沙利度胺联合环孢素A治疗骨髓增生异常综合征的临床研究

目的：初步评价沙利度胺联合环孢素A治疗骨髓增生异常综合征的疗效与不良反应。方法：35例低危骨髓增生异常综合征患者,随机分为2组,分别接受了沙利度胺联合环孢素A（A组,n=18）或单用环孢素A（B组,n=17）,比较2组的疗效和不良反应。结果：共24例患者取得血液学改善EA组16例（88．9％）,B组8例（47％）,P〈0．053。A组红系显效16例;血小板显效10例,微效4例;中性粒细胞显效10例,微效4例。B组红系显效6例,微效3例;血小板显效3例,微效3例;中性粒细胞显效4例,有效3例。A组15例依赖输血的患者中11例（73．3%）脱离输血,B组14例依赖输血的患者中5例（35．7％）脱离输血,2者疗效比较差异有统计学意义（P〈0．05）。共9例患者出现肝功能异常[A组6例（33．3％）,B组3例（21．4％）,P〉0．05）],3例出现肾功能异常CA组2例（11．1％）,B组1例（7．1％）,P〉0．053,经停药或治疗后均好转。结论：联合环孢素A和沙利度胺治疗骨髓增生异常综合征疗效较单用环孢素A好,出现肝、肾功能异常是可逆的。     

环孢素A单独或联合沙利度胺治疗骨髓增生异常综合征

目的初步评价环孢素A单独应用或联合沙利度胺治疗骨髓增生异常综合征的疗效与不良反应。方法于2000年10月至2005年10月取中国医学科学院中国协和医科大学血液学研究所血液病医院血液六科的32例骨髓增生异常综合征患者,随机分为两组,分别接受了环孢素A(A组,n=14)或环孢素A联合沙利度胺(B组,n=18)治疗,比较两组的疗效和不良反应。结果共15例患者取得血液学进步[A组3例(21.4%),B组12例(66.7%),P<0.05]。A组红系显效3例;血小板显效2例,有效1例;中性粒细胞显效2例,有效1例。B组红系显效11例,有效1例;血小板显效5例,有效2例;中性粒细胞显效3例,有效3例。A组11例依赖输血的患者中2例(18.2%)脱离输血,B组14例依赖输血的患者中9例(64.3%)脱离输血,二者疗效比较差异有统计学意义(P<0.05)。共9例患者出现肝功能异常[A组3例(21.4%),B组6例(33.3%),P=0.457],3例出现肾功能异常[A组1例(7.1%),B组2例(11.1%),P=0.702],经停药或治疗后均好转。结论联合环孢素A和沙利度胺治疗骨髓增生异常综合征疗效较单用环孢素A好,出现肝肾功能异常是可逆性的。     

雷那度胺治疗骨髓增生异常综合征临床观察

目的探讨雷那度胺治疗骨髓增生异常综合征的临床效果。方法 24例骨髓增生异常综合征患者被随机分成两组;对照组给予环孢素A口服,治疗组给予雷那度胺口服。治疗期间密切观察两组的不良反应;治疗结束2个月后,评价临床疗效和血液学指标改善程度。结果治疗组治疗有效率（58.33%）高于对照组（33.33%）（P〈0.05）,血液学指标改善程度亦优于对照组。结论雷那度胺能有效治疗骨髓增生异常综合征。     

三氧化二砷联合沙利度胺治疗骨髓增生异常综合征

目的:探讨沙利度胺联合三氧化二砷治疗骨髓增生异常综合征的有效性和安全性。方法:42例骨髓增生异常综合征患者分为2组,治疗组使用沙利度胺和三氧化二砷,对照组接受促红细胞生成素及输血为主的对症支持治疗。比较2组的疗效,观察药物的不良反应。结果:治疗组20例完全缓解1例,部分缓解3例,血液学改善11例,总有效率75%,未发现严重不良反应;对照组22例无完全缓解,部分缓解1例,血液学改善8例,总有效率40.91%,与治疗组比较,差异有统计学意义(P<0.05)。结论:沙利度胺联合三氧化二砷治疗骨髓增生异常综合征有效率高,不良反应轻微,耐受性好。     

沙利度胺联合治疗高危骨髓增生异常综合征及骨髓纤维化的疗效观察

目的：探讨骨髓增生异常综合征(MDS)高危患者及骨髓纤维化的有效治疗方法。方法：我们采用联合应用沙利度胺治疗高危MDS 22例及骨髓纤维化8例。结果：在19例可评价的MDS病例中完全缓解7例(36．8％)，部分缓解4例(21．1％)，进步3例(15．8％)，无效5例(26．3％)。8例骨髓纤维化中4例临床血液学完全缓解，4例贫血症状得到改善。在5例需长期输血的患者中，4例贫血情况得到缓解不再需要输血。3例血小板减少患者中，2例血小板计数增加了50％以上。8例脾大者均有缩小，5例缩小50％以上。毒副作用小。结论：沙利度胺联合治疗高危MDS及骨髓纤维化有明显的疗效，且毒副作用小，值得扩大病例进一步研究及推广。     

氨磷汀、沙利度胺辅助治疗MDS-RAEB12例疗效观察

将22例同期收治的难治性贫血伴有原始细胞过多MDS（MDS—RAEB）患者随机分为观察组12例和对照组10例。两组均予阿糖胞苷皮下注射，25mg／d，在此基础上观察组予氨磷汀联合沙利度胺治疗。结果观察组完全缓解（CR）1例、部分缓解（PR）3例、血液学改善5例，总有效率75．0％，1例转化为急性髓系白血病（AML）；对照组无CR病例，PR1例，血液学改善3例，总有效率40．0％，3例转化为AML，均无严重不良反。观察组总有效率显著高于对照组。认为AMF联合沙利度胺辅助治疗MDS—RAEB疗效确切，患者耐受性良好。     

小剂量联合诱导剂治疗20例骨髓增生异常综合征临床观察

1992年6月～1995年10月，用小剂量联合诱导剂（GRADT方案）治疗20例骨髓增生异常综合征。显效9例（45．0％），总有效率80．0％，无毒副反应。疗效高于单独应用维甲酸、小剂量阿糖胞苷、三尖杉及阿克拉霉素，是治疗骨髓增生异常综合征的较好方法。     

沙利度胺治疗克罗恩病疗效观察

目的观察沙利度胺对克罗恩病的临床疗效。方法选取邵阳市中心医院2004年1月。2007年8月住院的46例轻～中度克罗恩病患者，随机分成两组。治疗组23例，服用沙利度胺100mg／d，对照组23例，服用柳氮磺胺吡啶（SASP）4g／d，疗程8周，比较沙利度胺与柳氮磺胺吡啶的疗效。结果采用沙利度胺治疗的临房；缓解率26．08％（6／23），有效率65．22％（15／23），总有效率91．3％；对照组临床缓解率为21．74％（5／23），有效率56．52％（13／23），总有效率为78．26％。沙利度胺的总体疗效高于柳氮磺胺吡啶，具有显著胜差异（P〈0．05）。结论沙利度胺对轻～中度克罗恩病有效，其疗效优于传统的柳氮磺胺吡啶．可望成为一种治疗克罗恩病的新型药物。     

用环孢素A联合方案治疗骨髓增生异常综合征

目的：探讨用环孢素A联合方案治疗骨髓增生异常综合征（MDS）的疗效。方法：对43例MDS患者进行分组施治,低危组12例采用环孢素A联合康力隆,维甲酸口服,部分患者应用EPO进行治疗;高危组31例采用环孢素A联合康力隆,维甲酸口服,同时加用小剂量或标准剂量化疗。结果：低危组总有效率为75％,基本缓解率为42％,高危驵总有效率为74．2％,完全缓解率为54．8％,结论：用环孢素A联合诱导分化剂,小剂量（或标化量）化疗及细胞因子分型施治,可以明显提高MDS的疗效,改善其预后。     

胺碘酮在房性心律失常中的临床疗效与观察

目的观察胺磺酮（可达龙）在房性心律失常中的疗效与安全性。方法将140例房性心律失常的患者随机分为2组，A组为治疗组（n=70）给予可达龙治疗；B组对照组（n=70）给予心律平治疗。结果两组患者治疗后均有效，但治疗组显效率明显高于对照组，差异有显著性（P〈0．05）。结论大剂量静脉应用可达龙治疗房性心律失常安全有效。     

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     

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…     

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.     

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.