305例白细胞减少症临床分析

材料和方法1.病例选择: 本组病例,系1990年我院内科住院病人。在住院病程中,经实验室检查,凡外周血白细胞计数<4.0×10~9/L者,符合国内诊断标准。2.一般资料: 305例中,男162例,女143例。年龄14～87岁,<30岁79例,<40岁82例,<50岁44例,<60岁55例,>60岁45例。职业:工人91例,农民79例,干部68例,职员24例,学生17例,教师9例,医师9     

白细胞减少症的药物治疗

白细胞减少症是一种由化学、物理、生物等因素及不明原因引起的外周血中白细胞计数持续低于4×10^9/L的临床综合征。中性粒细胞低于0.5×10^9/L称粒细胞缺乏症,病死。     

氦—氖激光治疗白细胞减少症的研究

作者采用激光器照射人类离体淋巴细胞并进行细胞培养。结果表明照射后一定时间内可使细胞分裂指数与转化率增加,细胞微核率亦随照射时间增加而增高。对55例白细胞减少症给予激光穴位照射,显效率69%。     

黄芪注射液治疗白细胞减少症

白细胞减少症系多种原因引起的外周血白细胞持续低于正常值的综合征，临床较为常见。几年来，我们采用黄茂注射液治疗该症，临床疗效较好，报告如下。！材料与方法1．1病例选择1996年IH～1997年10H，白细胞值＜4．OX10’八，的住院病人。临床均有不同程度的头晕、之力、腰膝酸软、易患感冒等症状。随机分为治疗组及对照组。治疗组35例，男7例，女28例，年龄18～so岁，个均33岁。引起白细胞减少的原因；放、化疗所致者《例．免疫闪素4例，病毒感染14例，原因不明13例。对照组32例，男9例，女23例，年龄20～56岁，平均37岁。引起白细胞减少…     

肝病性白细胞减少症41例临床探讨

周围血液白细胞计数＜４×１０９／Ｌ称为白细胞减少症。本文对肝硬化肝功能失代偿期１１５例中合并的白细胞减少症４１例进行探讨。１　对象与方法１．１　研究对象　１９９３年以来收住的肝硬化肝功能失代偿期１１５例,其中合并白细胞减少症４１例。男３１例,女１０例。平均年龄５１．７６±１５．１２（２０～８４）岁。原发疾病有：门脉性肝硬化１７例,其中乙肝表面抗原阳性７例;血吸虫病性肝纤维化２０例,其中乙肝表面抗原阳性１０例;酒精性肝硬化４例。全部病例的肝硬化诊断均经病史、体检、肝功能检查、Ｂ型超声波检查及有关辅…     

苦参素注射液治疗白细胞减少症的临床观察

粒单核细胞集落刺激因子(GM-CSF)对白细胞减少症虽有较好的疗效，但其作用单一、价格昂贵，患者较难接受。我们采用苦参素注射液对其进行治疗，临床疗效显著。     

角鲨烯胶囊治疗白细胞减少症临床疗效分析

角鲨烯胶囊治疗白细胞减少症临床疗效分析同济医科大学附属协和医院内科高峰，凌淑端角鲨烯是从鲨鱼肝脏中提取的精制品，内含二十四碳六烯，能提高机体组织的氧利用，增强人体细胞免疫功能。临床上用于各种缺氧性疾病、心脏病、肝炎及癌症的防治。本文旨在观察角鲨烯胶囊...     

180例成人白细胞减少症的病因分析

在临床工作中经常遇到一些“白细胞减少”的患者，白细胞减少症是外周血白细胞计数持续低于4．0×10^9／L，多数是粒细胞减少的结果，故又称粒细胞减少症。其病因多种多样，发病机理各不相同，明确病因有利于治疗。现将1999—2005年我院收住的180例白细胞减少症病例分析报道如下。[第一段]     

大剂量利血生片治疗白细胞减少症的有效性和安全性

目的评价大剂量利血生片治疗白细胞减少症的临床疗效和安全性。方法将70例抗甲亢药物引起的白细胞减少症患者随机分为3组：A组30例，口服大剂量利血生片40mg／次，每日3次；B组30例，口服常规剂量利血生片20mg／次，每日3次；C组（安慰剂组）10例，口服维生素B1片20mg／次，每日3次。疗程均为4周，观察治疗前后白细胞计数的变化和不良反应，并进行组间疗效对比。结果A组显效16例，有效10例，无效4例，总有效率为87％；B组显效9例，有效12例，无效9例，总有效率为70％。两组总有效率均明显高于安慰剂组（20％，P〈0．01），但A组优于B组（P〈0．05）。在治疗过程中未发现利血生片有任何毒副作用。结论大剂量利血生片治疗白细胞减少症，疗效优于常规剂量且安全。     

量子血液疗法治疗27例化疗药物性白细胞减少症

作者应用量子血液疗法治疗恶性肿瘤化疗后白细胞减少症27例,并与非量子血液疗法治疗的病情相近的27例进行对照观察,7天内白细胞升高总有效率有非常显著性差异(P<0.01),且治疗组合并感染发热例数和天数均少于对照组。     

Does chemotherapy-induced leukopenia predict a response in small-cell lung cancer?

The correlation between chemotherapy-induced toxicity and treatment outcome in cancer patients has not been studied thoroughly. Our aim was to evaluate whether there is any relationship between chemotherapy-induced leukopenia and response to treatment in small-cell lung cancer (SCLC). Data derived from records of 228 patients treated within two prospective multicentre phase II studies were analysed. In the first study (101 patients) chemotherapy included vincristine, epirubicin and cyclophosphamide and, in the second (127 patients), cyclophosphamide, etoposide and epirubicin; both regimens were given every 3 weeks. In the present analysis, the correlation between treatment outcome (response rate and survival) and highest scores of leukopenia within the first two and up to the fourth chemotherapy cycle, respectively, was evaluated. The objective response rate for the entire group was 66%; 53% in patients whose white blood cells remained normal and 85% in those who developed leukopenia within the first two cycles (P=0.000). In multifactorial analysis, also including other treatment- and patient-related factors, independent correlation with response to chemotherapy was found for leukopenia (P=0.001), chemotherapy regimen (P=0.002) and the combined relative dose intensity (P=0.018), but not for patient sex, age, performance status, pre-study weight loss, extent of disease and initial white blood cell count. Leukopenia within the first two cycles of chemotherapy was not correlated with survival, whereas such correlation for leukopenia occurring up to the fourth cycle was at the borderline level (P=0.06). These findings suggest a relationship between chemotherapy-induced leukopenia and tumour response in SCLC. Received: 11 August 1997 / Accepted: 24 November 1997     

Reduction of leukocyte count is associated with thalidomide response in treatment of multiple myeloma

Fifty Taiwanese patients with relapsed and/or refractory multiple myeloma (MM) were treated with thalidomide on a dose-escalation schedule, commencing with 100 mg/d nightly and incremented either to the maximally tolerated dose or 800 mg/d. Twenty-two patients (44%) responded, with 10 (45.5%) classified as partial remission and 12 (54.5%) minimal response (MR). Complete response did not occur. Of the 28 non-responders, 14 were progressive disease and 14 stable. The median time from commencement of thalidomide treatment to initial achievement of MR was 29 days (range, 8~155), and the corresponding thalidomide dose was 200 mg/d (range, 100~500). The median tolerated dose of thalidomide for the entire sample was 400 mg/d (range, 100~800), with only two (4%) able to tolerate 800 mg/d. Comparing responsive and non-responsive patients, statistically significant differences were not demonstrated for any characteristics except for CRP level and percentage cytogenetic change, which was slightly higher in the latter group relative to the former. Of particular interest, 18 of the 22 responders experienced transient reduction of leukocyte count preceding the attainment of significant reduction in M-proteins in comparison to only four of the 28 non-responders (82% vs. 14%; p<0.001). The median time from commencement of thalidomide treatment to attainment of minimal leukocyte count was 28 days (range, 7~150), with a mean of 2.19×10⁹/l (range, 0.96~3.35×10⁹/l). Leukopenia was generally transient, with rapid recovery despite subsequent continuation of thalidomide. Levels of other non-hematologically adverse effects attributed solely to thalidomide were generally acceptable. For 25 patients, thalidomide treatment was supplemented with low-dose dexamethasone (4 mg, every other day). Of these, 11 had relapsed from and 14 were primarily refractory to thalidomide treatment. Nine of the 25 dexamethasone-supplemented patients were responders (36%). Of particular note were the unusual events noted with this thalidomide-dexamethasone combination, including vascular thrombosis, acute cholecystitis, idiopathic interstitial lung disease and sudden cardiac death. Our results suggest that thalidomide is also effective for Taiwanese patients with refractory and/or relapsed MM. Importantly, the transient reduction in leukocyte count after commencement of thalidomide treatment may serve as a clinical predictor for response. Adverse effects should be carefully monitored when combining thalidomide and dexamethasone, however.     

老年干燥综合征患者临床特点及相关因素分析

目的 探讨不同年龄原发性干燥综合征(pSS)患者的临床、实验室检查及治疗特点.方法 收集84例干燥综合征患者的临床资料,按年龄分为中青年组和老年组,回顾性分析其临床特点、实验室指标及药物治疗的差异,并应用卡方检验进行统计学分析.结果 干燥综合征患者84例,老年组30例,中青年组54例;老年组患者口干、眼干及猖獗龋的阳性...     

男性肝硬化患者面部皮肤损害与血清性激素水平及肝功能的关系

目的 探讨男性肝硬化患者面部皮肤损害的发生机制与性激素水平及肝功能等相关影响因素的关系.方法 随机选择同期50例有面部皮肤损害(蜘蛛痣、毛细血管扩张、特殊类型皮疹)的肝硬化患者为病例组,30例无面部皮肤损害的肝硬化患者为对照组,检测血清中黄体生成素(LH)、卵泡刺激素(FSH)、催乳素(PRL)、雌二醇(E2)、孕酮(PRGE)、睾酮(T)水平,两组间比较采用t检验.肝硬化的严重程度按照Child-Pugh评分,分为A、B、C级,两组各级之间的比较采用单因素方差分析.对皮肤损害的相关因素:丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血清总胆红素(TBil)、血清白蛋白(Alb)、凝血酶原时间(PT-SEC)、血肌酐(CREA)、血小板计数(PLT)水平,以及是否酗酒采用成组logistic回归方法进行评估.结果 (1)男性肝硬化面部皮肤损害患者血清LH、FSH、E2水平和E2/T值分别高于对照组(t值分别为2.01、2.03、2.08、2.98,P值均＜0.05)；T水平在三组皮肤损害患者中均低于对照组(t值分别为-2.20、-3.77、-2.01,P值均＜0.05);(2)有皮肤损害组E2水平随着肝功能损害程度的加重依次降低,而无皮肤损害组E2水平随着肝功能损害程度的加重依次增高,两组间E2值的差异均无统计学意义(F=3.59,P＞ 0.05).有皮肤损害组和无皮肤损害组T水平随着肝功能损害程度的加重均依次降低,两组之间T值的差异有统计学意义(F=3.70,P＜0.05);(3)多因素相关风险度显示:长期酗酒及AST的升高会使面部皮肤损害发病率增高,其OR值分别为4.46、11.87,95％置信区间分别为1.45 ～ 13.7和1.24～ 113.1,P值均＜0.05.结论 男性肝硬化面部皮肤损害患者血清中存在不同程度的性激素紊乱,肝硬化皮疹的严重程度与长期酗酒及肝功能的好坏有关.总之,酒精和肝功能受损以及性激素紊乱在肝硬化皮肤损害的发病机制中发挥重要作用.     

Haemostatic and fibrinolytic parameters in septic patients with leukopenia or leukocytosis

Abstract: Induction of leukocytopenia by cytotoxic drugs protects against the generalized Shwartzman reaction induced by endotoxin. To elucidate the relationship between leukocyte number and in haemostatic and fibrinolytic disturbances in human sepsis, we studied 32 septic patients with abnormal leukocyte counts. Twenty patients had sepsis in the setting of leukopenia after chemotherapy for haematological malignancies. Twelve patients with leukocytosis developed sepsis associated with benign disorders. Concentrations of thrombin-antithrombin III complex (TAT), plasminogen activator inhibitor-1 (PAI-1) and plasma thrombomodulin (TM) in the leukocytosis group of (12.0 ± 11.0, 40.2 ± 27.0 and 5.5 ± 2.3 ng/ml, respectively) were significantly elevated compared to the leukopenia group of (3.8 ± 2.3, 18.0 ± 15.0 and 3.1 ± 1.0 ng/ml, respectively) and controls (3.3 ± 0.4, 10.5 ± 5.3, 3.0 ± 0.5 ng/ml, respectively). On the other hand, there were no significant differences in these values between leukopenia group and controls. Thus leucocytes may play important roles in thrombin generation, PAI-1 release and injury to endothelial cells.     

无创呼吸机对慢性阻塞性肺疾病急性加重期合并2型糖尿病的疗效观察

目的 研究无创呼吸机对慢性阻塞性肺疾病急性加重期(AECOPD)合并2型糖尿病的患者的疗效观察.方法 将138例患者分为A1、A2和B三个组,每组46例,其中A1、A2组为AECOPD合并2型糖尿病患者,B组为无糖尿病的AECOPD患者.三组入院期间均给予常规治疗,三组同时用无创呼吸机治疗.结果 A2组和B组两组治疗前后血气分析和肺功能改善明显;A1组治疗前后动脉血氧分压无明显改善.经继续治疗后动脉血氧分压明显改善,但失败机会未改善.结论 对于AECOPD合并2型糖尿病的患者早期合理应用无创呼吸机对于血气分析及肺功能改善明显且使失败机会下降.

Abstract：

Objective To investigate the clinic effect of noninvasive ventilation(NIPV) on patients of acute exacerbation of chronic obstructive pulmonary (AECOPD) incorporating with diabetes 2. Methods The total of 138 patients were divided into 3 groups: AECOPD incorporating with diabetes 2 treating with NIPV:A1 group(46 cases), A2 group(46 cases),AECOPD group(46 cases). The 3 groups were given noninvasive ventilation and the routine therapy. Results After intervention,the results of blood gas analysis and pulmonary functionin group A2 and group B are statistically different ( P ＜ 0. 05) than before. The results of PaO2 in Group A1 are not statistically different than before. After intervention,PaO2is better than before in group Al, but the opportunity of failure is not improved. Conclusions Rational using the NIPV with AECOPD incorporating with diabetes 2 can improve blood gas analysis and pulmonary function, which decrease the opportunity of failure.     

Skin microcirculation in healthy subjects and patients with arteriosclerosis

The concept to use the human skin microcirculation as a pharmacological in-vivo test system is old; however, methods developed in the 50s have been abandoned because of side effects and/or use of radioactive substances. We describe a newly developed minimally invasive method that allows in-vivo pharmacology in the human skin microcirculation injecting very low doses of a substance of drug without any systemic effects. The double injection technique (DIT) bears the potential to predict the effects of a drug and/or the vascular reactivity or dysfunction of other less accessible areas of the circulation (e.g. the myocardium). The DIT has been applied for studies in healthy volunteers and patients with atherosclerosis; the focus of interest was endothelial (dys-)function and the effect of exogenous vasoactive drugs. Using endothelin antagonists, we investigated the role of endogenous endothelin under physiological conditions and in atherosclerosis. The NO-synthase inhibitor L-NMMA has been applied to study the L-arginine-NO-pathway and the role of endothelial adrenoceptors. Ongoing studies with the DIT comparing coronary and skin microcirculation may help to develop minimally invasive methods to predict the effects of drugs and vascular function in the heart.     

老年糖尿病患者应用阿司匹林反应性研究

目的研究老年糖尿病患者应用阿司匹林的反应及影响因素。方法采用光学法血小板聚集,分别应用花生四烯酸（arachidonicacid,AA）、二磷酸腺苷（adenosinediphosphate,ADP）作为诱导剂检测199例老年糖尿病患者血小板功能;全自动生化仪检测空腹、餐后2h血糖、血脂、肾功能;高压液相法测定糖化血红蛋白指标。运用real—timePCR、WesternBlot检测循环血中单核细胞环氧化酶一2（cyclooxygenase-2,COX-2）mRNA、蛋白表达水平;同时检测人单核细胞（THP-1）在不同时间（12h、24h）和不同葡萄糖浓度（5．6mmol／L、11．1mmol／L、22．2mmol／L）情况下COX-2mRNA的表达量。结果非阿司匹林敏感（notaspirinsensitive,NAS）组空腹血糖、糖化血红蛋白水平高于敏感组;糖化血红蛋白未达标组NAS发生率高于达标组;糖尿病病程长的组NAS发生率更高。空腹血糖、糖化血红蛋白是NAS的相关危险因素。NAS组外周血单核细胞中COX-2mRNA表达量、蛋白表达率高于阿司匹林敏感组（aspirinsensitive,ASo葡萄糖刺激人单核细胞（THP-1）COX-2mRNA表达增加,且所用葡萄糖浓度越高、时间越长COX-2mRNA表达量越高。结论空腹血糖、糖化血红蛋白是老年糖尿病患者阿司匹林不敏感独立的危险因素。高糖刺激COX-2表达增加,这可能是糖尿病患者阿司匹林不敏感发生率增高的原因之一。