直线加速器脾区照射治疗老年性特发性血小板减少性紫癜28例的疗效观察

特发性血小板减少性紫癜(ITP)是临床上常见出血性、自身免疫性疾病,常规应用激素、免疫抑制剂、脾脏切除、脾动脉栓塞等治疗.老年性ITP出血症状较严重[1],并发症较多,有使用激素禁忌证及手术禁忌证,或拒绝脾切除,因而老年性ITP治疗效果差.2000年1月至2004年12月,笔者应用直线加速器脾区照射治疗老年性ITP 28例,取得较好效果,报告如下.     

氨磷汀联合地塞米松治疗复发难治性ITP临床观察

原发免疫性血小板减少症（primary immune thrombocytopenia,ITP）,既往亦称特发性血小板减少性紫癜,是以血小板免疫性破坏伴巨核细胞成熟障碍导致外周血小板减少的出血性疾病.糖皮质激素是公认的ITP治疗首选药物,而脾切除则是对激素治疗失败患者的第一选择,但往往难以被患者接受.目前对于糖皮质激素治疗无效或切脾无效的ITP患者的治疗仍相当困难,存在缓解率低、疗效难以维持、不良反应明显以及价格昂贵不能有效地广泛应用等问题.近年研究表明,氨磷汀（Amifostine,AMF）为一种细胞保护剂,治疗ITP有效且安全[1-2].笔者应用氨磷汀联合地塞米松（Dexamethasone,DXM）治疗复发难治性ITP 29例,现报道如下.     

达那唑、阿赛松联合参血胶囊治疗难治性免疫性血小板减少症疗效观察

<正>免疫性血小板减少症(immune thrombocytopenia,ITP)是一种自身免疫性血液系统疾病。目前ITP的治疗主要通过包括糖皮质激素、免疫调节剂来调节患者体液或细胞免疫及脾切除减少血小板破坏等方法来达到提升血小板的治疗效果。但临床仍有约20%~30%的患者一线治疗效果不佳,脾切除后无效或者复发(或具有脾切术禁忌证),但仍需要治疗以降低出血危险,除外其他引起血小板减少症的原因,     

低剂量环孢素治疗难治/复发免疫性血小板减少症的疗效及安全性分析

目的 探讨环孢素A(CyA)在难治/复发性免疫性血小板减少症(ITP)治疗中的临床疗效和不良反应.方法 36例难治/复发ITP患者接受3～5mg/(kg·d)的CyA治疗并观察疗效和不良反应.结果 中位随访10个月,完全反应(CR) 13例(36.1%),有效(R)15例(41.7%),无效(NR)8例(22.2%),总有效率为77.8%.复发与难治两组疗效差异比较无统计学意义(P=0.083).常见的不良反应为胃肠道反应、头痛、血压升高及肝功能受损,多数患者能较好耐受.结论 低剂量的CyA治疗ITP是一种高效、安全的挽救性治疗方法,严重不良反应较少.     

重组人白细胞介素-11联合环孢菌素治疗激素无效的特发性血小板减少性紫癜

特发性血小板减少性紫癜 (idiopathic thrombocytopenic purpura, ITP)常规治疗包括糖皮质激素、脾切除,但部分患者糖皮质激素治疗无效但又不愿或不能行脾切除术,是个治疗难题.为了寻求糖皮质激素无效ITP患者安全有效的二线治疗方案,笔者采用重组人白细胞介素-11(rhIL-11)联合环孢菌素治疗激素无效的ITP 19例,疗效满意,报道如下.     

难治性特发性血小板减少性紫癜脾切除或脾栓塞的疗效分析

我院近年来收治的特发性血小板减少性紫癜(ITP)36例,其中8例确诊为难治性ITP,均经糖皮质激素、长春新碱、大剂量静脉用丙种球蛋白等药物治疗后效果不佳,或合并糖尿病、严重感染不能耐受激素或免疫抑制剂治疗,采用脾切除或大部分脾栓塞的办法治疗取得了较好的疗效.     

激素治疗无效的特发性血小板减少性紫癜的治疗方法探讨

目的回顾性分析比较脾切除术和免疫抑制剂分别对肾上腺糖皮质激素治疗不敏感或激素依赖的特发性血小板减少性紫癜（ITP）患者的疗效,以探讨适宜的二线治疗方案。方法收集广州市5家三级甲等医院,1997—2007年近10年间住院的所有诊断为ITP且对激素治疗无效的患者共52例,对其临床资料进行分析。根据不同的治疗方案将其分为2组,A组20例为脾切除组,B组32例为使用免疫抑制剂组（包括环孢菌素A、硫唑嘌呤、长春新碱,环磷酰胺）。分别比较两组患者在治疗前、治疗后第3天、7天、1月、6月、24月时的血小板计数（BPC）及治疗副作用。结果A组患者从治疗第3天起至24个月BPC均高于B组,差异有显著性（P〈0．05）。A组的总有效率高于B组,差异有显著性（P〈0．05）。A组治疗副作用包括术中出血、伤口愈合不良、脾切后继发感染等,发生率为15．0％;B组治疗不良反应包括感染、骨髓抑制、肝损害、‘肾损害、出血性膀胱炎、末梢性周围神经炎及其他等,发生率为45．0％。其中4例免疫抑制剂治疗无效的患者行脾切除后仍能达到有效。个别切脾后疗效不佳者仅需小剂量激素和（或）联用免疫抑制剂维持。结论对激素治疗不敏感或激素依赖的ITP患者,脾切除治疗起效时间快,效果好,副作用少,可作为激素治疗失败或不能耐受者的首选二线治疗方法。     

部分脾动脉栓塞术在ITP中的应用(附26例报告)

目的:探讨部分性脾动脉栓塞术 (PSE)治疗特发性血小板减少性紫癜(ITP)的临床价值.方法:对26例经内科治疗效差或无效的ITP患者进行部分性脾栓塞术治疗,观察其疗效、毒副作用.结果:显效13例,良效8例,进步5例.近期疗效84.62%,远期疗效:有效病例中9例20～60天后血小板下降,经内科治疗血小板维持25×109～80×109/L,无出血倾向,暂无死亡病例.副作用包括脾区疼痛、发热、左侧胸腔积液、脾脓肿.结论:部分脾动脉栓塞术对内科治疗效差或无效,激素治疗禁忌,心肾功能不全,血小板较低的原发性血小板减少性紫癜患者是一种具有创伤小,安全性好,疗效可靠的方法,值得推广开展.     

胸腺肽治疗免疫性血小板减少性紫癜效果观察

应用胸腺肽治疗免疫性血小板减少性紫癜(ITP)患者11例,剂量为40mg/日,静脉滴注,疗程为1～4个月,其中2例显效,8例良效,血小板较治疗前上升30×10~9/L,并维持2个月以上.本药副作用轻微,11例中仅1例出现荨麻疹,证明胸腺肽治疗免疫性血小板减少性紫癜具有可行性.     

升板合剂治疗成人原发免疫性血小板减少症的临床研究

目的观察升板合剂治疗成人原发免疫性血小板减少症(primary immune thrombocytopenia,ITP)的疗效及安全性。方法 60例ITP患者随机分为两组:激素组30例,采用"标准剂量肾上腺皮质激素"方案治疗,联合组30例,采用"标准剂量肾上腺皮质激素+升板合剂"方案治疗,比较两组患者血小板计数及疗效。结果联合组与激素组比较,P0.05,联合组优于激素组。结论研究发现,接受激素联合升板合剂治疗的成人慢性ITP患者,其血小板较单纯应用糖皮质激素的ITP患者明显改善,具有推广价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.