45例造血干细胞移植相关并发症分析

目的探讨造血干细胞移植（HSCT）治疗恶性血液病并发症的发生情况及其防治。方法45例急慢性白血病、恶性淋巴瘤患者中,30例选择自体造血干细胞移植（auto-HSCT）,15例接受异基因造血干细胞移植（allo-HSCT）,包括HLA不全相合3例及非血缘关系移植4例,混合移植2例;预处理auto-HSCT主要选用BE-AC、CBV方案,allo-HSCT采用BU/CY2及改良的BU/CY方案;移植物抗宿主病（GVHD）的预防采用环孢菌素A（CsA）＋甲氨喋呤（MTX）或CsA＋MTX＋骁悉（MMF）方案。结果30例auto-HSCT患者中70%出现口腔黏膜炎;40%出现不同部位的感染。15例allo-HSCT患者中80%出现口腔黏膜炎;53%出现不同部位的感染;巨细胞病毒（CMV）感染发生率20%;出血性膀胱炎（HC）发生率13%;7%出现肝静脉闭塞病（HVOD）;33%出现急性移植物抗宿主病（aGVHD）;7%出现慢性移植物抗宿主病（cGVHD）;移植相关死亡率27%。结论移植相关并发症是影响造血干细胞移植成功的重要因素,移植期间需要进一步探索、加强移植相关并发症的防治,以提高移植成功率。     

异基因造血干细胞移植中甲氨蝶呤3次与4次给药的比较

移植物抗宿主病(graft versus host disease, GVHD)及其相关并发症的发生严重影响了异基因造血干细胞移植的疗效,据统计,HLA配型相合的同胞间移植,≥Ⅱ度急性GVHD(aGVHD)的发生率为20%～60%.迄今为止环孢霉素A(cyclosporine, CSA)联合4次短程甲氨蝶呤(methotrexate, MTX)的方案仍是公认的、经典的、较好的预防aGVHD的方案.但也有单位采用3次或小剂量的MTX与CSA 联合[1].为了解MTX3次或4次给药方式的临床疗效,我们对在本单位进行同胞或亲属间移植的24名采用MTX3次给药方案的患者的临床资料进行了总结.     

异基因造血干细胞移植治疗重型再生障碍性贫血的疗效分析

目的:回顾性分析观察异基因造血干细胞移植治疗重型再生障碍性贫血(SAA)的安全性及临床疗效?方法:回顾分析本科自2007年8月~2012年6月接受异基因造血干细胞移植的9例SAA患者的临床资料,其中同胞人类白细胞抗原(HLA)全相合4例,亲缘半相合4例,无关供者全相合1例?均采用含环磷酰胺的预处理方案,移植物抗宿主病(GVHD)的预防:接受同胞全相合移植患者采用短程甲氨蝶呤(MTX)联合环孢素(CSA)方案,其他患者采用短程MTX?CSA?骁悉及舒莱联合方案?回输外周血干细胞中位单个核细胞数和CD34阳性细胞数分别为6.86 × 108个/kg和2.41 × 106个/kg?结果:9例患者全部获得造血重建,中性粒细胞和血小板的中位植活时间分别为17 d和19 d?除1例为自身造血恢复外,8例均为供者造血?1例接受亲缘半相合移植患者在移植后 + 186 d死于肺部感染?8例存活患者中位随访时间1 142(405~1 836)d,均达无病生存?结论:异基因造血干细胞移植治疗SAA安全有效,对于无全相合干细胞来源的SAA患者也可以考虑接受亲缘半相合移植?     

改良BU/CY预处理方案行同胞相合异基因外周造血干细胞移植治疗骨髓增生异常综合征

目的探讨改良BU/CY预处理方案行同胞相合异基因外周血造血干细胞移植(allo-PBSCT)治疗骨髓增生异常综合征(MDS)的疗效。方法收集2009年1月至2010年12月,哈尔滨血液病肿瘤研究所5例MDS进行allo-PBSCT患者。预处理方案为改良BU/CY;预防移植物抗宿主病(GVHD)采用环孢素A/甲氨蝶呤/吗替麦考酚酯(CSA/MTX/MMF)。结果 5例患者均获得移植,中性粒细胞(ANC)≥0.5×109/L的中位时间移植后12.4d(9～14d),血小板(PLT)≥20×109/L中位时间移植后13.25d(10～23d),2例出现Ⅱ度急性移植物抗宿主病(aGHVD),2例出现局限型慢性移植物抗宿主病(cGVHD),3例发生Ⅱ度口腔溃疡,发热4例,其中1例败血症,1例合并肺部感染;2例发生巨细胞病毒(CMV)血症,出血性膀胱炎(HC)2例,1例出现纯红再生性障碍性贫血;中位随访时间12.8个月(8～22个月),1例骨髓增生异常综合征-环形铁粒幼性难治性贫血(MDS-RAS)移植后7个月复发后合并肺部感染死亡,无病存活4例。结论改良BU/CY方案用于MDS移植预处理疗效较好,不良反应可以耐受,安全性好。     

异基因造血干细胞移植后重度肠道急性移植物抗宿主病的临床分析

目的 探讨异基因造血干细胞移植(Allo-HSCT)后重症肠道急性移植物抗宿主病(aGVHD)的发生情况及预后.方法 2例慢性粒细胞白血病(慢性期)患者接受异基因造血干细胞移植,预处理方案为BU/CY、GIAC方案,以CsA、MMF、ATG加短程MTX预防aGVHD.结果 2例分别于移植后21、40d并发重度肠炎,诊断为肠道aGVHD,予以糖皮质激素为主的综合治疗包括FK506、抗CD25单克隆抗体后缓解.结论 重度肠道aGVHD是异基因造血干细胞移植后常见的最严重并发症之一,有效治疗直接关系到疾病的预后.     

异基因造血干细胞移植治疗多发性骨髓瘤疗效观察

目的评价异基因造血干细胞移植治疗多发性骨髓瘤(MM)的临床疗效。方法回顾分析2007年1月～2012年3月期间,笔者医院开展的异基因造血干细胞移植(allo-HSCT)治疗多发性骨髓瘤5例,其中3例为HLA全相合同胞供者,2例为HLA全相合非亲缘供者。例1采用环磷酰胺联合大剂量马法兰用于预处理方案,其余4例采用硼替佐米联合大剂量马法兰用于预处理方案,其中1例非亲缘加用抗胸腺细胞免疫球蛋白(ATG)。预防移植物抗宿主病(GVHD)采用环孢素A(CsA)联合短疗程甲氨蝶呤(MTX)的经典方案。结果 5例患者allo-HSCT后均获得造血重建,中位随访时间32.3(1.7～63)个月。1例死于aGVHD,1例于移植后44个月复发,目前仍维持治疗中。其余3例目前仍完全缓解,患者最长无病生存时间已达63个月。结论 Allo-HSCT是治愈年轻MM患者的有效方法,使患者获得长期生存。     

异基因造血干细胞移植治疗骨髓增生异常综合征及其转化急性髓系白血病的疗效分析

目的 探讨异基因造血干细胞移植（allo-HSCT）治疗骨髓增生异常综合征（MDS）及MDS转化急性髓系白血病（MDS-AML）的疗效及安全性。方法回顾性分析2015年5月至2022年3月38例MDS和13例MDS-AML患者的临床资料,51例患者全部接受异基因造血干细胞移植,其中同胞全合移植17例,单倍体移植33例,无关供者移植1例。总结治疗过程及转归信息,分析患者移植前疾病状态、供者选择、干细胞来源、预处理方案、移植物抗宿主病（GVHD）等对移植疗效的影响。结果 49例（96.1%）患者移植后获得造血重建,中性粒细胞中位植活时间11(10, 12)d,血小板中位植活时间14(12, 19)d。Ⅱ～Ⅳ度急性移植物抗宿主病（aGVHD）及慢性移植物抗宿主病（cGVHD）发生率分别为14.3%和34.7%。截至随访日期,15例（29.4%）患者死亡,中位死亡时间为移植后21(7,44.5)个月,死亡原因包括肺部感染（6例）、复发（5例）、GVHD(3例)、脓毒血症（1例）。移植相关死亡（TRM）为19.6%,移植后100天内TRM为7.8%。中位随访时间7(2, 26)个月,3年预计总生...     

异基因造血干细胞移植治疗重型再生障碍性贫血的疗效研究

目的 探讨异基因造血干细胞移植(allo-HSCT)治疗重型再生障碍性贫血(SAA)的疗效.方法 8例SAA患者接受allo-HSCT,其中1例接受亲缘白细胞抗原(HLA)全相合allo-HSCT,4例接受单倍体相合allo-HSCT,3例接受非血缘全相合allo-HSCT.预处理方案:非亲缘及亲缘全相合移植采用氟达拉滨(FLU)+环磷酰胺(CTX)+抗人T淋巴细胞球蛋白(ATG);单倍体相合移植采用FLU+CTX+马利兰(BU)+ATG/抗胸腺细胞球蛋白.移植物抗宿主病(GVHD)预防:亲缘全相合移植采用联合免疫抑制剂的方法预防,环孢素A(CSA)+短程氨甲蝶呤(MTX),单倍体相合及非亲缘全相合除以上药物外,加用CD25单克隆抗体和霉酚酸酯(MMF).结果 患者全部获得造血重建,中性粒细胞≥0.5×109/L的时间为10～17 d,中位时间为12.5 d;血小板≥20×109/L的时间为9～25 d,中位时间为13.8 d,植入证据检测证明为完全供者造血.5例合并巨细胞病毒(CMV)血症,3例合并出血性膀胱炎,2例发生急性和慢性Ⅰ～Ⅲ度GVHD,1例合并中枢神经系统感染及纯红再障.8例全部存活,存活时间为9～38个月,中位存活时间为20个月.结论 亲缘、非亲缘全相合及单倍型相合的allo-HSCT均是治愈SAA的有效方法,可为患者提供长期生存的机会.     

无血缘关系供者异基因外周血干细胞移植治疗急、慢性白血病49例

目的 观察无血缘关系供者外周血干细胞移植治疗急、慢性白血病的疗效.方法 自2005年1月至2009年10月本科行无血缘关系供者造血干细胞移植治疗急、慢性白血病患者49例,供、受者之间人类白细胞抗原(HLA)配型全相合43例,HLA 1个位点不合6例(其中,A位点不合2例,B位点不合1例,CW位点不合2例,DQ位点不合1例).预处理方案环磷酰胺(CY)+全身放疗(TBI)方案28例、BU/CY方案21例.采用环孢菌素A(CSA)+骁悉+甲氨喋呤(MTX)+抗胸腺细胞球蛋白(ATG)预防性控制移植物抗宿主病.结果 移植后10～23 d(中位时间14.8 d)中性粒细胞大于0.5×109/L;移植后13～27 d(中位时间18.6 d),血小板大于20×109/L.14例(HLA 1个位点不合者2例)发生Ⅱ度急性移植物抗宿主病(aGVHD),予甲强龙治疗后控制,28例发生慢性移植物抗宿主病(cGVHD),局限型14例,广泛型14例;无1例发生肝静脉闭塞病(VOD)及巨细胞病毒感染;移植相关毒副作用方面CY+TBI方案与BU/CY方案差异无统计学意义;随访5～63个月,41例患者无病生存,8例死于本病复发和移植并发症;21例慢性粒细胞白血病bcr/abl融合基因检测转阴.结论 无血缘关系供者外周血干细胞移植是一种有效的血液肿瘤治疗方法.     

ATG用于异体造血干细胞移植前预防移植物抗宿主反应

目的 分析异体造血干细胞移植前加用抗T淋巴细胞球蛋白(ATG)预防移植物抗宿主反应(GVHD)的疗效.方法 27例白血病患者分为两组,每组移植供体来源及病种类似,分别有同胞兄妹、无关供体和人类白细胞抗原(HLA)半相合供体.A组(n=12):采用经典的CsA+MTX预防GVHD;B组(n=15):采用CsA + MTX+ATG预防GVHD.结果 B组15例患者全部存活,除4例出现Ⅱ°急性GVHD(aGVHD)外,其余11例均在移植后30 d左右仅出现Ⅰ° GVHD,并很快控制.A组12例患者中,3例HLA半相合移植患者分别在移植后第7、9和10天即出现Ⅳ°超急性GVHD,另有1例无关供体患者出现Ⅲ° aGVHD,该4例患者由于重度GVHD继发肺部感染而死亡;其余8例同胞之间的移植分别出现Ⅱ°～Ⅲ°aGVHD.结论 在异体造血干细胞移植前应用ATG可以有效预防GVHD的发生或减轻GVHD的严重度,明显减少移植相关死亡率.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.