血小板生成素和巨核细胞对特发性血小板减少性紫癜预后的影响

目的探讨血小板生成素(TPO)和巨核细胞计数对特发性血小板减少性紫癜(ITP)患儿预后的意义.方法采用夹心酶联免疫吸附法测定122例ITP患儿血清TPO水平,根据巨核细胞数分为A组(巨核细胞数≤35/6 cm2)与B组(巨核细胞数＞35/6 cm2),两组进行TPO水平比较,并观察各组疗效.结果 A和B组TPO水平分别为(368.33±39.47) ng/L,(141.48±11.28) ng/L.A组明显高于B组,有显著性差异(t=7.44 P＜0.01).A组治疗有效率为23.8%,明显低于B组84.2%,其差异有显著性(χ2=6.54 P＜0.05).A组有效5例TPO为(109.60±15.59) ng/L,无效16例TPO为(449.18±29.59) ng/L,其差异有显著意义(t=-6.23 P＜0.01).结论 ITP患儿血清TPO水平存在较大差异,TPO水平明显增高且无巨核细胞数增高者疗效差,可能提示预后不良.     

重组人血小板生成素治疗儿童免疫性血小板减少性紫癜临床观察

目的观察重组人血小板生成素(rhTPO)治疗儿童免疫性血小板减少性紫癜(ITP)的疗效。方法 2011年南京医科大学附属南京儿童医院血液肿瘤科收住院ITP患儿142例,常规给予激素治疗。在24例激素治疗无效患者中,16例(治疗组)采用rhTPO+小剂量激素(泼尼松5～10mg/d)治疗,8例(对照组)在小剂量激素基础上分别采用注射用重组人白介素-11(3例)、大剂量激素冲击(2例)、CD20单克隆抗体(利妥昔单抗)(1例)、脾动脉栓塞(1例)、升血小板胶囊(1例)。rhTPO采用300U/kg,1次/d,连用14d,或血小板计数>50×109/L即停用,继续观察血小板数值1个月,同时观察出血情况。结果男性、有前驱感染患儿对常规激素治疗反应更明显(P<0.01),而是否有伴随症状、皮肤出血情况则无意义。rhTPO治疗组9例血小板>50×109/L,对照组3例血小板>50×109/L,但无统计学差异。与对照组比较,治疗组能显著改善出血倾向(P<0.05)。结论对激素无效ITP患儿,rhTPO治疗能够显著改善出血症状,一定程度上提升血小板计数,但维持时间短。对于激素治疗无效的儿童ITP,尚须进一步寻找有效的治疗方法。     

特发性血小板减少性紫癜患儿血小板生成素及其受体基因转录水 …

目的 探讨急性特发性血小板减少性减少性紫癜（ＡＴＴＰ）患儿血小板生成素（ＴＰＯ）及血小板ＴＰＯ受体ｃ－ＭＰＬ ｍＲＮＡ基因转化水平变化的意义。方法 采用ＥＬＩＳＡ法检测血清ＴＰＯ、血小板相关抗体（ＰＡＩｇＧ）水平;半定量ＲＴ－ＰＣＲ法检测外周血血小板ｃ－ＭＰＬ ｍＲＮＡ的相对量。结果 ＡＴＴＰ患儿初治时血浆ＴＰＯ水平增高,血小板ｃ－ＭＯＬ ｍＲＮＡ较低;以大剂量甲基强的松龙冲击治疗后,位随血小板计     

血小板生成素在新生儿血小板减少症中的应用

37年前Ｋｅｌｅｍｅｎ首先发现动物血液中存在着调节血小板生成的体液因子 ,命名为血小板生成素 (ＴＰＯ)。但在随后的几十年中 ,由于检测手段的限制 ,使这种调节血小板生成的激素 ,先后改名为血小板生成刺激因子和巨核细胞刺激因子 ,直到 1994年成功地克隆出人类ＴＰＯ补偿脱氧核糖核酸(ｃＤＮＡ)和基因后 ,ＴＰＯ这一概念才被人们开始接受。随着分子生物学的进展和分子生物学技术的应用 ,已成功地应用重组ＤＮＡ技术 ,产生重组人类ＴＰＯ(ｒｈＴＰＯ) ,并在试管内、动物体内和人体内作了大量实验。本文将对ＴＰＯ的生物学特性以及在血小板…     

血小板生成素和巨核细胞对特发性血小板减少性紫癜患儿预后的影响

目的探讨血小板生成素(TPO)和巨核细胞计数对特发性血小板减少性紫癜(ITP)患儿预后的意义。方法采用夹心酶联免疫吸附法测定122例ITP患儿血清TPO水平,根据巨核细胞数分为A组(巨核细胞数≤35/6 cm2)与B组(巨核细胞数>35/6 cm2),两组进行TPO水平比较,并观察各组疗效。结果A和B组TPO水平分别为(368.33±39.47)ng/L,(141.48±11.28)ng/L。A组明显高于B组,有显著性差异(t=7.44 P<0.01)。A组治疗有效率为23.8%,明显低于B组84.2%,其差异有显著性(χ2=6.54 P<0.05)。A组有效5例TPO为(109.60±15.59)ng/L,无效16例TPO为(449.18±29.59)ng/L,其差异有显著意义(t=-6.23 P<0.01)。结论ITP患儿血清TPO水平存在较大差异,TPO水平明显增高且无巨核细胞数增高者疗效差,可能提示预后不良。     

新生儿血小板减少症和血小板生成素在其发病机制中的作用

血小板减少症 (<15 0× 10 9/Ｌ)是新生儿时期常见的一种血液系统症状。在非选择性的新生儿人群中发生率为0 5 %～ 0 9%[1,2 ] 。严重的血小板减少症 (<5 0× 10 9/Ｌ)的发生率为 0 12 %～ 0 14%[1,3 ] 。在ＮＩＣＵ中近 15 %～ 40 %的住院患儿出现血小板减少[4 ] 。危重早产儿血小板减少症的发生率高达 72 %[5] ,有 75 %的患儿发生于出生后 48ｈ内[4 ,6] 。早期诊断和处理对减少严重的合并症及降低死亡率十分重要。新生儿血小板减少症发生的原因除免疫和遗传因素外 ,大多数 (6 5 %)新生儿的血小板减少与胎儿期、产前及产后的合并症有关…     

特发性血小板减少性紫癜及再生障碍性贫血患儿血清血小板生成素的测定

研究特发性血小板减少性紫癜及再生障碍性贫血患儿血清血小板生成素水平变化及其临床意义 ,采用放射免疫法检测 1 5例特发性血小板减少性紫癜患儿、9例再生障碍性贫血患儿和 1 3例正常儿童血清血小板生成素水平。结果显示 ,特发性血小板减少性紫癜患儿血清血小板生成素水平为 ( 1 0 0 0 8± 38 4 )pq ml,与正常对照组无显著差异 (P >0 0 5) ,再生障碍性贫血患儿血清血小板生成素水平为 ( 1 4 4 0 7±2 83)pq ml,显著高于正常儿 (P <0 0 5)。因此 ,儿童特发性血小板减少性紫癜血清血小板生成素水平受骨髓巨核细胞数调控 ,外周血血小板数量则是再生障碍性贫血患儿血清血小板生成素水平的主要调节因素。     

特发性血小板减少性紫癜的诊断和治疗

目的特发性血小板减少性紫癜(ITP)是一种因免疫异常导致的疾病。它的诊断目前主要依靠病史、临床表现、实验室检查。但目前对其诊断、治疗仍然存在争议。本文对近年来有关ITP的诊断、临床分级、鉴别诊断、治疗情况作一介绍。实用儿科临床杂志,2006,21(3):185-188     

血清降钙素原测定在感染性疾病中的诊断价值

目的 探讨血清降钙素原(PCT)在感染性疾病中的诊断价值.方法 采用血清半定量免疫色谱法测定120例感染性疾病疑似患儿和40例健康儿童PCT水平.120例感染性疾病疑似患儿分为局部感染组50例,重症感染组40例和病毒感染组30例,分析各组测定结果和阳性率.结果 局部感染组PCT为(0.84±1.03) μg·L-1,重症感染组为(31.75±81.25) μg·L-1,病毒感染组为(0.62±1.01) μg·L-1,健康对照组为(0.26±0.11) μg·L-1.重症感染与局部感染组比较,差异有统计学意义(t=2.596,P＜0.01);重症感染组与病毒感染组比较,差异有统计学意义(t=2.517,P<0.01);重症感染组与健康对照组比较(t=2.642,P<0.01).PCT阳性率重症感染组与局部感染组比较,差异有统计学意义(t=2.031,P<0.01);重症感染组与健康对照组比较,差异有统计学差异(t=2.451,P<0.01).结论 PCT有助于细菌感染与病毒及结核感染、感染性疾病与非感染性疾病、局部轻症感染与全身重症感染的临床鉴别,可作为儿科严重感染及脓毒症的诊断指标之一.     

网织血小板测定对特发性血小板减少性紫癜诊疗的价值

目的　探讨外周血网织血小板 (RP)变化对特发性血小板减少性紫癜 (ITP)的诊断价值及疗效判定。方法　利用流式细胞仪测定ITP(ITP组 )、再生障碍性贫血及白血病 (非ITP组 )及对照组外周血RP百分率 ,并计算其绝对值。结果　ITP组RP百分率明显高于非ITP组及对照组 (P <0 .0 1 ) ,绝对值明显低于对照组 (P <0 .0 1 ) ;非ITP组RP百分率与对照组比较无明显差异 (P >0 .0 5) ,但RP绝对值明显低于对照组 (P <0 .0 1 ) ;ITP组治疗有效者RP百分率明显降低 ,与治疗前比较差异显著 (P <0 .0 1 )。结论　RP百分率及绝对值可反映骨髓血小板生成情况 ,对血小板减少症发病机制判断具有重要意义 ,可作为血小板减少症鉴别诊断的重要指标 ,是确诊ITP诊断依据和疗效判定的监控指标。     

Diagnostic Value of Serum Procalcitonin Level in Differentiating Bacterial from Nonbacterial Meningitis in Children

Objective:

Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis.

Methods:

45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients).

Findings:

Serum procalcitonin levels were significantly higher in bacterial meningitis group (637±325 pg/ml) compared with non-bacterial meningitis (380±170 pg/ml); P<0.001. Procalcitonin levels were more sensitive and specific (79%, 81%) than C-reactive protein (76%, 75%) and white blood cell count (72%, 75%) in the diagnosis of bacterial meningitis.

Conclusion:

Elevated serum procalcitonin level could be a predictor of bacterial causes of meningitis and is more sensitive and specific than other diagnostic predictors.     

脂多糖干预小胶质细胞后细胞内促血小板生成素与炎症因子的表达

目的 探讨脂多糖(LPS)干预小胶质细胞后细胞内促血小板生成素(TPO)及炎症因子的表达.方法将BV2细胞分为6组.1.空白12 h组:BV2细胞正常培养12 h,不添加任何干预因素;2.LPS 0.5 mg·L-1 12 h组:在培养好的BV2细胞内添加预先配好的LPS溶液共同培养12 h,并使其终质量浓度为0.5 mg·L-1;3.LPS 1.0 mg·L-112 h组:在培养好的BV2细胞内添加预先配好的LPS溶液共同培养12 h,并使其终质量浓度为1.0 mg·L-1;4.空白 24 h组:BV2细胞正常培养24 h,不添加任何干预因素;5.LPS 0.5 mg·L-1 24 h组:在培养好的BV2细胞内添加预先配好的LPS溶液共同培养24 h,并使其终质量浓度为0.5 mg·L-1;6.LPS 1.0 mg·L-1 24 h组:在培养好的BV2细胞内添加预先配好的LPS溶液共同培养24 h,并使其终质量浓度为1.0 mg·L-1.采用ELISA法检测BV2细胞内炎症因子(IL-1、IL-6、NF-κB)和TPO的表达;实时荧光定量PCR法检测细胞内IL-1 mRNA、IL-6 mRNA、NF-κB mRNA及TPO mRNA表达水平.结果 LPS 0.5 mg·L-1和1.0 mg·L-1干预BV2细胞后12 h和24 h,IL-1、IL-6、NF-κB和TPO表达水平及其mRNA水平均较空白组升高,且12 h组高于24 h组,但其差异均无统计学意义(Pa>0.05).TPO表达水平与IL-1、IL-6、NF-κB及其mRNA水平的表达均呈显著正相关(Pa<0.01).结论 LPS干预小胶质细胞后IL-1、IL-6、NF-κB和TPO表达升高,参与炎症、凋亡和神经元保护等多种调控机制.     

Simplified Immunoglobulin Treatment of Idiopathic Thrombocytopenic Purpura

ABSTRACT. The recommended dose of intravenous IgG for idiopathic thrombocytopenic purpura has been 0.4 g/kg on 5 consecutive days. A simplified approach, giving a single infusion of 0.8–1.0 g/kg over 8 hours, has been tried in a series of 11 children with newly diagnosed disease. In 8 cases the infusion produced a prompt platelet response culminating at 128–502×10⁹/1 after 3–13 days, and 4 of these cases required no further treatment while 2 needed a booster infusion due to an early relapse and 2 followed a chronic course. In 3 cases platelet responses were poor in spite of supplementary doses to a total of 1.4–2.0 g/kg: 2 infants failed to achieve normal platelet counts and 1 case with fulminant bleeding manifestations proved completely resistant. Significant side effects were not observed. These results indicate that IgG-therapy practically may be initiated with a single infusion, the resulting platelet response indicating the need for further infusions.     

Oral Megadose Methylprednisolone Versus Intravenous Immunoglobulin for Acute Childhood Idiopathic Thrombocytopenic Purpura

Twenty children with acute idiopathic thrombocytopenic purpura (ITP) were randomized to receive either oral megadose methylprednisolone (MDMP) or intravenous immunoglobulin G (IV IgG). Normal platelet counts (150 × 10⁹/l) were obtained in 6 patients of each group in 3 days and in 8 and 9 patients treated with oral MDMP and with IV IgG within 1 week, respectively. It is concluded that oral MDMP could easily be used for the early elevation of platelet counts, which is important for ITP treatment.     

血清铁蛋白在全身型幼年特发性关节炎中的诊断价值

目的 探讨血清铁蛋白(SF)在全身型幼年特发性关节炎(SJIA)中的诊断价值.方法 30例SJIA患儿(SJIA组)及28例普通呼吸道感染患儿(对照组),在治疗前均采用放射免疫法测定其SF水平,仪器采用德国DATE BAHRIHG铁蛋白分析仪,并同时测定其CRP及ESR.SJIA组于病情缓解后再次抽血复查以上指标.采用SPSS 11.5软件进行统计学分析.结果 SJIA患儿SF水平明显高于对照组,差异有统计学意义(P<0.01).SF>正常值5倍的例数,2组比较差异有统计学意义(P<0.01).以SF>正常值5倍为诊断SJIA的临界值,其敏感性为83.33 %,特异性为92.85%,阳性预测值92.59%.2组ESR、CRP水平比较差异均无统计学意义(Pa>0.05).经治疗后,SJIA组30例患儿病情缓解,其SF、ESR、CRP水平均较治疗前显著降低,治疗前后比较,差异均有统计学意义(Pa<0.01).结论 SF对诊断SJIA具有重要临床意义,以SF>正常值5倍作为诊断SJIA的临界值可较好地兼顾敏感性和特异性.SF亦可作为监测SJIA患儿病情活动度及指导治疗的指标.     

Rituximab Efficacy in the Treatment of Children with Chronic Immune Thrombocytopenic Purpura

Background: There are several medications for treatment of immune thrombocytopenic purpura (ITP), including corticosteroids, intravenous immunoglobulin, immunosuppressive drugs, and even splenectomy. In case of failure, Rituximab as one of the medications used in these patients should be considered. Method: This Case—series study was conducted prospectively in patients who were referred to Hematology & Oncology Clinic of Ali Asghar Hospital. Eighteen Patients were followed up for at least 3–5 years. Results: Four weeks after treatment, only in 6 patients (33/3%) of 18 patients, complete response (Plt > 100,000) were obtained and most patients (67/66%) had no appropriate response. In subsequent surveys conducted at 6 and 36 months after treatment, the percentage of patients responding fell to 22/2% hit. Conclusion: The results of this study demonstrate proper safety of Rituximab in the treatment of chronic ITP. However, the drug had no significant effect on the expected improvement in platelet count of patients. It seems that monotherapy is ineffective in the treatment of chronic ITP and combination with other complementary therapies is recommended.