急性淋巴细胞白血病染色体分析及其临床意义

目的 研究儿童急性淋巴细胞白血病（ALL）染色体变化，探讨其临床意义。方法 通过直接法或短期培养法对40例ALL患儿骨髓细胞进行染色体分析并观察临床疗效。结果 40例ALL患儿染色体异常检出率70％（28／40），其中数目异常50％，结构异常35．7％，数目合并结构异常14．3％，核型正常组及超二倍体组患儿缓解率高于亚二倍体组及假二倍体组，具有显著统计学意义（P＜0．01），亚二倍体及t(9;22)核型为预后不良因素。结论 染色体分析对儿童ALL预后及治疗具有指导意义。     

去铁胺诱导白血病细胞HL-60凋亡线粒体膜电位变化的研究

近年来国外的研究发现，铁螯合剂可抑制多种肿瘤细胞增殖并诱导其凋亡，有望成为一种新的治疗肿瘤的药物，而国内相关研究较少。新近对铁螯合剂——去铁胺(deferoxamine，DFO)诱导白血病细胞凋亡的作用及其凋亡机理进行了探讨。     

线粒体细胞病1例临床和基因突变分析

目的分析线粒体细胞病的临床表现、遗传学特点及其基因突变特点,从基因水平了解线粒体细胞病致病因素,并达到基因诊断和遗传咨询的目的。方法对1例线粒体细胞病患儿临床表现及实验室检查结果进行分析。提取患儿外周血基因组DNA,运用聚合酶链式反应先扩增患儿外周血线粒体基因3243、8344、8993三个热点突变所在片段,对扩增片段进行正反向序列测定,以检测突变。然后扩增已知的62个常见突变位点所在片段,对扩增片段同样进行正反向序列测定以检测突变。随机选择55例无血缘关系的健康成年人作为健康对照。结果男性患儿,出生2 d出现持续高乳酸血症、反复严重代谢性酸中毒、黄疸、肝功能异常、抽搐,头颅CT平扫示双侧大脑实质弥散性对称性低密度灶,2个月龄时死亡。线粒体3243、8344、8993三个位点均未发现突变,但细胞色素B基因存在15765 G→A突变,导致氨基酸序列340位由甘氨酸(G)转变为谷氨酸(E)。患儿母亲身体健康,外周血中亦同样存在该突变,患儿父亲及55例健康对照者皆无此突变。结论线粒体细胞病可表现为高乳酸血症、代谢性酸中毒、肝功能异常、神经系统疾病等多脏器功能损伤。线粒体细胞色素B基因15765 G→A突变可能是线粒体细胞病的一个致病突变。     

急性白血病细胞的遗传学改变及其临床意义

目的 探讨小儿急性白血病（ＡＬ）细胞的遗传学改变及其临床意义。方法 采用细胞遗传学技术对８７例小儿ＡＬ进行染色体检查和临床治疗观察。结果 ８７例ＡＬ细胞核型异常检出率为６２％（５４／８７）,结果异常与白血病类型有特殊的对应关系,核型正常组缓解率高于核型异常组（Ｐ〈０．０５）,核型正常,超二倍体及ｔ（１５;１７）易位者疗效较好,而伴ｔ（９;２２）、ｔ（４;１１）及ｔ（８;２１）易位者疗效较差;缓解期     

铁对白血病细胞HL-60线粒体膜电位及凋亡的影响

目的研究铁对人白血病细胞HL-60线粒体膜电位(ΔΨm)及凋亡影响,探讨其可能机制。方法HL-60细胞分别与10、50、100μmol/L去铁胺(DFO)和10、100μmol/L三氯化铁(FeCl3)共培养,分别造成细胞内铁剥夺和富铁状态,噻唑蓝(MTT)法检测不同铁状态下细胞活力变化;相差显微镜观察凋亡细胞的形态学改变,流式细胞仪(FCM)检测细胞凋亡率及ΔΨm变化;原位杂交法检测凋亡基因Bax转录水平。结果DFO组细胞生长率呈下降趋势,而FeCl3组细胞生长率呈上升趋势;HL-60细胞经DFO处理后,细胞凋亡率增加、ΔΨm下降(P<0.01);100μmol/L DFO作用细胞244、8 h后,凋亡基因Bax的转录水平均较对照组增高(P<0.01)。FeCl3组细胞ΔΨm及Bax转录无明显变化,但凋亡率较对照组略下降。结论铁剥夺可降低ΔΨm,诱导HL-60细胞凋亡;而富铁对细胞ΔΨm无明显影响,但可增强细胞活力,使细胞凋亡率下降。     

人参皂甙对人白血病-60细胞凋亡的影响

目的：探讨人参皂甙对白血病细胞的致凋亡作用及其相关作用机制。方法：采用MTT细胞毒实验检测不同浓度（100、50、25、12.5、6.25、3.125、1.5625 μmol/L）人参皂甙对人白血病-60（HL-60）细胞的生长抑制活性;流式细胞术Annexin V/PI双染法检测不同浓度（0、5、10、20 μmol/L）人参皂甙诱导HL-60细胞凋亡情况;提取各种浓度人参皂甙处理的细胞总蛋白,Western blot检测caspase-8、caspase-9和caspase-3裂解情况;Western blot检测10 μmol/L人参皂甙处理HL-60细胞后caspase-8和caspase-9 抑制剂对caspase-3 裂解情况的影响。结果：人参皂甙对白血病HL-60细胞具有高效的细胞毒作用,IC50值为7.3±1.2 μmol/L;0、5、10、20 μmol/L 人参皂甙处理HL-60细胞48 h后,流式细胞仪检测细胞的凋亡率呈剂量依赖性,各处理组之间差异有统计学意义（F=12.67,P<0.01）;Western blot检测细胞中caspase-9和caspase-3出现裂解带,而caspase-8未出现裂解带;10 μmol/L人参皂甙诱导caspase-3裂解可以被caspase-9的特异性抑制剂Z-LEHD-FMK所抑制,而caspase-8的特异性抑制剂Z-IETD-FMK却没有这一作用。结论：人参皂甙对人白血病HL-60细胞具有高效的致凋亡作用,激活线粒体凋亡途径可能是其致凋亡的主要作用机制。     

使用C_s3000细胞分离器去除白血病细胞

使用Ｃｓ３０００ｐｌｕｓ细胞分离器对小儿急性白血病病人的高白血病细胞进行一次性大量去除，避免了在治疗高白细胞性白血病过程中易产生的高尿酸血症、肾衰和栓塞等合并症，并保证了尽早地进行强烈有效的诱导化疗，在临床上有明显的治疗意义。     

小儿急性淋巴细胞白血病中枢神经系统白血病诊治现状

中枢神经系统白血病(CNSL)的防治是小儿急性淋巴细胞白血病(ALL)治疗的一部分。诊断时高白细胞计数、T细胞型及分子遗传学为t(4;11)和Ph 是CNS复发的危险因素,脑脊液不同检查结果的预后价值有待明确。头颅放疗已不用于标危ALL患儿,头颅放疗的预防剂量已减为12Gy,鞘内及全身化疗对CNSL的治疗有重要作用。部分小儿CNS复发经挽救治疗可以长期存活,早期CNS复发的患儿应在第2次CR期进行异基因骨髓移植。     

Pulmonary hypertension in a child with juvenile myelomonocytic leukemia secondary to pulmonary leukemic cell infiltration

A 4-year-old girl with juvenile myelomonocytic leukemia presented to the emergency room with dyspnea. Echocardiography was performed due to cardiomegaly and prominent main pulmonary artery on a chest X-ray film. On echocardiography the right ventricular pressure calculated from the velocity of tricuspid regurgitation jet was 55 mmHg with no pulmonary stenosis. Despite treatment for pulmonary hypertension and provision of respiratory support, the patient died. A postmortem lung biopsy specimen showed infiltration by tumor cells, which suggested that the pulmonary hypertension had been caused by leukemic infiltration. In conclusion, the findings suggest that leukemic infiltration into the lungs may occur in children with juvenile myelomonocytic leukemia. It should be recognized as a potentially treatable cause of pulmonary hypertension in patients with juvenile myelomonocytic leukemia.     

热休克蛋白90抑制剂DMAG对白血病细胞株HL-60的作用

目的研究热休克蛋白90(HSP90)抑制剂17-二甲胺乙胺基-17-去甲氧基格尔德霉素(DMAG)对白血病细胞株HL-60的抑制作用及相关机制。方法通过MTT法、流式细胞术检测HL-60细胞在DMAG作用下增殖及凋亡情况;流式细胞术检测HL-60细胞周期的改变;流式细胞术及Westen blot法检测HL-60细胞Raf蛋白含量;RT-PCR法检测raf-mRNA表达量的变化。结果 DMAG能抑制HL-60细胞的生长,并诱发凋亡。细胞周期分析显示,DMAG作用后,G0/G1期细胞增多,S期细胞减少。DMAG能降低HL-60细胞Raf蛋白的含量,但raf-mRNA表达量无明显变化。结论 DMAG能引起HL-60细胞的凋亡,抑制其生长。DMAG引起HL-60细胞凋亡的机制与降低Raf蛋白含量有关。     

Dynamic movement of cytochrome c from mitochondria into cytosol and peripheral circulation in massive hepatic cell injury

BACKGROUND: In the process of apoptosis, it is known that the transition of cytochrome c from mitochondria into the cytosol occurs, and tumor necrosis factor (TNF)-alpha is one of the molecules responsible for this event. But in the state of hypercytokine induced by D-galactosamine (D-GaIN)/Lipopolysaccharide (LPS), the localization of cytochrome c is little known. METHODS: Rats were administrated with D-GaIN(700 mg/kg)/LPS(200 microg/kg). Blood and tissue samples were collected and examined for levels of pro-inflammatory cytokines, the apoptosis of liver cells, and the localization of cytochrome c. RESULT: Before administration of D-GaIN/LPS, cytochrome c was definitely localized in the mitochondria. At 2 h after simultaneous administration of D-GaIN/LPS, cytochrome c had accumulated in the cytosol following abrupt increases of plasma TNF-alpha. Massive cell destruction due to apoptosis proved by Terminal deoxynucleo-tidyl transferase-mediated dUTP nick end labeling staining was observed in liver tissue 4 h later and markedly increased levels of cytochrome c were detected in the plasma 12 h after D-GaIN/LPS administration. CONCLUSION: Liver injury induced by simultaneous administration of D-GaIN/LPS was closely associated with the production of TNF-alpha, and also with the dynamic movement of cytochrome c from the mitochondria into the cytosol, and then into the systemic circulation. The detection of plasma cytochrome c levels may be a useful clinical tool for the detection of apoptosis in vivo.     

RSV感染毛细支气管炎患儿血清Clara细胞分泌蛋白、总IgE及ECP的临床研究

目的 探讨血清Clara细胞分泌蛋白(Clara cell secretory protein,CCSP)、总IgE和嗜酸性粒细胞阳离子蛋白(eosinophil cationic protein,ECP)在呼吸道合胞病毒(respiratory syncytial virus,RSV)感染所致毛细支气管炎发病中的临床意义.方法 采用酶联免疫吸附法测定32例RSV感染引起的毛细支气管炎患儿血清的CCSP含量.同时应用uniCAP100变态反应检测仪检测血清总IgE、ECP;另设25例正常婴幼儿作对照.结果 与正常对照组比较,RSV组患儿血清的CCSP含量显著降低(t=10.52,P<0.001)、血清总IgE显著增高(t=5.96.P<0.01)、血清ECP水平差异无统计学意义(t=1.97,P0.05).RSV组患儿血清CCSP与总IgE之间呈显著负相关(r=-0.654,P<0.05)、血清CCSP与ECP(r=-0.166.P0.05)以及总IgE与ECP(r=0.137,P0.05)之间无统计学相关关系.结论 血清CCSP的降低与总IgE水平的增高在呼吸道合胞病毒感染所致毛细支气管炎发病中发挥着重要作用.呼吸道合胞病毒感染毛细支气管炎患儿血清ECP无异常改变.     

Natural coagulation inhibitors (protein C, protein S, antithrombin) in patients with sickle cell anemia in a steady state

BACKGROUND: Patients with sickle cell anemia (SCA) run the risk of having decreased levels of natural coagulation inhibitors. This may be due to either hemostatic abnormalities or hepatic dysfunction. This study is designed to evaluate coagulation profiles of patients with SCA in a steady state and to determine whether hypercoagulable state is present or not. METHODS: Seventeen children with SCA in a steady state were included in this study. The routine hematological evaluation was done with a coulter-counter. Reticulocyte percentage and blood coagulation tests were also determined. The coagulation inhibitors such as protein C (as activated partial thromboplastine time prolongation time), protein S (as Factor V inhibition) and antithrombin (colorimetric assay) were measured in all cases. RESULTS: In the coagulation profile, mean euglobuline lysis time and mean fibrin degradation product levels were both significantly higher in the patient group than in the control group (P<0.05), although other parameters were within normal limits. The values for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and indirect reacting bilirubin were significantly higher in the patient group than in the control group (P<0.001, P<0.005, P<0.0001, respectively). The serum protein levels were normal. Mean factor V level was significantly lower and mean factor VIII level was found significantly higher in the patient group than in the control group (P<0.05 and P<0.005, respectively). Protein C and AT levels were lower in patients with SCA than in control subjects (P<0.001). Protein S levels were also lower in the patient group than in the control group, but the difference between the two groups was not significant (P>0.05). CONCLUSION: It is indicated that antithrombotic functions of patients with SCA are handicapped even in a steady state; and both hemostatic abnormalities and hepatic dysfunction contribute to low levels of natural coagulation inhibitors.     

Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia

We prospectively compared the diagnostic value of C-reactive protein (CRP) and white blood cell counts for detection of neonatal septicaemia. Sensitivity and specifity in receiver operating characteristics, and positive and negative predictive value of CRP and white blood cell count were compared in 195 critically ill preterm and term newborns clinically suspected of infection. Blood cultures were positive in 33 cases. During the first 3 days after birth CRP elevation (sensitivity 75%, specifity 86%), leukopenia (67%/90%), neutropenia (78%/80%) and immature to total neutrophil count (I/T) ratio (78%/73%) were good diagnostic parameters, as opposed to band forms with absolute count (84%/66%) or percentage (79%/71%), thrombocytopenia (65%/57%) and toxic granulations (44%/94%). Beyond 3 days of age elevated CRP (88%/87%) was the best parameter. Increased total (84%/66%) or percentage band count (79%/71%) were also useful. Leukocytosis (74%/56%), increased neutrophils (67%/65%), I/T ratio (79%/47%), thrombocytopenia (65%/57%) and toxic granulations had a low specifity. The positive predictive value of CRP was 32% before and 37% after 3 days of age, that of leukopenia was 37% in the first 3 days.     

Clara cell protein 10 polymorphism is not associated with severe respiratory syncytial virus infection*

Aim: To investigate a possible correlation between severe respiratory syncytial virus (RSV) infection and single‐nucleotide polymorphism (SNP) in the Clara cell protein 10 (CC10) gene (A38G). Methods: Children hospitalized with severe RSV lower respiratory tract (LRTI) infection at Karolinska University Hospital, Stockholm, during three subsequent RSV seasons were selected and genotyped. Age‐matched controls were used. The two groups were compared regarding SNP in the CC10 gene (A38G) and regarding later development of wheezing. Results: No correlation was found between the genotype CC10 +38AA and severe RSV infection or wheezing during follow‐up. Wheezing (p = 0.022), frequent wheezing (≥3 episodes) (p = 0.042) as well as ever wheezing (p = 0.0022) occurred significantly more often after discharge in children hospitalized for RSV compared with the control group. Conclusion: Single‐nucleotide polymorphism in the CC10 gene (A38G) does not seem to be involved in the severity of RSV infection or wheezing. In agreement with other studies, we found that children with severe RSV are at increased risk of future wheezing. The latter finding implies that the studied population represented children with severe LRTI, which supports that a correlation between the genotype CC10 +38AA and severe RSV is less likely.     

INFANT ANAPLASTIC LYMPHOMA: Case Report and Review of the Literature

Anaplastic large cell lymphoma (ALCL) is a well-known entity, but there are no data on prognosis according to the age of the patient, especially in infants. A 2-month-old girl was admitted with a 2-week history of coughing, fever, and lymphadenopathy. Physical examination revealed mild respiratory distress, an erythematous macular rash on her trunk, massive cervical lymphadenopathy, splenomegaly, and very mild ascites. Chest radiograph showed bilateral pulmonary infiltrates, pleural effusion, and a mediastinal mass. CBC count showed WBC: 172,000/μL (PMN 40%, lymphocytes 47%, monocytes 3%); hemoglobin concentration: 8.7 g/dL; platelets: 390,000/μL. Cervical lymph node biopsy revealed anaplastic lymphoma with positive staining to ALK 1 and TIA 1. Immunophenotypic analysis of peripheral and bone marrow lymphoid cells showed an aberrant T-cell immunophenotype, including expression of CD3, CD45R0⁺, CD43⁺, and CD30⁺. Cytogenetic analysis performed on blood and bone marrow samples demontrated the translocation t(2;5) (p23;q35), and trisomy 47. After leucophoresis, the child received chemotherapy according to the ALCL-99-EICNHL protocol, and was started on corticosteroids and cyclophosphamide, which resulted in marked improvement. After the second course, WBC decreased to 6000/μL without tumor lysis syndrome, but the child developed bacterial and fungal disseminated infections and died of septic shock with multiorgan failure. This report is of a rare case of infant anaplastic lymphoma and excellent response to treatment. Unfortunately, she did succomb to overwhelming infection. More reports of similar cases may determine the cause and prognosis of such children, helping to tailor therapy according to the age of the child and other prognostic factors, especially bone marrow involvement.     

Infant anaplastic lymphoma: case report and review of the literature

Anaplastic large cell lymphoma (ALCL) is a well-known entity, but there are no data on prognosis according to the age of the patient, especially in infants. A 2-month-old girl was admitted with a 2-week history of coughing, fever, and lymphadenopathy. Physical examination revealed mild respiratory distress, an erythematous macular rash on her trunk, massive cervical lymphadenopathy, splenomegaly, and very mild ascites. Chest radiograph showed bilateral pulmonary infiltrates, pleural effusion, and a mediastinal mass. CBC count showed WBC: 172,000/μL (PMN 40%, lymphocytes 47%, monocytes 3%); hemoglobin concentration: 8.7 g/dL; platelets: 390,000/μL. Cervical lymph node biopsy revealed anaplastic lymphoma with positive staining to ALK 1 and TIA 1. Immunophenotypic analysis of peripheral and bone marrow lymphoid cells showed an aberrant T-cell immunophenotype, including expression of CD3, CD45R0⁺, CD43⁺, and CD30⁺. Cytogenetic analysis performed on blood and bone marrow samples demontrated the translocation t(2;5) (p23;q35), and trisomy 47. After leucophoresis, the child received chemotherapy according to the ALCL-99-EICNHL protocol, and was started on corticosteroids and cyclophosphamide, which resulted in marked improvement. After the second course, WBC decreased to 6000/μL without tumor lysis syndrome, but the child developed bacterial and fungal disseminated infections and died of septic shock with multiorgan failure. This report is of a rare case of infant anaplastic lymphoma and excellent response to treatment. Unfortunately, she did succomb to overwhelming infection. More reports of similar cases may determine the cause and prognosis of such children, helping to tailor therapy according to the age of the child and other prognostic factors, especially bone marrow involvement.