淋巴瘤自体外周血造血干细胞移植12例

目的：探讨自体造外周血造血干细胞移植治疗有多个预后不良因素和难治或复发淋巴瘤的疗效及安全性。方法：2005年2006年采用大剂量化疗加自体外周血造血干细胞支持治疗淋巴瘤的患者12例,其中非霍奇金淋巴瘤（NHL）的患者10例,霍奇金淋巴瘤的患者（HL）2例,动员方案：NHL的患者给予Hy-per-CVAD方案（CTX 2.5 g/m^2、VCR 2 mg、ADR 60 mg/m^2、DEX 40 mg）、DOAME方案（DEX 40 mg、VCR 2 mg、MTZ 10 mg/m^2、ARA-C 3 g/m^2、VP-16 200 mg/m^2）、DICE（Dex 40 mgI、FO 4 g/m^2、VP-16 400 mg、DDP 100 mg/m^2）,HL的患者给予CTX 4 g/m^2、DOAME方案,4例CD20＋的B细胞NHL患者加用美罗化进行体内净化,预处理方案采用BEAC（BCNU 300 mg/m^2、VP-16 1200 mg/m^2,ARA-C1.8 g/m^2,CTX 3.6 g/m^2）,肿块大于4 cm的移植后给予补救性放疗。结果：所有患者随访半年,12例患者中11例获CR,1例患者SD,移植2个月后进展,行异基因造血干细胞移植。结论：常规化疗有效患者造血干细胞移植后疗效好,对常规化疗耐药患者疗效差,安全性好、费用低,是难治或复发和有多个不良因素患者的选择,远期疗效目前正在随访中。     

自体干细胞移植支持下的大剂量化疗治疗侵袭性非霍奇金淋巴瘤

目的:探讨自体血干细胞移植(ASCT)支持下的大剂量化疗(HDC)治疗侵袭性非霍奇金淋巴瘤(NHL)的疗效。方法:23例侵袭性NHL患者经过3～7周期常规化疗疗效达完全或部分缓解后行自体外周血干细胞动员,大剂量化疗方案采用BEAC(BCNU450mg/m2,VP-16800mg/m2,Ara-C1.5g/m2,CTX3.6g/m2)方案。结果:23例患者均移植成功,重建造血功能,无移植相关死亡。移植前9例达CR或CRu,14例达PR;移植后13例达CR或CRu,10例达PR。全部病例均得到随访,中位随访时间为29个月(1个～84个月),移植后3例病情进展,其中1例死亡,3年的无进展生存率为79.4%。结论:HDC/ASCT治疗侵袭性NHL是有效的治疗方法。     

自体造血干细胞移植对预后不良非霍奇金淋巴瘤的效果

目的评价自体外周血造血干细胞移植(APBSCT)治疗预后不良非霍奇金淋巴瘤(NHL)病人效果。方法8例复发和具有不良预后因素晚期NHL病人,经BEAM方案预处理后采取APBSCT治疗。结果8例病人均获快速造血功能重建,中性粒细胞≥0.5×109/L时间为8~14 d,平均9 d,血小板≥20×109/L时间为8~17 d,平均11 d。其中4例移植时PR者3例达CR,1例为PR;另4例移植时CR的难治NHL病人已无病存活8~10个月。结论APBSCT支持下超大剂量化疗是治疗预后不良和复发非霍奇金淋巴瘤安全有效的方法。     

自体造血干细胞移植治疗首次CR非霍奇金淋巴瘤

目的报告8例首次CR非霍奇金淋巴瘤（NHL）在外周血干细胞移植（PBSCT）支持下接受超大剂量化疗（HDC）的初步经验并评价所用外周血造血干细胞（PBSC）动员方案的动员效果,预处理方案的耐受性以及PBPC回输后造血重建情况。方法 8例NHL经常规化疗获首次完全缓解后,采用大剂量ICE方案（IFO5g/m2、卡铂AUC=7、VP-16500mg/m2）＋G-CSF5μg/（kg.次）作动员方案,经超大剂量化疗方案BEAM（BCNU300mg/m2d1,VP-16200mg/m2d1-4,Ara-C200mg/m2q12hd1-4,Mephlan140mg/m2d4）进行预处理后回输PBSC。结果分别采集到MNC2.7（2.3-4.3）×108/kg,CFU-GM5.0（2.5-9.8）×105/kg和CD34＋细胞2.9（2.1-8.8）×106/kg。回输PBSC后,均获快速重建造血功能,ANC〉0.5×109/L和Pt〉2.0×109/L的时间为10（8～12）d和11（9～18）d。非造血系统毒性较轻。随访至2009年6月底,中位随访时间24（10～46）个月,6例存活,1年生存率100%,3年存活率75%。结论自体外周血干细胞移植支持下超大剂量化疗是治疗首次CR非霍奇金淋巴瘤安全有效的临床手段,值得进一步研究。     

自体造血干细胞移植治疗恶性血液病

目的　评价自体造血干细胞移植 (AHSCT)治疗恶性血液病的疗效。　方法　用 AHSCT治疗白血病及恶性淋巴瘤患者共 5 8例 ,年龄 31.9± 10 .5 (14～ 5 8)岁。其中急性非淋巴细胞白血病 (ANL L ) 30例 (CR1 2 4例 ,CR2 5例 ,CR31例 ) ,急性淋巴细胞白血病 (AL L ) 18例 (CR1 13例 ,CR2 3例 ,CR32例 ) ,慢性粒细胞白血病 (CML ) 3例 (均获血液学缓解 ) ,恶性淋巴瘤 7例 (CR4例 ,PR3例 )。预处理化疗方案选用以下药物中任意两种或三种联合 :阿糖胞苷 3～ 4g/ m2 ,环磷酰胺 4～ 6 g/ m2 ,鬼臼乙叉苷 (VP- 16 ) 0 .5～ 1.0 g/ m2 。除 5例联合全身骨髓照射 (剂量为7～ 8Gy) ,其余均单用化疗。　结果　所有患者移植后均重建造血 ,移植相关死亡 1例 (1.72 % )。ANL L、AL L CR1期移植者 3年无病生存率分别为 5 2 .4%± 4.2 %和 46 .1%± 3.5 % ,复发率分别为 37.7%± 4.5 %和 40 .5 %±6 .7%。 10例 CML 和恶性淋巴瘤患者中 ,除 1例 期恶性淋巴瘤患者复发 ,余均获持续完全缓解。　结论　为降低白血病和恶性淋巴瘤的复发率 ,提高患者的无病生存期 ,无造血干细胞供者的 CR1 期白血病及恶性淋巴瘤患者应积极行 AHSCT。     

自体外周血干细胞移植治疗恶性实体瘤

目的:报告自体外周血造血干细胞移植(APBSCT)治疗恶性实体瘤的初步经验。方法:用APBSCT治疗恶性实体瘤3例,其中小细胞肺癌(SCLC)2例,非霍奇金淋巴瘤(NHL)1例。外周血干细胞的动员方法:2例SCLC者中1例单用造血细胞刺激因子(G-(CSF,惠尔血),另1例用CAP方案+G-CSF,NHL者用Ara-C 10g/m~2静点+G-CSF。干细胞动员后.采集单个核细胞数(MNC)均≥3.85×10~8/kg;CD34~+细胞数均≥6.96×10~6/kg;CFU-GM培养集落数≥4.41×10~5/kg。预处理方案:2例SCLC均为VP-16 750mg/m~2,CPB 800mg/m~2;NHL为CTX 4g/m~2,VP-16800mg/m~2+全身照射(TBI)780cGY。结果:3例患者移植后均获得造血重建。1例移植前已有脑转移的SCLC,移植后病变未获得缓解,于移植后6个月死干脑疝。另1例移植前肺部病变获得部分缓解的SCLC,移植后肺部病变获得完全缓解,8个月后出现肝转移,于移植后10个月死于肝昏迷。NHL移植前浅表淋巴结、纵隔、脾脏部位病变获得部分缓解,移植后病变获得完全缓解,随访至2001年12月28日,已无病存活14个月。3例病人均无移植相关死亡。结论:APBSCT联合大剂量放、化疗对恶性实体瘤有一定疗效,尤其对淋巴瘤效佳,且毒副反应能耐受,值得进一步研究探索。     

自体造血干细胞移植治疗难治性恶性淋巴瘤

目的　观察自体造血干细胞移植 (AHSCT)对难治性恶性淋巴瘤的疗效及不良反应。方法　 4例对CHOP方案为主化疗反应不良的恶性淋巴瘤 ,以HD -VCCA方案化疗加TLI预处理的自体外周血干细胞移植 (APBSCT)治疗。自体骨髓移植 (ABMT)两例 ,CTX加VP 16联合rhG CSF动员外周血干细胞的APBSCT者两例。干细胞 4℃保存 ,72h内回输。结果　 4例移植期间中性粒细胞计数恢复到≥ 0 .5× 10 9/L的时间 ,血小板达≥ 5 0× 10 9/L的时间和网织红细胞比例达≥ 0 .5 %的时间 ,APBSCT和ABMT分别平均为 9.5d和 11d ; 14d和 2 1.5d ; 9d和 16 .5d。不良反应主要为消化道反应 ,移植后血清卵泡刺激素 (FSH)和黄体生成素 (LH)水平升高 ,雌二醇 (E2 )水平降低的继发性闭经 2例。 4例已无病生存 8～ 5 7个月。结论　干细胞不冷冻的AHSCT治疗难治性恶性淋巴瘤安全、简便、有效。APBSCT较ABMT造血功能恢复快 ,不良反应小。预处理对性腺有损伤。     

大剂量BEAC方案联合自体外周血干细胞移植治疗弥漫大B细胞淋巴瘤的临床分析

目的观察大剂量BEAC方案[卡莫司汀(BCNU)、依托泊甙(VP-16)、阿糖胞苷(Ara-C)、环磷酰胺(CTX)]联合自体干细胞移植(autologous stem cell transplantation,ASCT)治疗具有不良预后因素的弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的疗效。方法选择2000年1月-2011年12月新疆医科大学附属肿瘤医院收治按年龄调整的国际预后指数(Age-adjusted international prognostic index,aaIPI)评分为1～3分、行大剂量BEAC联合ASCT治疗的DLBCL患者35例,常规化疗疗效达完全缓解或部分缓解后行自体外周血干细胞动员,动员方案为VP-16联合粒细胞集落刺激因子(Granulocyte colony-stimulating factor,G-CSF)。大剂量化疗(high-dose chemotherapy,HDC)方案采用BEAC(BCNU 450mg/m2,第1～2d静注;VP-16 800mg/m2,第1～3d分2次静注;Ara-C 1.5g/m2,第1d静注;CTX 3.6g/m2第1～2d静注)方案。采用Kaplan-Meier法进行生存分析。结果 35例患者均移植成功,重建造血功能。移植前13例CR,22例PR,移植后23例CR,12例PR,无移植相关死亡,中位随访时间为39个月(7～135个月),随访期间6例因病情进展死亡,5年生存率为80%。结论采用大剂量BEAC方案联合ASCT治疗具有不良预后因素的DLBCL取得了较好疗效,值得进一步研究。     

自体外周血造血干细胞移植支持大剂量化(放)疗治疗恶性淋巴瘤22例报告

目的:研究自体外周血造血干细胞移植支持下的大剂量化(放)疗对高危、复发恶性淋巴瘤的治疗效果.方法:22例恶性淋巴瘤经CHOP方案等化疗或局部复发病灶放疗达CR或PR后,实施自体外周血造血干细胞移植,观察大剂量化(放)疗的近期疗效、不良反应及远期疗效.结果:22例恶性淋巴瘤实施自体外周血造血干细胞移植支持下的大剂量化(放)疗后均为CR,所有患者的骨髓抑制均迅速恢复,未发生严重出血、感染及治疗相关死亡,平均无病生存期已达26个月.结论:自体外周血造血干细胞移植结合大剂量化(放)疗,对恶性淋巴瘤是一种很好的治疗方法,有较高的CR率及长期无病生存率.     

自体外周血干细胞移植治疗恶性淋巴瘤

目的 :探讨高剂量化放疗联合自体外周血干细胞移植 (APBSCT)治疗恶性淋巴瘤的疗效和安全性。 方法 :接受高剂量化放疗联合APBSCT治疗的 5例恶性淋巴瘤 ,其中非霍奇金淋巴瘤 (NHL) 4例 ,霍奇金淋巴瘤(HL) 1例。外周血干细胞的动员方法 :1例采用Ara C 10 g/m2 静点 G CSF ,余 4例采用VP 16 15 0 0mg/m2 静点 G CSF。干细胞动员后 ,采集单个核细胞数 (MNC)均≥ 3.85× 10 8/kg ;CD3 4 细胞数均≥ 6 .96× 10 6/kg ,CFU GM培养集落数≥ 4 .4 1× 10 5/kg。预处理方案 :1例NHL为CTX 4 g/m2 ,分 2次静点 ,VP 16 80 0mg/m2 ,分 4次静点 ,并加全身照射 (TBI) 780cGY。余 4例为CTX 4 g/m2 ,VP 16 80 0mg/m2 静点 ,BCNU 4 5 0mg/m2 静推 ,移植后进行了原发病灶的放疗。随访 9～ 4 3个月 ,中位 18个月。 5例移植前浅表淋巴结、纵隔、脾脏部位病变均获得部分缓解。 结果 :5例患者移植后均获得造血重建。移植后病变获得完全缓解 ,随访至 2 0 0 4年 5月 ,均无病存活。结论 :APBSCT联合大剂量化放疗 ,对恶性淋巴瘤疗效佳 ,且毒副反应能耐受 ,安全性好 ,值得进一步临床应用。     

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.     

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.