106例成人急性白血病流式细胞术免疫分型分析

目的研究成人急性白血病免疫分型及与预后的关系。方法以CD45/SSC双参数散点图设门,采用流式细胞术检测106例成人急性白血病患者免疫分型情况。结果(1)71例急性髓系白血病(AML)患者主要表达CD13、CD33、HLA-DR、CD34和CD117抗原,23.9%的AML患者伴有淋系抗原表达,15.5%的AML病人伴有CD56抗原的表达。(2)29例急性淋巴细胞白血病(ALL)患者主要表达HLA-DR、CD10、CD19、CD34和CD7,34.5%的ALL患者伴有髓系抗原的表达。(3)伴有淋系抗原表达的AML患者化疗完全缓解(CR)率为52.9%(9/17),显著低于未伴有淋系抗原表达的AML病人(77.8%)(P<0.05);伴有髓系抗原表达的ALL患者化疗后CR率为70.0%,而未伴有髓系抗原表达的ALL患者CR为94.7%,两者差异无显著性(P>0.05);CD56 AML患者化疗后CR率仅36.4%,显著低于CD56- AML患者(78.3%)(P<0.025);CD34 AML患者化疗后CR率为56.0%,显著低于CD34- AML患者(80.4%)(P<0.05)。结论采用CD45和SSC双标记设门可较好地排除正常骨髓细胞的影响,较准确地反映病人的免疫学分型;伴淋巴系抗原表达的AML、CD56 AML及CD34 AML化疗后CR率低,预后差。     

P-gp和细胞表面分化抗原在ALL中表达的关系和临床意义

目的探讨初治急性淋巴细胞白血病(ALL)中P-糖蛋白(P-gp)与细胞表面分化抗原表达的关系及意义。方法应用流式细胞术对64例初治ALL患者进行P-gp及免疫表型的检测。结果 P-gp的阳性表达率为45.3%,CD34为59.4%,My+ALL为31.3%,其中CD13阳性率最高,为20.3%。P-gp与预后呈负相关(P0.05),CD34+、My+ALL与CD34-、My-ALL的CR率差异均无统计学意义(P0.05)。P-gp+组中CD34的表达显著高于P-gp-组(P0.05),其他中晚期抗原表达差异无统计学意义。P-gp与CD34协同表达则CR率更低(52.2%vs90.0%)。结论 P-gp的表达在初治ALL患者中具有重要的预后意义。P-gp的过度表达与CD34有关,P-gp+/CD34+的ALL属于一种预后不良的临床亚型。     

104例急性白血病流式细胞免疫表型分析及意义

目的探讨多参数流式细胞仪检测急性白血病免疫表型及临床意义。方法采用多参数流式细胞术方法检测104例急性白血病患者的免疫表型并分析其比较AL各类型白血病免疫表型的表达情况及与完全缓解率(CR)的关系。结果①104例AL患者以系列专一表达为主,同时存在抗原交叉表达,M3极少表达CD34、HLA-DR。HAL主要为髓/B混合表达,未检测到T系表达;②AML中,CD34 、HLA-DR 组的CR率低于阴性组患者的CR率(P<0.05);CD33 组的CR率明显高于CD33-组(P<0.05)。Ly AML的CR率(50%)低于Ly-AML的CR率(86.8%)(P<0.05);My ALL的CR率与My-ALL的CR率无显著性差异(P>0.05);HAL组CR率(42.8%)低于ALL(95.6%)、AML的CR率(76.8%)(P<0.05)。结论①AL的免疫表型可提高AL的诊断率,HAL主要为髓系/B系混合表达;Ly -AML、CD34 -AML、HLA-DR -AML及HAL对化疗反应较差,预后不良,ALL中,髓系相关抗原的表达对CR没有影响。     

儿童急性白血病CD34、CD117抗原表达分析

目的 探讨儿童急性白血病（AL） CD34和CDll7抗原表达的临床意义.方法 采用流式细胞术对68例急性淋巴细胞白血病（ALL）及43例急性髓系白血病（AML）患儿的骨髓细胞进行CD34和CD117抗原检测,并比较CD34、CD117和CD34/CD117共表达在AL患儿表达的差异及与诱导化疗疗效的关系.结果 CD34在ALL和AML患儿中均有表达,差异无统计学意义（P＞0.05）.而CD117、CD34/CD117在AML患儿中的表达率明显高于ALL患儿（P＜0.05）.AL患儿中CD34＋组肝脾、淋巴结肿大及首轮诱导化疗缓解（CR）率与CD34-组差异均有统计学意义（P＜0.05）;CD34＋/CD117＋组CR率明显低于CD34-/CD117-组（P＜0.05）.ALL中回族患儿CD117表达率高于汉族患儿（x2=43.391,P=0.000）.CDll7＋及CD34＋/CD117＋组血小板（PLT）水平分别较阴性组低（P＜0.05）.在AML患儿中CD34＋组PLT水平较CD34-组低（P＜0.05）,CD117＋、CD34＋/CD117＋组肝脾肿大分别较阴性组多见（P＜0.05）.AML患儿中CD34、CD117、CD34/CD117在汉族阳性表达率均高于回族（P＜0.05）.结论 CD34抗原表达是儿童AL的独立高危因素,临床特征上主要表现为髓外浸润.CD117、CD34/CD117可作为AL患者MICM诊断分型的髓系免疫学依据.CD34/CD117有助于AML的诊断.CD34、CD34/CD117的表达可作为预测AL诱导化疗疗效的指标.     

Characteristics of abnormal immunophenotype and clinical significance in acute myelocytic leukemia

目的 探讨急性髓细胞白血病( acute myelocytic leukemia,AML)患者的异常免疫表型特点及临床意义.方法 采用多色流式细胞术对初诊的38例AML患者进行白血病免疫表型检测.结果 AML患者髓系特异性抗原表达阳性率高低依次为:CD33、CD13、cMPO、CD117、CD11b:部分患者异常表达淋巴系抗原,表达率高低依次为CD19、cCD79a、CD7等.CD19+、CD7+患者完全缓解( complete remission,CR)率低于CD19-、CD7-患者,差异有统计学意义(P＜0.05);部分患者表达非特异性早期抗原CD34、HLA-DR、CD38,CD34+患者CR率与CD34 -患者CR率相比差异无统计学意义(P＞0.05),CD56+患者CR率与CD56 -患者CR率相比差异无统计学意义(P＞0.05).结论 CD33、CD13、cMPO、CD117为髓系常见且敏感的抗原.伴有CD19、CD7表达的患者,化疗后完全缓解率低于阴性者.     

小儿急性白血病CD34抗原表达的临床意义

目的探讨儿童急性白血病CD34抗原表达的临床意义。方法采用流式细胞术对78例急性淋巴细胞白血病(ALL)及27例急性髓系白血病(AML)进行免疫表型分析。结果 78例ALL患儿CD34阳性率为43.6%,27例AML患儿CD34阳性率为29.6%,CD34+组与CD34-组在性别和初诊时白细胞计数比较差异无统计学意义(P>0.05);CD34+组与CD34-组在肝脾淋巴结肿大等髓外浸润表现、诱导治疗4周的缓解率上差异有统计学意义。结论 CD34抗原表达在临床特征上主要表现在髓外浸润,为化疗反应差的影响因素。     

成人急性髓细胞白血病异常免疫表型特点及临床意义

目的探讨急性髓细胞白血病(acute myelocytic leukemia,AML)患者的异常免疫表型特点及临床意义。方法采用多色流式细胞术对初诊的38例AML患者进行白血病免疫表型检测。结果 AML患者髓系特异性抗原表达阳性率高低依次为:CD33、CD13、cMPO、CD117、CD11b;部分患者异常表达淋巴系抗原,表达率高低依次为CD19、cCD79a、CD7等。CD19+、CD7+患者完全缓解(complete remission,CR)率低于CD19-、CD7-患者,差异有统计学意义(P<0.05);部分患者表达非特异性早期抗原CD34、HLA-DR、CD38,CD34+患者CR率与CD34-患者CR率相比差异无统计学意义(P>0.05),CD56+患者CR率与CD56-患者CR率相比差异无统计学意义(P>0.05)。结论 CD33、CD13、cMPO、CD117为髓系常见且敏感的抗原。伴有CD19、CD7表达的患者,化疗后完全缓解率低于阴性者。     

儿童急性白血病免疫分型及其临床意义

目的 探讨儿童急性白血病(AL)抗原表达规律及其临床意义.方法 采用流式细胞术检测46例儿童AL的免疫表型.结果 46例AL中,急性淋巴细胞白血病(ALL)30例,急性髓细胞白血病(AML)10例,杂合型6例.30例ALL中,T系ALL 4例(13.3%),B系ALL 26例(86.7%).ALL中3例(10%)有髓系抗原表达,以CD33阳性最常见;AML中4例(40%)有淋系抗原表达,以CD7阳性率最高.儿童AML淋系抗原表达阳性率高于儿童ALL髓系抗原表达(X2=4.32,P＜0.05).B系ALL中CD34阳性率为56.5%.AML中CD34的表达频率为40.0%,其中M2的CD34阳性率为66.6%,高于其他AML病儿的CD34阳性率(X2=5.42,P＜0.05).结论 应用免疫分型可以较好地分析每例白血病病儿,尤其是对于混合型白血病及抗原交叉表达者更有意义.     

急性淋巴细胞白血病免疫表型特点及其临床意义

目的 为探讨急性淋巴细胞白血病(ALL)的免疫表型特征及与治疗的关系.方法 采用流式细胞仪对77例ALL患者进行免疫表型分析.结果 ①77例ALL中L1型44.16%,L2型50.65%,L3型5.19%;B淋巴细胞性ALL(B-ALL)80.52%,T淋巴细胞性ALL(T-ALL)15.58%.②77例ALL中髓系抗原(My)阳性率为 57.14%;其中表达CD13的阳性率最高,为84.09%,其次为CD33和CD15;My+B-ALL占B-ALL的58.06%.My+T-ALL占T-ALL的50%,两组比较差别无统计学意义(P>O.05);My+ALL组CR率为81.82%,略低于My-ALL组(88.24%),但差异无统计学意义(P>0.05).③CD34表达阳性率为49.35%,B-ALL中为56.45%,明显高于T-ALL的25%(P<0.05);My+ALL中CD34表达阳性率为71.05%,高于My-ALL的33.33%(P<0.05);CD34+ALL组CR率为76.47%,低于CD34-ALL组的90.91%,但差异无统计学意义(P>0.05).结论 ALL免疫分型与FAB分型变化无相关性;My+ALL患者中CD34表达阳性率高于My-ALL患者;CD34和髓系抗原的表达与CR率无相关性.     

急性髓系白血病的免疫表型分析及临床意义

目的 探讨成人急性髓细胞白血病(AML)的免疫表型特征及临床意义.方法 采用流式细胞仪对113例AML患者进行免疫表型分析.结果 髓系抗原表达阳性率依次为CD13＞CD33＞CD15＞CD14,AML患者CD34阳性表达率为35.40%.113例患者中有28例(24.78%)伴有淋系抗原表达,以CD7多见,表达阳性率为71.43%,其次CD19表达阳性率为35.71%.Ly+AML与Ly-AML相比较,两者在个别形态学亚型、临床体征及CD34表达差异有统计学意义,而在异常染色体核型检出率方面无统计学意义.CD+34组CR率(69.23%)较其阴性组(78.05%)低,但两者差别无统计学意义;Ly+AML组CR率为52.94%(9/17),低于Ly-AML组78%(39/50),其中,CD+7组CR率(41.67%)与其阴性组(80%)相比差别有统计学意义.结论 AML患者高表达CD13、CD33,部分患者同时表达髓系、淋系抗原;CD34及CD7阳性与治疗反应显著相关.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.