标准剂量去甲氧柔红霉素联合阿糖胞苷治疗急性髓细胞白血病

目的:探讨标准剂量的去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)治疗急性髓细胞白血病(AML)的疗效和不良反应。方法:14例AML患者,年龄13～70岁(中位年龄36岁),男8例,女6例。初治AML10例,难治、复发AML4例。所有患者均在治疗前进行染色体核型分析,4例染色体异常。诱导方案为IDA 12 mg·m-2·d-1,第1～3天,Ara-C 100 mg·m-2·d-1,持续静脉点滴,第1～7天。结果:1个疗程结束后总有效率92．9％(13／14),完全缓解率85．7％(12／14),其中初治AML的CR率为90．0％(9／10),复发、难治AML的CR率为75．0％(3／4),3例染色体异常患者达细胞遗传学缓解,未发生早期死亡。化疗的不良反应主要为骨髓抑制和粒细胞缺乏所致感染,未见严重的非造血系统不良反应。结论:标准剂量的IDA联合Ara-C 24 h持续静脉点滴,为初治、复发难治AML的高效、安全的方案。     

G-CSF预激的小剂量HA方案诱导缓解老年或低增生急性髓细胞白血病的临床研究

目的:探讨初治的老年或低增生性急性髓细胞白血病(AML)患者采用粒细胞集落刺激因子(G-CSF)预激的小剂量高三尖杉酯碱(HHT)和阿糖胞苷(Ara-C)方案(G-HA)诱导缓解的疗效、毒副作用。方法:选择年龄>60岁或低增生AML初治患者共25例,采用G-CSF预激的小剂量HA方案诱导治疗。在化疗的前12h皮下注射G-CSF200μg/m2。治疗过程中,白细胞计数>20×109/L时暂停用,而不停止化疗,待白细胞回落后再继续使用。HHT:1mg/m2,d1～14,每日1次;Ara-C:10mg/m2,d1～14,皮下注射,每12h1次。对完全缓解(CR)者行后期可选择不同标准方案交替巩固化疗,第1年每月1次,第2年每2月1次。结果:第1个疗程后10例患者获得CR,9例获得部分缓解(PR),6例未缓解(NR)。9例PR患者中5例患者经过第2个疗程该方案后取得CR。总有效率76。15例获得CR的患者中11例按计划巩固强化治疗患者未复发,生存期为8～35个月,中位数17个月。有4例复发,经过原方案诱导后1例CR,2例PR,1例死亡。该方案血液学毒性轻,非血液学毒性不明显。结论:初治的老年或低增生性急性髓细胞白血病患者采用G-CSF预激的小剂量HA方案诱导缓解的疗效较好、毒副作用可耐受。     

DAV_(m26)方案治疗急性非淋巴细胞白血病10例

1995～1997年,我院应用DAVm26(柔红霉素、阿糖胞苷、鬼臼噻吩甙)方案治疗急性非淋巴细胞白血病(ANLL)患者10例,取得较好效果。临床资料:本组男6例,女4例;年龄19～48岁。其中M12例,M2a4例,M43例,M51例。初治6例,复治4例,后者中在院外应用HA(高三尖杉酯碱、阿糖胞苷)方案及DA方案治疗均无效。治疗方法:DAVm26方案:柔红霉素(DNR)40mg/d,静脉注射,第1～3天;阿糖胞苷(Ara-C)200mg/d,静脉滴注,第1～7天;鬼臼噻吩甙(Vm26)100mg/d,静脉滴注,第1～3天。间歇3周左右。完全缓解(CR)后采用原方案巩固治疗1个疗程,然后换用其它方案,每1～2个月…     

FLAG方案再诱导化疗急性髓细胞白血病临床观察

目的:初步探讨氟达拉滨(FDR)、高剂量阿糖胞苷(Ara-C)和粒细胞集落刺激因子(G-CSF)即FLAG方案在急性髓细胞白血病(AML)再诱导化疗中的疗效及不良反应。方法:12例经标准HA、DA、MA或IA方案化疗1疗程后未达完全缓解(CR)、骨髓原始细胞下降低于60%的AML患者,予FLAG方案再诱导化疗,即FDR30mg.m-2.d-1静脉滴注,d1～5;Ara-C1g/m2,静脉滴注,每12h1次,d1～5;G-CSF300μg/d皮下注射,第0天开始至白细胞恢复正常。结果:9例(75%)患者获得CR,3例(25%)患者获得部分缓解(PR)。主要不良反应为骨髓抑制,非血液学不良反应不明显。结论:FLAG方案再诱导化疗AML耐受性较好,有效率较高,不良反应可耐受。     

外周血淋巴细胞早期恢复在IA诱导治疗初治AML患者预后中的临床意义

目的:探讨外周血淋巴细胞绝对计数(ALC)与IA方案即标准剂量的去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)诱导治疗初治急性髓系白血病(AML)(除外急性早幼粒细胞白血病)患者预后的关系。方法:155例初治AML患者均接受IA方案诱导治疗:IDA 10~12mg/(m~2·d),第1~3天,Ara-C 100mg/(m~2·d),持续静脉滴注第1~7天。126例IA诱导治疗达完全缓解(CR)患者的后继治疗包括:70例采用以大剂量Ara-C为主的化疗;32例行自体干细胞移植(auto-HSCT);24例行异基因造血干细胞移植(allo-HSCT)。回顾性分析诱导治疗后第10天ALC(ALC-10)、第14天ALC(ALC-14)与总生存时间(OS)、无复发生存时间(RFS)的关系。结果:首次诱导治疗后,5例(3.2%)发生早期死亡,其余150例进行疗效评估,其中126例(84.0%)达到CR,9例(6.0%)获得部分缓解。ALC-10≥0.435×10~9/L者与ALC-100.435×10~9/L者中位OS分别为13.6个月、18.5个月(P=0.019),前者中位RFS优于后者(13.6个月∶10.0个月,P=0.007);ALC-14≥0.270×10~9/L者与ALC-140.270×10~9/L者中位OS分别为14.8个月、17.0个月(P=0.002),前者中位RFS优于后者(11.8个月∶10.0个月,P=0.002)。多因素分析显示,ALC-14是影响RFS的独立危险因素。在以大剂量Ara-C为主的化疗组和auto-HSCT组,ALC-14≥0.270×10~9/L者与ALC-140.270×10~9/L者相比,RFS均明显延长(P=0.025、0.028)。在allo-HSCT组,ALC-14对RFS的影响无统计学意义。结论:ALC-14可以作为判断IA方案诱导治疗初治AML患者预后的指标,尤其是CR后接受以大剂量Ara-C为主的化疗和auto-HSCT患者。     

外周血淋巴细胞早期恢复在IA诱导治疗初治AML患者预后中的临床意义

目的:探讨外周血淋巴细胞绝对计数(ALC)与IA方案即标准剂量的去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)诱导治疗初治急性髓系白血病(AML)(除外急性早幼粒细胞白血病)患者预后的关系。方法:155例初治AML患者均接受IA方案诱导治疗:IDA 10~12mg/(m~2·d),第1~3天,Ara-C 100mg/(m~2·d),持续静脉滴注第1~7天。126例IA诱导治疗达完全缓解(CR)患者的后继治疗包括:70例采用以大剂量Ara-C为主的化疗;32例行自体干细胞移植(auto-HSCT);24例行异基因造血干细胞移植(allo-HSCT)。回顾性分析诱导治疗后第10天ALC(ALC-10)、第14天ALC(ALC-14)与总生存时间(OS)、无复发生存时间(RFS)的关系。结果:首次诱导治疗后,5例(3.2%)发生早期死亡,其余150例进行疗效评估,其中126例(84.0%)达到CR,9例(6.0%)获得部分缓解。ALC-10≥0.435×10~9/L者与ALC-100.435×10~9/L者中位OS分别为13.6个月、18.5个月(P=0.019),前者中位RFS优于后者(13.6个月∶10.0个月,P=0.007);ALC-14≥0.270×10~9/L者与ALC-140.270×10~9/L者中位OS分别为14.8个月、17.0个月(P=0.002),前者中位RFS优于后者(11.8个月∶10.0个月,P=0.002)。多因素分析显示,ALC-14是影响RFS的独立危险因素。在以大剂量Ara-C为主的化疗组和auto-HSCT组,ALC-14≥0.270×10~9/L者与ALC-140.270×10~9/L者相比,RFS均明显延长(P=0.025、0.028)。在allo-HSCT组,ALC-14对RFS的影响无统计学意义。结论:ALC-14可以作为判断IA方案诱导治疗初治AML患者预后的指标,尤其是CR后接受以大剂量Ara-C为主的化疗和auto-HSCT患者。     

MxA方案治疗难治性复发性白血病临床研究

我院近年来应用米妥蒽醌（Mitoxantrone,Mx）加阿糖胞苷（Ara-C）联合治疗复发性难治性白血病9例,报告如下。1 材料和方法1.1 病例选择 9例均为住院病人,男7例,女2例;年龄21～42岁,中数年龄35岁:难治性急非淋6例,复发性急淋2例,慢粒急变1例,急非淋及慢粒急变病例均经DA或HA方案治疗>2个疗程而未缓解,急淋均为缓解后6个月内复发病例。1.2 治疗方案 采用MxA方案,即Mx10mg/d,第1～5天,Ara-C100～200mg/d,第1～7天,间歇期14～21天。密切观察血象、肝功能、心电图及临床症状变化,分别于停药后7～10天及停药后21～28天检查骨髓。2个疗程无效换其它方案。     

HA预激方案治疗老年急性髓系白血病的疗效观察

目的:探索含HA预激方案治疗老年急性髓系白血病(AML)的疗效。方法:11例老年AML患者(治疗组)予高三尖杉酯碱(HHT)1 mg·m-2·d-1,静脉滴注,第1-14天;阿糖胞苷(Ara-C)10 mg·m-2·12 h-1,皮下注射,第1-14天;粒细胞集落刺激因子(G-GSF)200μg·m-2·d-1,皮下注射,第1天注射Ara-C之前开始使用,至最后1次Ara-C之前停用。如果中性粒细胞>10×109/L,G-GSF用量减半,>20×109／L,则暂停用G-CSF,但不停化疗,待白细胞回落后再用。如果1个疗程未获完全缓解(CR),则进行第2个疗程,方案同第1疗程。如果2个疗程未获缓解,则视为治疗无效。对照组予标准DA方案治疗。结果:11例患者中第1个疗程CR 7例,第2个疗程CR 1例,1例第2疗程达部分缓解,CR率72．7％,有效率81.8％。结论:小剂量HA与G- CSF预激方案治疗老年AML有较高的疗效且不良反应少。     

CAG预激方案治疗老年人急性髓细胞白血病的临床观察

目的探讨小剂量阿糖胞苷（Ara-C，C）和阿克拉霉素（Acla，A）联合粒细胞集落刺激因子（G-CSF，G）治疗老年人急性髓细胞白血病（AML）的疗效和不良反应。方法回顾性分析60-81岁的AML患者52例，男28例，女24例。5例曾接受2个疗程正规剂量的化疗，均未缓解；40例作染色体核型分析，10例为预后不良染色体异常。52例均采用CAG预激方案治疗，即Acla 10mg／d，第1～8天，Ara-C10 mg／m^2，1次／12h，第1～14天，G-CSF200μg·m^-2·d^-1，第1～14天。结果化疗后总有效率69．2％，完全缓解（CR）率55．8％。初诊患者CR率为65．7％；复发、难治患者为35．2％；≥70岁患者为44．4％。10例预后不良染色体异常的患者完全缓解4例。全组早期病死率7．7％，总生存期中位时间14个月。化疗的不良反应主要为骨髓抑制，未见严重的非造血系统不良反应。结论CAG预激方案为治疗老年人AML的比较有效、安全的方案。     

HAA方案治疗急非淋白血病疗效观察

我院1993年1月～1996年1月用阿克拉霉素(Acl)、三尖杉酯碱(Har)、阿糖胞苷(Ara-C)组成的HAA方案治疗急性非淋巴细胞白血病(ANLL)25例,取得较满意疗效。1 材料和方法1.1 病例选择 25例ANLL均系住院患者,男15例,女10例,年龄14～59岁,中位年龄29岁,按文献标准诊断:M_1 2例,M_2 14例,M_4 1例,M_5 8例。初治20例,复发性2例,难治性3例。1.2 治疗方法 Har 3mg/d,静滴7d;Acl 20mg/d,静滴3d;Ara-C 200mg/d,静滴7d,7d一疗程,间歇10～14d重复下一疗程,3个疗程未能获得完全缓解者换用其它方案治疗。化疗期间给予足够支持治疗,输成分血,有感染时联合应用抗生素。定期复查肝、肾功能,作心电图检查,每周查血象3次,每疗程结束后作骨髓检查。1.3 缓解后治疗 完全缓解后间隔2～3周重复HAA方案巩固2疗程。然后用DAE方案:柔红霉素(D)40mg/d,静滴3d;Ara-C 300mg/d,静滴7d;足叶乙甙(E)100mg/d,静滴5d,与HAA方案交替     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.