大剂量阿糖胞苷治疗急性髓性白血病缓解后患者15例分析

目的观察急性髓性白血病(AML)缓解后应用大剂量阿糖胞苷(HD-Ara-C)联合常规化疗治疗的疗效。方法将29例AML患者随机分为治疗组和对照组。治疗组15例患者在常规化疗基础上第1、3、5d用HD-Ara-C持续3h以上静脉滴注,1~2次/年。对照组患者行常规化疗。比较两组患者治疗后1年、3年和5年的无病生存(DFS)情况。结果两组患者治疗后1年、3年和5年的DFS情况间差别均有显著性意义(P<0·01)。结论HD-Ara-C用于AML缓解后的维持强化治疗疗效较好,可延长患者的DFS期。     

标准诱导化疗与粒细胞集落刺激因子预激序贯双诱导治疗原发性初治急性髓细胞白血病

目的观察粒细胞集落刺激因子(G-CSF)预激序贯双诱导治疗原发性初治急性髓细胞白血病(AML)的疗效和安全性,并与标准诱导化疗方案进行比较。方法将接受标准诱导化疗1个疗程的AML患者分为治疗组和对照组,治疗组接受G-CSF预激序贯双诱导治疗,对照组再接受第2个疗程标准诱导化疗。结果治疗组和对照组患者各18例,年龄分别为(38．3±13．8)和(40．7±13．1)岁。治疗组的完全缓解(CR)率和总反应(CR 部分缓解)率分别为72%和83%,显著高于对照组的33%和50%(P=0．019和0．034)。治疗组达到CR的时间为(17．3±4．7)d,显著短于对照组的(20．9±3．7)d(P=0．04)。治疗中最常见的不良反应为感染,治疗组的肺部感染率为39%,显著低于对照组的72%(P=0．044)。对照组发生严重感染和出血并发症各1例。结论标准诱导化疗与G-CSF预激序贯双诱导治疗原发性初治AML有效且安全。     

79例儿童t(8;21)急性髓系白血病的核型及预后分析

目的 调查儿童t(8;21)急性體系白血病(AML)的核型异常情况,评估缓解后治疗强度对预后的影响.方法 采用形态学、免疫学和细胞遗传学(MIC)方法对79例儿童t(8;21)AML患者进行检测确诊.诱导缓解治疗采用高三尖杉酯碱联合阿糖胞苷(HA)/柔红霉素联合阿糖胞苷(DA)/高三尖杉酯碱、阿糖胞苷和柔红霉素联合(HAD)方案.缓解后进行异基因造血干细胞移植或5～7疗程的联合化疗.结果 79例患儿中,55例(69.6%)有附加染色体异常,其中40例(50.6%)伴性染色体丢失,9例(11.4%)为del(9q),7例(8.9%)为复杂变异型t(8;21)异常.3例患儿染色体数量在90条以上且伴双重t(8;21)四倍体核型,预后均不良.1、2疗程完全缓解(CR)率分别力81.7%(49/60)和94.8%(55/58);3年无事故生存率、无病生存(DIS)率和总生存率分别为(26.2 ± 6.8)%、(31.3 ± 6.7)%和(27.6 ± 6.6)%;29例患儿缓解后治疗疗程数为5个或以上,其3年DFS率为(51.7 ± 9.3)%.单纯t(8;21)±性染色体丢失组与伴其他附加染色体异常组患儿的3年DFS率差异无统计学意义(P=0.36).大剂量阿糖胞苷组患儿的3年DFS率明显优于标准化疗组(66.7% vs.27.3%,P=0.03).结论 多数儿童t(8;21)AML患者伴有附加染色体核型异常,附加染色体核型异常对患儿生存没有不良影响.染色体数量在90条以上且伴双重t(8;21)四倍体核型少见,但预后不良.儿童伴t(8;21)AML治疗CR率高,远期疗效好.采用大剂量阿糖胞苷作为缓解后治疗能提高远期疗效.     

三维适型放疗联合化疗治疗早期NK/T细胞淋巴瘤初步疗效

目的 分析放化疗联合治疗对鼻腔NK/T细胞淋巴瘤的近期疗效.方法 2004年4月至2010年12月收治的54例早期鼻腔NK/T细胞淋巴瘤患者,对照组18例接受单纯放疗治疗,治疗组36例接受放-化疗联合治疗.其中12例化疗1个周期后再放疗,24例同步行放化疗,化疗采用LOAP(左旋门冬酰胺酶L-AS P5000～6000U/m2,静脉滴注,每日1次,共5天;长春新碱1m g/m2,静脉滴注,第1天;阿糖胞苷100mg,每日1次,共5天;强的松45mg,每日1次,共5天,1周期21天)方案治疗3-8周期.两组患者治疗结束后1个月内评价疗效.结果 治疗组临床疗效明显好转,完全缓解率为86.1%,高于对照组(50.0%),两组比较有显著性差异(P<0.05).结论 放-化疗联合治疗早期鼻腔NK/T细胞淋巴瘤近期疗效较好.     

含羟基喜树碱的预激方案诱导治疗高危骨髓增生异常综合征及骨髓增生异常综合征转化的急性髓系白血病的疗效观察

目的 观察含羟基喜树碱的低强度化疗CHG(羟基喜树碱、阿糖胞苷和粒细胞集落刺激因子)预激方案诱导治疗高危骨髓增生异常综合征(MDS)及MDS转化的急性髓系白血病(AML)的疗效和毒副作用及其与CAG(阿克拉霉素、阿糖胞苷和粒细胞集落刺激因子)方案的比较.方法 按自愿原则选择32例(CHG组)未接受化疗的高危MDS及MDS转化的AML患者给予CHG方案诱导治疗;29例(CAG组)未接受化疗的高危MDS及MDS转化的AML患者给予CAG方案诱导治疗,观察并比较1个疗程后两组患者的临床疗效及毒副作用.结果 1个疗程结束后,CHG组患者中完全缓解(CR)14例,部分缓解(PR)7例,血液学改善1例,总有效率68.8%;CAG组患者中CR 12例,PR 6例,血液学改善3例,总有效率72.4%.两组的CR率和总有效率比较,差异均无统计学意义(P＞0.05).两组各项毒副作用发生情况比较,差异亦均无统计学意义(P＞0.05).随访发现,CHG组14例CR患者中3例因心律失常仅接受HA(三尖杉酯碱+阿糖胞苷)/EA(足叶乙甙+阿糖胞苷)方案巩固及强化,已全部复发.11例患者交替接受HA/AA(阿克拉霉素+阿糖胞苷)/TA(拓扑替康+阿糖胞苷)/MA(米托蒽醌+阿糖胞苷)/IA(去甲氧柔红霉素+阿糖胞苷)等方案化疗,1例失访,7例分别在3~16个月复发,3例进展为AML;4例缓解期超过6个月的复发患者中有2例取得CR,很快再次复发.CAG组12例CR患者,2例失访,8例分别在2.6~17个月复发,2例进展为AML.5例复发患者再用CAG方案,未取得CR,3例应用CHG方案,1例取得CR,1例取得PR.结论 CHG方案治疗中高危MDS和MDS转化的AML安全有效,CR后应强化治疗或多种方案交替治疗,避免早期复发.     

地西他滨联合以阿糖胞苷为基础的低剂量化疗方案治疗老年急性髓系白血病的临床研究

目的探究对老年急性髓系白血病(AML)患者予以地西他滨联合以阿糖胞苷进行低剂量化疗治疗的临床效果。方法选取2014年3月至2018年7月我院血液科收治的27例AML老年患者,均予以地西他滨联合阿糖胞苷进行低剂量化疗治疗,分析其临床治疗效果。结果 27例患者经治疗后,有2例完全缓解(7.41%)、12例部分缓解(44.44%)、10例稳定(37.04%)、3例疾病进展(11.11%),其总缓解率为51.85%;不良反应有10例骨髓抑制(37.04%)、15例肺部感染(55.56%)。结论对AML老年患者予以低剂量的地西他滨和阿糖胞苷化疗,可明显增高有效率,提高患者的生存率,患者的耐受性较好,值得推广。     

多参数流式细胞术检测白血病微小残留在急性髓细胞性白血病诱导治疗阶段的临床意义

目的研究急性髓细胞性白血病（AML）患者第1次诱导治疗后和第1次完全缓解时多参数流式细胞术（MFC）监测白血病微小残留（MRD）对预测疾病复发和判断预后的作用,探讨MRD监测的临床价值。方法回顾性研究246例成人AML患者治疗及MRD的监测数据,分析MRD水平与疾病复发和预后的相关性。结果（1）第1次标准方案诱导化疗后,ROC分析确定MRD阈值为1．5×10-2,Cox比例风险模型显示相对于MRD阴性组,MRD阳性组的相对危险度（RR）为2．41。在缓解后采用联合方案化疗的患者中,MRD阳性组和MRD阴性组的中位无复发生存时间（RFS）分别为（19．45±3．74）个月和（56．46±4．28）个月,中位总生存时间（os）分别为（29．37±4．47）个月和（77．97±4．30）个月,差异均有高度统计学意义（均P〈0．01）。（2）第1次达完全缓解时,ROC分析所确定的MRD阈值为3．0×10-3,Cox比例风险模型显示相对于MRD阴性组,MRD阳性组的RR值为1．75。缓解后采取联合化疗,MRD阳性组和MRD阴性组患者的中位RFS分别为（28．36±3．40）个月和（55．70±4．32）个月,中位OS分别为（39．30±3．73）个月和（70．19±4．34）个月,差异均有高度统计学意义（均P〈0．01）。结论MFC检测MRD在AML诱导治疗过程中具有预测复发、判断预后的价值。     

EA方案治疗老年急性髓细胞白血病

目的观察EA方案治疗老年急性髓细胞白血病(AML)的疗效及毒副作用。方法22例经我院确诊的AML老年患者采用EA方案即足叶乙甙(VP16)100mg/d静滴,第1~5天,阿糖胞苷(Ara-C)150~200mg/d分两次静滴,第1~7天,观察患者化疗前后心电图,血生化,肝、肾功能,骨髓像。完全缓解(CR)后原方案巩固2个疗程,然后换用HA、MA、DA、中剂量阿糖胞苷等方案巩固化疗,每1~2个月1次。结果22例经1~2个疗程化疗后完全缓解(CR)14例,部分缓解(PR)2例,总有效率72.7%;未缓解(NR)6例;所有病人均有骨髓抑制、消化道反应,但均能控制;无明显心脏毒性。结论EA方案可作为治疗老年急性髓细胞白血病的一线方案应用。     

去甲氧柔红霉素治疗急性髓细胞性白血病临床观察

目的:观察以去甲氧柔红霉素(IDA)为主的化疗方案治疗急性髓细胞性白血病(AML)的疗效和不良反应。方法:39例AML患者,随机分为2组。对照组16例采用柔红霉素+阿糖胞苷(Ara-C)治疗,治疗组23例采用IDA+Ara-C治疗,观察治疗后缓解率及不良反应。结果:2组治疗完全缓解率分别为82.6%和43.8%,总有效率分别为91.3%和62.5%,临床严重感染率分别为40.0%和41.7%。2组总有效率差异有统计学意义(P0.05),但2组的严重感染发生率差异无统计学意义(P0.05)。结论:以IDA组成的联合化疗方案治疗AML疗效较好。     

小剂量柔红霉素对老年急性髓细胞白血病的临床疗效观察

目的观察小剂量柔红霉素在老年急性髓细胞白血病(AML)中的应用效果。方法选择中山大学附属东华医院2008年10月至2012年5月老年AML患者30例,采用数字表法将其随机分为观察组和对照组。观察组给予柔红霉素+阿糖胞苷(DA化疗)化疗方案,即小剂量柔红霉素30 mg/(m2·d),第1³天;同时给予阿糖胞苷100 mg/(m2·d),第13天;同时给予阿糖胞苷100 mg/(m2·d),第1⁷天。对照组给予阿糖胞苷100 mg/(m2·d),第17天。对照组给予阿糖胞苷100 mg/(m2·d),第1⁷天,同时给予柔红霉素45 mg/(m2·d),第17天,同时给予柔红霉素45 mg/(m2·d),第1³天。两组患者均连续治疗2个疗程,疗程间隔33天。两组患者均连续治疗2个疗程,疗程间隔3⁴周。两组患者均根据具体情况给予支持治疗。结果观察组与对照组有效率分别为66.7%和60.0%,比较两组的临床疗效其差异无统计学意义(Z=2.43,P>0.05)。观察组和对照组化疗过程中不良反应的发生率分别为93.33%和80.00%,差异有统计学意义(P<0.05)。结论小剂量柔红霉素联合阿糖胞苷对老年AML进行化疗,疗效显著,不良反应少,值得借鉴。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.