小剂量利妥昔单抗联合艾曲波帕治疗激素耐药性ITP的临床疗效

【摘要】 目的 探讨小剂量利妥昔单抗联合艾曲波帕治疗激素耐药性免疫性血小板减少症（ITP）患者的临床疗效及安全性。 方法 选取2018年5月～2019年5月中国联勤保障部队920医院血液科收治的激素耐药性ITP患者24例,行单臂前瞻性研究,随机分为观察组与对照组,每组各12例,观察组采用小剂量利妥昔单抗联合艾曲波帕治疗,对照组采用艾曲波帕单药治疗。观察治疗前后血小板计数变化,并总结药物的不良反应。 结果 两组患者在治疗前及治疗7、14天、1个月的血小板计数差异无统计学意义（P＞0.05）,在治疗3、6个月观察组血小板数量较对照组显著提升（P＜0.05）;观察组患者治疗有效率显著优于对照组（P＜0.05）;观察组与对照组不良反应发生率差异无统计学意义（P＞0.05）。 结论 小剂量利妥昔单抗联合艾曲波帕治疗激素耐药性ITP可显著提升患者血小板数量,疗效优于单独使用艾曲波帕单药治疗,且不良反应较轻,可在临床推广使用。     

艾曲波帕联合激素药物治疗成人原发免疫性血小板减少症的效果观察

目的：探讨艾曲波帕联合激素药物对成人原发免疫性血小板减少症的治疗效果。方法：选取2021年1-12月东台市人民医院血液内科收治的52例成人原发免疫性血小板减少症患者为研究对象,随机分为观察组和对照组,各26例。对照组采用激素药物治疗,观察组采用艾曲波帕联合激素药物治疗。对比两组患者的临床疗效、免疫功能变化、不良反应发生率、血小板(PLT)计数。结果：观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组CD3⁺、CD4⁺、CD8⁺水平比较,差异无统计学意义(P>0.05);治疗后,观察组CD3⁺、CD4⁺、CD8⁺水平均高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。治疗前,两组PLT计数比较,差异无统计学意义(P>0.05);治疗后1、2、3、4周,观察组PLT计数均高于对照组,差异有统计学意义(P<0.05)。结论：采用艾曲波帕联合...     

网织血小板测定在特发性血小板减少性紫癜中的意义

目的 探讨网织血小板（RPs）检测在慢性特发性血小板减少性紫癜（cITP）中的临床意义以及RPs百分率与血小板计数的相关性。方法 利用流式细胞仪测定cITP组、非cITP组及对照组外周血RPs百分率。对cITP患者RPs百分率与血小板计数做相关性分析。结果 cITP组治疗有效者RPs百分率明显降低，与治疗前比较差异有统计学意义（P＜0.01）；cITP组RPs百分率明显高于非cITP组及对照组（P＜0.01）；非cITP组与正常对照组比较，两者差异无统计学意义（P＞0.05）。RPs%与血小板计数呈负相关（r=－0.672，P＜0.01）。结论 RPs百分率可反映骨髓产生血小板的状况，对探讨血小板减少性疾病发病机制具有重要意义，可作为血小板减少症鉴别诊断的重要指标，对诊断cITP有一定价值，同时也是cITP疗效判定的监控指标。     

激素联合小剂量静脉丙种球蛋白治疗重症血小板减少性紫癜疗效观察

目的探讨激素联合小剂量静脉丙种球蛋白（IVIG）治疗重症特发性血小板减少性紫癜（ITP）的疗效。方法将64例重症特发性血小板减少性紫癜患者随机分为对照组31例和治疗组33例,治疗组采用激素联合小剂量静脉滴注丙种球蛋白,对照组采用激素联合大剂量静脉丙种球蛋白进行治疗,比较两组治疗效果。结果两种方案治疗第3天比较血小板计数,差异有统计学意义（P〈0.05）,但到治疗第6天,结果无显著性差异（P〉0.05）;两组治疗方案出血倾向消失时间比较,无显著性差异（P〉0.05）,两组均无危及生命的严重出血发生。结论激素联合小剂量IVIG治疗重症ITP能达到迅速提升血小板计数,控制出血症状,且具有剂量小、费用少、安全性高、不良反应少等优点。     

幽门螺杆菌感染与儿童慢性特发性血小板减少性紫癜的关系

目的探讨幽门螺旋杆菌Hp）感染与儿童慢性特发性血小板减少性紫癜cITP）之间的关系及清除Hp对cITP的疗效。方法用粪便检测Hp抗原及血清检测Hp抗体两者联合检测62例cITP患者、88例aITP患者及150例健康儿童;将Hp^＋cITP患者随机分为两组：治疗组用糖皮质激素＋抗Hp治疗;对照组用糖皮质激素治疗。结果aITP患儿、cITP患儿、健康儿童三者感染率比较差异无统计学意义（P〉0．05）;治疗组与对照组疗效比较差异无统计学意义（P〉0．05）。结论本次研究未能证实Hp儿童cITP患者的Hp高感染率及根治Hp能升高血小板的可能性。     

双嘧达莫联合人免疫球蛋白及阿司匹林治疗川崎病患儿的效果观察

目的 探究双嘧达莫联合人免疫球蛋白及阿司匹林治疗川崎病（Kawasaki disease,KD）患儿的临床疗效。方法 选取2018年1月至2022年1月九江市妇幼保健院收治的72例KD患儿作为研究对象,采用随机数字表法将其分为对照组（36例）和观察组（36例）。对照组患儿予阿司匹林+人免疫球蛋白治疗,观察组患儿在对照组基础上加用双嘧达莫。于治疗8周后评价疗效,比较两组患儿治疗前后的临床症状改善情况及抗血小板聚集相关因子、炎症因子的变化,并记录不良反应。结果 观察组患儿的治疗总有效率为97.22%,显著高于对照组的77.78%（P<0.05）,手足肿胀、发热、黏膜充血、淋巴结肿大及皮疹消退时间均显著短于对照组（P<0.05）;治疗后,观察组患儿的白细胞计数、红细胞沉降率、血小板计数、白细胞介素–6、C反应蛋白、降钙素原均显著低于对照组（P<0.05）;两组患儿的不良反应比较差异无统计学意义（P>0.05）。结论 双嘧达莫联合人免疫球蛋白及阿司匹林治疗KD效果确切,可有效改善患儿的临床症状,抑制血小板聚集,减轻炎性反应,且不良反应少。     

艾曲波帕联合硫唑嘌呤治疗难治性特发性血小板减少性紫癜的疗效及其对细胞免疫功能的影响研究

背景　难治性特发性血小板减少性紫癜（RITP）的治疗一直是临床的一大难题,目前尚无统一的安全有效的治疗方案,且对于部分血小板计数（PLT）极度下降的患者有致死的出血风险。艾曲波帕作为升血小板的新药,为RITP的治疗提供了一个安全有效的治疗方法。目的　探究艾曲波帕联合硫唑嘌呤治疗RITP的疗效,并观察其对细胞免疫功能的影响。方法　选择2013年1月-2018月1月在绍兴市人民医院血液科住院治疗的46例RITP患者,依据随机数字表法将其分为治疗组和环孢素（CSA）组,各23例。另选取同期在本院进行体检的健康者25例作为对照组。治疗组患者给予艾曲波帕联合硫唑嘌呤治疗;CSA组患者给予环孢素联合达那唑治疗。治疗3个月进行疗效评价。比较治疗组与CSA组临床疗效。收集治疗组和CSA组患者治疗前和治疗3个月外周血Th1细胞因子〔白介素（IL）-2、γ干扰素（IFN-γ）〕和Th2细胞因子（IL-4、IL-5）、B1淋巴细胞（CD+19淋巴细胞百分数、CD5+CD+19淋巴细胞百分数）、PLT,并与对照组比较。记录治疗组和CSA组患者不良反应发生情况。结果　治疗组患者总有效率为69.9%（16/23）,CSA组患者总有效率为73.9%（17/23）;两组患者总有效率比较,差异无统计学意义（χ2=0.107,P=0.743）。治疗组、CSA组患者治疗前IL-2、IFN-γ、CD+19淋巴细胞百分数、CD5+CD+19淋巴细胞百分数高于对照组,IL-4、IL-5、PLT低于对照组（P<0.05）;治疗组、CSA组患者治疗3个月IL-2、IFN-γ、CD+19淋巴细胞百分数、CD5+CD+19淋巴细胞百分数低于本组治疗前,IL-4、IL-5、PLT高于本组治疗前（P<0.05）。治疗组8例患者发生肝功能损伤,CSA组16例患者发生肝功能损伤;治疗组患者肝功能损伤发生率（34.8%）低于CSA组（69.6%）（χ2=6.527,P=0.013）。结论　艾曲波帕联合硫唑嘌呤治疗RITP,安全有效,患者耐受性好;艾曲波帕联合硫唑嘌呤可能通过调节RITP患者外周血Th淋巴细胞及B1淋巴细胞,进而促进血小板生成,从而发挥治疗作用。     

艾曲波帕治疗激素治疗无效或激素依赖性儿童免疫性血小板减少症疗效观察

目的 探讨艾曲波帕治疗激素治疗无效或激素依赖性儿童免疫性血小板减少症(ITP)的临床效果.方法 选择2018年2月至2019年6月新乡市中心医院收治的30例激素治疗无效或激素依赖性ITP患儿为研究对象,根据治疗方法将患儿分为观察组和对照组,每组15例.对照组患儿给予静脉注射用人丙种球蛋白治疗,观察组患儿给予艾曲波帕治疗...     

逍遥散联合草酸艾司西肽普兰片治疗抑郁症疗效观察

目的：比较逍遥散加减联合草酸艾司西酞普兰片与单独使用草酸艾司西酞普兰片治疗抑郁症的疗效及安全性。方法：将确诊为抑郁症的60例患者随机分为治疗组（逍遥散加减联合草酸艾司西酞普兰片组）30例,对照组（草酸艾司西酞普兰片组）30例,用汉密尔顿抑郁量表（HAMD）在治疗前及治疗后2、4、6、8周评定疗效,用不良反应量表（TESS）评定安全性。结果：治疗组有效率为93.33%,对照组为83.33%,两组比较,差异有统计学意义（P〈0.05）;治疗后2、4、6、8周,治疗组HAMD评分均低于对照组,差异有统计学意义（P〈0.05）;治疗组出现不良反应4例,对照组出现12例,两组比较,差异有统计学意义（P〈0.05）。结论：逍遥散加减联合草酸艾司西酞普兰片治疗抑郁症起效快,疗效好,不良反应少。     

中西医结合治疗老年慢性免疫性血小板减少症的临床研究

目的探讨中西医结合治疗老年慢性免疫性血小板减少症的临床效果。方法免疫性血小板减少症患者116例根据入院顺序分为治疗组与对照组各58例,治疗组接受标准激素联合中药治疗,对照组接受单纯标准激素治疗。结果治疗组总有效率为96.6%,对照组总有效率为75.9%,治疗组的近期疗效明显好于对照组（P〈0.05）。两组不良反应情况比较差异无统计学意义（P〉0.05）。两组治疗前CD19＋/CD20＋淋巴细胞数比较差异无统计学意义,治疗后两组均明显下降（P〈0.05）,组间比较差异有统计学意义（P〈0.05）。结论应用中西医结合治疗免疫性血小板减少性症可提高治疗疗效,安全性好,能有效改善免疫功能,值得推广应用。     

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.