮助确诊。结果 7例植入ILR的患者平均随访（12.7±5.1）个月。随访期内7例患者共记录心电图191段,其中患者手动触发记录49段,ILR自动触发记录142段,64段心电图为心律失常事件。根据症状-心律相关性,监测到6例患者出现胸闷、晕厥等症状,其中5例患者明确为心律失常性事件引起,1例为非心律失常性事件引起。1例无症状发作。提示ILR诊断复发原因的效率为85.71%。根据ILR监测结果明确病因的6例患者得到进一步治疗,症状发作好转或减少。结论 ILR用于诊断心房颤动射频消融术后复发具有安全、高效、监测时间长、信息量大等优点,动态优化ILR系统,将进一步提高ILR在临床诊断、疗效追踪、指导治疗等方面的临床应用价值。     

Simultaneous Occurrence of Immune-Mediated Thrombocytopenia and Myocarditis After mRNA-1273 COVID-19 Vaccination: A Case Report

With the global spread of severe acute respiratory syndrome coronavirus 2, several vaccines were developed; messenger RNA (mRNA) vaccines have recently been widely used worldwide. However, the incidence of myocarditis following mRNA vaccination is increasing; although the cause of myocarditis has not yet been clearly identified, it is presumed to be caused by a problem in the innate immune system. Immune-mediated thrombocytopenia (ITP) after vaccination is rare but has been reported and is also assumed to occur by the same mechanism. We report the first case of simultaneous myocarditis and ITP after mRNA vaccination. A 38-year-old woman presented with chest pain, mild dyspnea, and sweating after vaccination with mRNA-1273 vaccine (Moderna) 4 days prior to admission. Upon admission to the emergency department, cardiac enzymes were elevated; blood test performed 5 months ago showed normal platelet count, but severe thrombocytopenia was observed upon admission. After administration of intravenous immunoglobulin, the platelet count improved; subsequently, myocarditis was observed on endomyocardial biopsy. Thus, myocarditis and ITP were judged to have occurred simultaneously due to the expression of the innate immune system markers after mRNA vaccination. The patient was discharged on day 6 of admission.     

Intravenous immunoglobulin does not increase FcγRIIB expression levels on monocytes in children with immune thrombocytopenia

Intravenous immunoglobulin (IVIG) produces a rapid and prolonged increase in the platelet counts of children with immune thrombocytopenia (ITP). The mechanism of IVIG efficacy in a murine model of ITP has been reported to operate through an IVIG-mediated increase in the expression of the inhibitory Fc receptor FcγRIIB(CD32B) on splenic macrophages. This investigation examined whether IVIG administration results in a similar increase in FcγRIIB expression on peripheral blood CD14(+) monocytes in 20 children with ITP. FcγRIIB expression on peripheral blood monocytes was measured by flow cytometry in ITP patients, before and after IVIG therapy, as well as in control subjects. Peripheral blood monocytes were labelled with fluorescent-specific antibodies. There were no significant differences in the percentages or numbers of CD14(+) CD32B(+) monocytes, or in the percentage of CD14(+) CD32B(+) monocytes present in children with ITP before and after IVIG therapy. We suggest that IVIG does not increase FcγRIIB expression in peripheral blood monocytes in children with ITP.     

Circulating immune complexes and platelet IgG in various diseases

Correlation between platelet associated IgG (PAIgG), platelet count, and plasma polyethylene glycol (PEG) precipitable IgG immune complex (IC) like material was tested in normal subjects and patients with immune thrombocytopenia (ITP), systemic lupus erythematosus (SLE) and various types of liver disease. Elevated IC were observed in 27% and 22% of ITP and recovered ITP, respectively. A significant inverse correlation between platelet count and PAIgG was demonstrable in the ITP group. A significant direct correlation between platelet count and IC was found only in SLE patients. Impaired reticuloendothelial cell (RE) Fc receptor function in SLE patients is suggested as a possible explanation for the data. If receptor function was normal in SLE patients, lower IC levels and lower platelet counts would have been expected.     

Assessment of thrombocytopenic patients for splenectomy.

Platelet survival and splenic sequestration patterns were studied in 32 patients with thrombocytopenia using donor platelets labelled with chromium-51. A shorter mean platelet lifespan was observed in immune thrombocytopenia (ITP) (mean 12 hours) than in hypersplenism (mean 56 hours) or marrow hypoplasia (mean 102 hours). There was no such correlation between diagnosis and splenic sequestration. A biphasic survival curve was seen in nine of 22 patients with ITP. Thirteen patients underwent splenectomy with complete (9) or partial (4) response, but no consistent pattern of results was manifest. It is concluded that in vivo isotope studies are of little value in predicting the benefit of splenectomy in thrombocytopenic patients, although they may demonstrate the mechanism of the thrombocytopenia, in particular the biphasic survival curve revealing separate 'immune' and 'hypersplenic' components of platelet destruction in ITP.     

脑组织射频消融的有限元仿真与分析

目的 运用有限元方法（finite element method,FEM）模拟颅内病灶射频消融过程中的温度场分布,以合理有效利用热疗方案,提高射频消融对颅内病灶的治疗效果.方法 建立电导率不变和电导率随温度变化的两种有限元模型,并对两种模型的中心温度、电场强度、热生成率、比吸收率（specific absorption rate,SAR）,以及热损伤区域进行对比分析.结果 对比电导率不变的有限元模型,在电导率随温度变化的情况下,电场强度减小,电流密度增大,中心温度升高,热损伤范围增大;当消融温度接近100 ℃时电导率变化明显,其对消融效果影响较大.结论 射频热疗手术中考虑随温度变化的组织参数有较高的临床参考价值.     

肝癌的射频消融治疗进展

目的：探讨射频消融在肝癌治疗中的治疗进展。方法：查阅相关中外文献,对射频消融治疗肝癌的效果进行综述。结果：射频消融治疗肝癌疗效确切、微创小,发展迅速。射频消融联合其他治疗进一步扩大了治疗范围,提高了治疗效果。结论：射频消融是治疗手术不能切除的肝癌的理想方法。     

Flow cytometric measurement of antiplatelet antibodies

A flow cytometric technic was developed to detect platelet surface-bound immunoglobulin in patients with thrombocytopenia. Elevated platelet surface IgG and/or IgM was detected in 90.9% of patients with immune thrombocytopenia purpura (ITP). False positive results occurred in 9.3% of patients with nonimmune thrombocytopenia usually associated with sepsis. False negatives occurred most frequently in adults with chronic ITP. Measurement of platelet surface immunoglobulin with this flow cytometric technic helps differentiate immune from nonimmune thrombocytopenia.     

The experience of Flebogammadif® in primary immune thrombocytopenia

Primary immune thrombocytopenia (ITP) is a common autoimmune disease characterized by autoantibody-induced platelet destruction, suboptimal megakaryocytic production of platelets and consequent bleeding. Numerous controlled trials have proved that the administration of high-dose intravenous immunoglobulins (IVIG) results in rapid increases in the platelet numbers. Therefore, they are indicated in emergency settings or in patients needing surgical procedures. Here, the efficacy and safety of Flebogammadif?, a new high-purity IVIG, was assessed by an open, multi-centre, non-controlled, prospective study in 20 adult patients diagnosed with ITP for at least 6 months before recruitment and with a platelet count ≤ 20,000/μl before treatment. Patients received 0·4 g/kg/body weight of Flebogammadif? for 5 consecutive days and were followed-up for 3 months. There were three efficacy end-points: proportion of patients who reached a platelet count ≥ 50 000/μl; time for the platelet count to reach that level; and duration of response. Safety parameters [adverse events (AE), laboratory determinations and vital signs] and viral markers were monitored regularly. A total of 14 patients achieved a platelet count of ≥ 50,000/μl. The median time to platelet response was ≤ 2·5 days and the median number of days in which the platelet count remained ≥ 50,000/μl was ≥ 7·0 days. A regression of haemorrhages was reported for 17 patients on day 14. Eight patients presented 20 AEs (mainly mild) related potentially to the study drug. Neither abnormalities in laboratory values nor in viral markers were registered during the follow-up period. In conclusion, Flebogammadif? was well tolerated and succeeded in providing a haemostatic platelet count in ITP patients.     

网织血小板检测在血液系统疾病诊断中的初步应用

目的探讨网织血小板（RP）检测在血液系统疾病诊断中的初步应用。方法对107例血液病人及100例正常人进行网织血小板的检测，并对它们的检测结果进行单因素方差分析。结果12例ITP病人网织血小板百分比（RP％）测量结果为（28．87±8．91）％（范围从15．16％±44．98％），明显高于正常对照组；4例治疗后的ITP病人RP％为（9．06±3．87）％，与正常对照组无差异；12例AA的RP％为（5．96±3．01）％（范围从2．50％±14．49％），低于正常对照组，RP绝对值为（1．57±1．90）×10^9／L，结果明显低于正常对照组。36例ALL组RP％为（12．20±5．33）％，30例ANLL组RP％为（10．83±5．16）％，与正常对照组相比差异无统计学意义（P〉0．05）；8例慢性粒细胞白血病RP绝对值为（139．67±80．06）×10^9／L，RP绝对值明显高于正常对照组（P=0．000）。5例MDS病人RP％为（21．75±7．37）％，高于正常对照组（P〈0．05）。分析了6例病人骨髓巨核细胞检测结果，并与RP％结果进行了对照分析，发现6例病人的网织血小板的检查结果与骨髓巨核细胞检查结果相符。结论RP％及RP在不同血液疾病中的测定结果显示RP％对于血小板减少性疾病的病因诊断有一定的参考价值。     

Primary percutaneous coronary intervention for acute myocardial infarction with idiopathic thrombocytopenic purpura: a case report

Acute myocardial infarction (AMI) is rare in patients with idiopathic thrombocytopenic purpura (ITP). We describe a case of an AMI during thrombocytopenia in a patient with chronic ITP. A 47-yr-old woman presented with anterior chest pain and a low platelet count (21,000/microliter) at admission. Urgent coronary angiography revealed total occlusion of proximal right coronary artery and primary percutaneous coronary intervention (PCI) was performed successfully. This case suggests that primary PCI may be a therapeutic option for an AMI in patients with ITP, even though the patient had severe thrombocytopenia.