急性脑梗死患者血清同型半胱氨酸水平及临床意义

目的探讨高同型半胱氨酸血症与急性脑梗死之间的关系及临床意义。方法采用循环酶法测定40例急性脑梗死患者和40例健康对照者的血清同型半胱氨酸水平。结果急性脑梗死组血清同型半胱氨酸水平为(16.79±4.16)μmol/L,明显高于对照组的(8.29±3.76)μmol/L,差异有统计学意义(P<0.05)。结论高同型半胱氨酸是急性脑梗死的一个独立危险因素,开展同型半胱氨酸的常规检测,利于早期发现脑梗死及进行预防。     

高同型半胱氨酸血症治疗药物研究进展

高同型半胱氨酸血症是心脑血管疾病的一个独立的、重要的危险因素.本文综述近年高同型半胱氨酸血症治疗药物研究进展,重点介绍药物的临床应用以及活性化合物和复合制剂的开发.     

高同型半胱氨酸血症在脑血管病中的意义探讨

目的探讨高同型半胱氨酸血症在脑血管病中的临床意义。方法选取本院自2011年5月-2013年5月收治的60例脑血管病患者作为观察组,选取同期60例正常体检者作为参考组,对两组研究者的同型半胱氨酸水平进行测定比较。结果观察组患者同型半胱氨酸水平明显高于参考组,P〈0．05。结论高同型半胱氨酸血症在脑血管病中诊断具有重要意义。     

微机分析24例多发性骨髓瘤预后因素

本文综合分析了24例多发性骨髓瘤患者的疗效、血红蛋白、生活自理程度及骨髓损害程度对生存期的影响、用多元回归法经微机处理后得出结论,疗效对生存期影响最大,而骨损害对生存期无响影。     

高同型半胱氨酸与痴呆关系研究进展

1933年,美国首次报道1例8岁儿童由于高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)继发颈动脉粥样硬化,最后因脑梗死死亡.1969年,McCully报道1例少见的先天性异常病例,患儿表现出严重的动脉硬化征象,并发现HHcy可能是导致动脉硬化的最终决定因素.至此,人们发现了HHcy与血管性病变的关系,并发现阿尔兹海默病(AD)和血管性痴呆(VaD)患者血同型半胱氨酸(homocysteine,Hcy)增高[1].进一步研究证明,HHcy是痴呆发病的独立危险因素[2].本文就近年来HHcy与痴呆的关系及导致痴呆发病机制的研究进展予以综述.     

脑血管疾病患者高同型半胱氨酸血症的防治

高Hcy是脑血管疾病的独立危险因素，其机制可能与其诱导动脉粥样硬化有关，Hcy代谢相关基因形态性如MTAFR，CBS等突变可能通过影响酶的活性导致高Hcy血症，进而与脑血管疾病相关联，补充叶酸，VitB6和VitB12可以治疗和预防高Hcy，至关重要，但其远期效果有待进一步研究。     

Cereblon在多发性骨髓瘤中的研究进展及临床意义

以沙利度胺、来那度胺、泊马度胺为代表的免疫调节药物,对于多发性骨髓瘤患者的治疗反应率及预后产生了重要影响。Cereblon(CRBN),最初发现与常染色体隐性遗传非综合征性智力发育迟缓相关,近年研究已经证明其不仅为沙利度胺致畸作用的靶点,还与免疫调节药物抗骨髓瘤作用的临床反应率及患者的生存时间相关;目前认为,CRBN可能是通过形成DDB1-CUL4-ROC1泛素连接酶复合物介导抗骨髓瘤活性。还需要更多有关CRBN分子机制及临床相关性研究以促进免疫调节药物耐药机制的进一步发展以及更有效、低毒性的药物出现,提高多发性骨髓瘤患者的生存质量。     

叶酸在治疗高同型半胱氨酸血症相关疾病中的合理应用

同型半胱氨酸是蛋氨酸代谢通路上的中间代谢产物,多年来的研究结果已证明高同型半胱氨酸血症与高血压、脑卒中、抑郁、阿尔茨海默病、糖尿病周围神经病变及慢性肾脏病等疾病的发生有关.尽管叶酸可以有效降低体内同型半胱氨酸水平,但其在治疗高同型半胱氨酸血症相关疾病中可能存在超适应证、超剂量等不合理用药现象.建议临床在应用叶酸时,应采...     

高同型半胱氨酸在亚急性联合变性中的诊断价值

目的探讨高同型半胱氨酸血症(hyperhomocysteinaemia Hhcy)在亚急性联合变性(subacute combined degeneration,SCD)中的诊断意义。方法回顾性分析临床确诊的26例SCD患者及25例健康对照的临床资料、血常规、血清同型半胱氨酸(homocysteine Hcy)、维生素B12、神经电生理检查、MRI检查,并观察其特点,对比SCD组与健康对照组血清Hcy的差异。结果 SCD组的血清Hcy水平明显高于健康对照组,其差异具有统计学意义[(77.83±62.87)μmol/L与(16.19±6.95)μmol/L,t=4.968,P<0.01];维生素B12治疗后SCD患者Hcy明显下降(t=0.394,P=0.001)。结论 Hhcy可作为SCD临床诊断及病情变化的重要生物学指标。     

高同型半胱氨酸血症与缺血性脑卒中关系

目的　分析高同型半胱氨酸 (Hcy)血症与缺血性脑卒中的关系。方法　应用高压液相色谱法(HPLC)对 35例缺血性脑卒中组患者和 35例对照组中的健康体检者进行血浆Hcy测定。结果　缺血性脑卒中患者的平均血浆Hcy(18. 9±6. 8)μmol/L高于对照组(11. 4±4. 1)μmol/L,且具有显著性差异(P<0. 001)。结论　高同型半胱氨酸血症是缺血性脑卒中的独立危险因子,应该给予重视及治疗。     

多发性骨髓瘤治疗策略及治疗新药

多发性骨髓瘤是一种起病隐匿、治疗难度较大的浆细胞恶性增殖性疾病,如何更准确地判断治疗时机以及选择适宜的治疗策略和治疗药物一直是临床上亟待解决的重大课题。近20年来,随着造血干细胞移植术和治疗新药的应用,多发性骨髓瘤治疗已取得重大进展,治疗疗效和患者的预后都得到了明显改善。     

Menogaril in the treatment of relapsed multiple myeloma

Summary Fifteen patients with relapsed multiple myeloma (MM) were treated with menogaril 160 mg/m² intravenously (IV) every 28 days. No responses were seen: 8 patients had stable disease, 4 progressed after one course of therapy, and 3 patients were removed from study after 1 course for other reasons. Four of the 8 patients with stable disease had an improved performance status, and 3 had a decrease in analgesic use. The major toxicity was myelosuppression. The median progression-free interval was 3.0 months with a range of 0.7 to 22 months and median survival was 11.3 months with a range of 0.7 to 39+ months. Menogaril displays little activity in patients with previously treated MM.     

多发性骨髓瘤患者血栓弹力图检测的临床意义

目的：探讨血栓弹力图（TEG）对多发性骨髓瘤患者体内凝血状态的应用效果。方法：对24例多发性骨髓瘤患者于进行TEG测定,了解其凝血功能情况。结果：患者TEG表现为高凝图像,Angle值、CI值较诈常对照组明显增高（P〈0．05）。结论：多发性骨髓瘤患者体内存在病理性高凝状态,应用TEG动态观察多发性骨髓瘤患者凝血状态,对病情评估及指导治疗有重要意义。     

硼替佐米治疗多发性骨髓瘤的临床观察

目的观察硼替佐米在治疗多发性骨髓瘤中的临床疗效及其不良反应。方法选择我院2004年2月至2011年5月住院治疗的62例多发性骨髓瘤患者,按治疗方案不同分为2组。治疗组(n=38)采用硼替佐米加大剂量地塞米松治疗6疗程;对照组(n=24)采用VAD方案(长春新碱、阿霉素及地塞米松)治疗6疗程。结果治疗组和对照组完全缓解率(CR)分别为39.4%和20.8%,总有效率(TERs)分别为81.6%和58.3%;不良反应中周围神经病变发生率分别为34.2%和37.5%,血小板减少发生率分别为28.9%和20.8%,感染发生率分别为10.5%和8.3%;死亡发生率分别为2.6%(1/38)和0%。两组TERs比较,差异有统计学意义(P<0.05);但2组不良反应(包括周围神经病变、血小板减少和感染)发生率比较差异无统计学意义(P>0.05)。结论硼替佐米治疗多发性骨髓瘤的疗效确切。     

血清微RNA-34a在多发性骨髓瘤中的表达及其临床意义

目的 检测初诊多发性骨髓瘤（MM）病人血清微RNA-34a(miR-34a)表达水平,并探讨其临床意义。方法 选取2017年3月至2021年5月石家庄市人民医院收治的102例初诊MM病人作为疾病组,并同期选取100例性别、年龄匹配的健康体检者作为对照组,采用实时荧光定量多聚核苷酸链式反应法（qRT-PCR）检测两组血清miR-34a表达水平,对比疾病组MM不同临床病理特征病人血清miR-34a表达水平。另疾病组均行以硼替佐米为基础的方案化疗,评估不同化疗方案的效果,并采用logistic回归分析法分析血清miR-34a表达水平对MM病人化疗效果的影响。结果 疾病组血清miR-34a表达水平低于对照组（0.63±0.10比1.45±0.23,P<0.05）;疾病组国际分期系统（ISS）分期Ⅲ期、修订版国际分期系统（R-ISS）分期Ⅲ期、免疫球蛋白G(IgG)型、FISH筛查高危病人血清miR-34a表达水平均低于ISS分期Ⅱ期、免疫球蛋白A(IgA)、轻链型和其他类型、荧光原位杂交（FISH）筛查非高危病人（P<0.05）;疾病组化疗4个周期后总有效率为75.49%,其中PT...     

Smoldering multiple myeloma: to treat or not to treat

Introduction: Smoldering multiple myeloma (SMM) is an asymptomatic disorder characterized by the presence of ≥ 30 g/l serum M-protein and/or ≥ 10% bone marrow plasma cell infiltration. The progression risk to active multiple myeloma (MM) is not uniform, and several prognostic parameters are useful for identifying patients at high risk of progression. A watch-and-wait approach has been the standard of care up to now. However, recently, it has been demonstrated that a subset of high-risk cases can benefit from early treatment with new drugs.

Areas covered: In this editorial, we focus on SMM and evaluate the diagnostic work-up and the prognostic factors predicting progression to symptomatic MM. We also review the studies in which the role of early treatment has been evaluated for patients with SMM.

Expert opinion: After the update performed by the International Myeloma Working Group regarding MM diagnosis, it is now time to change the therapeutic paradigm for this disease. While “ultra high-risk” myeloma should now be considered as active MM, for low-risk patients the “watch-and-wait” strategy is still recommended. More caution is needed for the high-risk group: physicians should continue monitoring patients using every tool now available while waiting for results from ongoing trials that will establish if this group will benefit from an early intervention.     

Ixazomib for the treatment of multiple myeloma

Introduction: Proteasome inhibition is a mainstay in the treatment of multiple myeloma (MM). Bortezomib, the first proteasome inhibitor (PI) approved for MM therapy, has shown efficacy in relapsed/refractory patients and in the front-line setting. Among second-generation PIs, MLN9708 (ixazomib) is the first oral compound to be evaluated in MM treatment and has shown improvement in pharmacokinetic and pharmacodynamic parameters compared with bortezomib with a similar efficacy in the control of myeloma growth and in the prevention of bone loss.

Areas covered: In this review, the authors discuss the rationale for use of PIs. They then summarize the clinical development of ixazomib in MM, from initial Phase I to Phase II studies as a monotherapy and in combination with other chemotherapeutics.

Expert opinion: Preliminary data of Phase I/II trials showed that ixazomib had a good safety profile and exerted anti-myeloma activity as a single agent in relapsed/refractory patients. Furthermore, ixazomib also had efficacy in patients who were refractory to bortezomib. Its use in combination with lenalidomide and dexamethasone was shown to be an effective and well-tolerated regimen in up-front treatment leading to minimal residual disease negativity in a significant number of patients. Results of Phase III trials, evaluating ixazomib in induction or maintenance therapy, are awaited.     

沙利度胺联合地塞米松治疗难治性复发性多发性骨髓瘤的临床疗效

目的评价沙利度胺单独或联合地塞米松治疗难治性复发性多发性骨髓瘤(MM)的临床疗效。方法42例难治性复发性MM患者,单用组20例:沙利度胺起始剂量100 mg.d-1,每周增加100 mg,直至患者最大耐受剂量或最大剂量600 mg.d-1。联合组22例:在沙利度胺治疗剂量至200 mg.d-1时,给予地塞米松40 mg.d-1(d 1~4、9~121、7~20),1 mo为1个疗程。持续治疗3 mo。结果单用组总有效率35.0%,明显低于联合组68.2%(P<0.05)。结论沙利度胺能有效治疗难治性复发性MM,在联合地塞米松时可提高有效率。     

Ixazomib for the treatment of multiple myeloma

ABSTRACT

Introduction: Proteasome inhibitors (PIs) are among the backbones of multiple myeloma (MM) treatment; however, their long-term use can be limited by parenteral administration and treatment-related toxicities. Ixazomib, the first oral PI to enter the clinic, is approved around the world, in combination with lenalidomide and dexamethasone, for the treatment of patients with MM who have received at least one prior therapy.

Areas covered: This review summarizes the clinical data leading to approval of ixazomib; its pharmacology, efficacy, and safety. Building on the data in relapsed/refractory MM (RRMM), it also reviews the available clinical trial data for ixazomib across the MM treatment algorithm in newly diagnosed MM, RRMM, and as maintenance therapy, and looks ahead to ongoing clinical trials and the expanding role of ixazomib in these indications.

Expert opinion: Ixazomib is an efficacious and well-tolerated addition to the treatment armamentarium for RRMM, with benefit as a long-term, continuous therapy for all patients, including ‘poor prognosis’ patients, such as those with advanced stage disease, high-risk cytogenetic abnormalities, and elderly and frail patients. Data from ongoing clinical studies are expected to expand the role of ixazomib across the MM treatment algorithm and in a broader range of combination regimens.     

113例多发性骨髓瘤校正血钙的意义

目的 分析正血钙在多发性骨髓瘤(MM)对判断预后及指导治疗方面的临床意义。方法 采用回顾性方法对113例MM患者的血钙水平以同时抽血所没得血清白蛋白浓度进行校正后,进行正前后血钙水平及高钙血症发生率的比较。结果 多发性骨髓瘤Ⅰ期患者血钙水平校正前后分别为(2.41±0.087)mmol/L和(2.376±0.149)mmol/L,两者无显著差异(P>0.05)。Ⅱ期患者的血钙水平在校前后分别为(2.264±0.372)mmol/L和(2.376±0.092)mmol/L,两者有显著 性差异(P<0.05),Ⅲ期患者血钙在校正前后分别为(2.377±0.360)mmol/L和(2.539±0.399)mmol/L,两者有显著差异(P<0.01),校正后高钙血症发生率(31.0％)比校正前(17.7％)显著升高(P<0.05)。结论 常规检测血钙值低估了MM患者血钙的真实水平,校正血钙比血钙在MM的诊断,指导治疗及预后方面更具有临床应用价值。