CAG和IA方案治疗老年急性髓细胞白血病的疗效分析

老年急性白血病的治疗一直存在争议,老年人的生理学特点及常见的伴随疾病使患者无法接受正规联合化疗,但目前多数学者认为老年白血病应个体化治疗.本文拟分析CAG(阿糖胞苷、阿克拉霉素、G-CSF)及IA(去甲氧柔红霉素、阿糖胞苷)方案治疗老年急性髓细胞白血病(AML)的疗效及不良反应,为寻找更有效的老年AML诱导缓解方案提供临床依据.     

去甲氧柔红霉素与柔红霉素在初治急性髓系白血病诱导治疗中的疗效与安全性分析

目的:比较分析去甲氧柔红霉素联合阿糖胞苷(IA)方案与柔红霉素联合阿糖胞苷(DA)方案在初治成人急性髓系白血病(AML)(非M3)诱导治疗中的疗效及安全性。方法:选取30例AML患者,随机将患者分为研究组(IA)14例,采用去甲氧柔红霉素联合阿糖胞苷(Ara-C)方案;对照组(DA)16例采用柔红霉素联合Ara-C方案。诱导化疗1个疗程骨髓抑制期结束后,观察2组患者的完全缓解率、总有效率以及骨髓抑制阶段的不良反应率。结果:IA组的完全缓解率为71.43%,总有效率为92.88%;DA组的完全缓解率为43.75%,总有效率为68.75%;2组有效率之间比较差异有统计学意义(P0.05)。2组之间不良反应率比较,除IA组因骨髓抑制导致死亡1例外,其余差异无统计学意义(P0.05)。结论:IA方案在初治成人AML(非M3)诱导化疗中比DA方案疗效更好,除死亡1例外,不良反应无明显差异。     

预激方案和标准方案治疗初治急性髓系白血病的临床观察

目的:比较预激方案与标准化学治疗(化疗)方案治疗初治急性髓系白血病(AML)的疗效、不良反应和生存情况。方法:回顾性分析175例可随访的初治AML患者,分成预激方案组(n=60)和标准方案组(n=115),标准方案组采用IA(去甲氧柔红霉素、阿糖胞苷)或DA(柔红霉素、阿糖胞苷),预激方案组采用CAG(阿克拉霉素、阿糖胞苷和粒细胞集落刺激因子)或IAG(去甲氧柔红霉素、阿糖胞苷和粒细胞集落刺激因子)诱导治疗,2组患者均为一疗程缓解,同方案巩固2个疗程,或2个疗程缓解,同方案巩固一疗程,随后进入巩固维持治疗阶段。结果:预激方案组与标准方案组在完全缓解率、无病生存率和总生存率方面差异无统计学意义(均P0.05),但预激方案组患者化疗后骨髓恢复时间、感染发生率及单采血小板的输注量均低于标准方案组患者(均P0.05)。结论:预激方案在治疗初治AML的临床疗效和患者生存情况与标准方案相类似,但骨髓抑制及感染发生等不良反应较标准方案轻微,故可作为初治AML患者诱导治疗的可选方案之一。     

预激CAG方案治疗老年初治急性髓系白血病的临床分析

目的:评价CAG(阿糖胞苷、阿柔比星、粒细胞集落刺激因子)方案治疗老年初治急性髓系白血病(AML)的疗效及不良反应。方法:64例老年初治AML作为观察对象,其中39例患者予以CAG预激方案治疗,完全缓解(CR)后序贯予原方案、HA(高三尖杉酯碱和阿糖胞苷)、DA(柔红霉素和阿糖胞苷)、MA(米托蒽醌、阿糖胞苷)、中剂量阿糖胞苷巩固治疗至少2个循环;25例患者予以标准方案DA或HA方案化学治疗(化疗),CR后序贯予HA或DA、MA、中剂量阿糖胞苷至少2个循环。观察其疗效及不良反应。结果:CAG预激治疗组1个疗程CR 17例,2个疗程CR 6例,总CR率为59%,7例部分缓解(PR),总有效率77%。常规化疗组患者中1个疗程CR 7例,2个疗程CR 4例,总CR率为44%,2例PR,总有效率52%,与CAG预激治疗组相比差异有统计学意义(P<0.05);CAG组的胃肠道反应、感染、出血、脱发、肝功能及肾功能受损、心毒性、骨髓抑制不良反应发生率均明显少于常规化疗组,差异均有统计学意义(均P0.05)。结论:CAG预激方案治疗初治老年AML患者较之传统常规治疗具有有效率高、不良反应较小、患者生活质量高的优点,适合老年AML患者使用。     

LD—HA诱导治疗非M3型老年急性髓系白血病疗效观察

目的观察小剂量高三尖杉酯碱＋阿糖胞苷（LD—HA）诱导治疗非M3型老年急性髓系白血病（AML）的疗效和不良反应。方法将35例初治老年AML患者随机分为A组（19例）及B组（16例）。A组采用LD—HA方案：高三尖杉酯碱（H）1～2mg／d,阿糖胞苷（Ara—C）25mg,q12h,第1—14天化疗。B组采用标准剂量HA或DA方案。结果1个疗程结束后,A组和B组的完全缓解（CR）率分别为68．4％和37．5％;病死率分别为10．5％和18．7％,差异有统计学意义。血液学毒性两组差异无统计学意义;非血液学毒性的发生率A组低于B组。结论LD—HA诱导治疗老年AML近期疗效好,不良反应较轻。     

FLAG方案再诱导化疗急性髓细胞白血病临床观察

目的:初步探讨氟达拉滨(FDR)、高剂量阿糖胞苷(Ara-C)和粒细胞集落刺激因子(G-CSF)即FLAG方案在急性髓细胞白血病(AML)再诱导化疗中的疗效及不良反应。方法:12例经标准HA、DA、MA或IA方案化疗1疗程后未达完全缓解(CR)、骨髓原始细胞下降低于60%的AML患者,予FLAG方案再诱导化疗,即FDR30mg.m-2.d-1静脉滴注,d1～5;Ara-C1g/m2,静脉滴注,每12h1次,d1～5;G-CSF300μg/d皮下注射,第0天开始至白细胞恢复正常。结果:9例(75%)患者获得CR,3例(25%)患者获得部分缓解(PR)。主要不良反应为骨髓抑制,非血液学不良反应不明显。结论:FLAG方案再诱导化疗AML耐受性较好,有效率较高,不良反应可耐受。     

Venetoclax联合化疗治疗难治/复发急性髓系白血病8例并文献复习

目的:评价短疗程Venetoclax(VEN)联合小剂量阿糖胞苷(ara-C)方案在难治/复发急性髓系白血病(AML)患者中的疗效和安全性.方法:报告8例以短疗程VEN+小剂量ara-C方案联合治疗的难治/复发AML患者.VEN使用剂量为200～400 mg QD 口服,ara-C 10 mg/m2 Q12 h皮下注射...     

预激方案对老年急性髓性白血病的诱导作用

目的:评价预激方案小剂量阿克拉霉素,阿糖胞苷及GCSF在老年急性髓性白血病(AML)诱导治疗作用。方法:14例老年AML患者应用阿克拉霉素10～20mg/d,静脉滴注7d;阿糖胞苷10～20mg/次q12h,皮下注射连用14d;GCSF150～300μg/d,至WBC恢复到2×109/L,进行诱导化疗。结果:14例患者均可耐受化疗,10例获得了完全缓解,缓解率为71%,不良反应轻,患者无严重感染发生。结论:小剂量阿克拉霉素、阿糖胞苷及GCSF可作为老年AML患者诱导治疗方案,其疗效好,且不良反应轻。     

不同剂量阿糖胞苷对急性髓性白血病缓解后巩固治疗的疗效分析

目的:探讨不同剂量阿糖胞苷对急性髓性白血病(AML)缓解后巩固治疗的疗效和安全性。方法:将62例经过诱导化疗取得完全缓解的AML患者,随机分为大剂量阿糖胞苷组(29例)和中剂量阿糖胞苷组(33例),在完全缓解后分别给予不同剂量的单药阿糖胞苷[2.0g/(m~2·次)及1.0~1.5g/(m~2·次),1次/12h,第1、3、5天],共6次为1个疗程,同组患者相同方案巩固4个疗程,随访12~48个月。结果:大剂量阿糖胞苷组1、2、3年的无复发生存率分别为93.8%、77.9%和56.8%,中剂量阿糖胞苷组1、2、3年的无复发生存率分别为83.5%、50.6%和23.1%,2组间比较差异有统计学意义(P0.05);2组患者持续缓解时间差异无统计学意义;大剂量阿糖胞苷组患者的肺部感染发生率高于中剂量阿糖胞苷组,差异有统计学意义(55.2%∶36.4%,P0.05)。结论:大剂量阿糖胞苷巩固治疗AML的疗效相比中剂量更有优势,在加强感染预防与治疗准备的前提下,值得进一步临床推广。     

地西他滨联合预激方案和传统治疗方案治疗老年MDS/MPD转化的急性髓系白血病的疗效和安全性的比较研究

目的:对地西他滨联合预激方案和传统治疗方案治疗老年骨髓增生异常综合征(MDS)或骨髓增殖性疾病(MPD)转化的急性髓系白血病(AML)的有效性和安全性进行比较研究。方法:回顾性分析28例MDS/MPD转化的老年AML患者的临床资料,分别应用地西他滨联合预激方案11例和传统治疗方案17例(其中"3+7"标准方案8例、CAG方案6例及支持治疗3例),比较分析2组患者的临床疗效及不良反应。结果:地西他滨联合预激组中完全缓解(CR)7例(63.6%),未缓解(NR)4例(36.4%),总有效率(ORR)为63.6%;传统治疗组中CR 4例(23.5%),分别为"3+7"标准方案2例、CAG方案2例,NR 13例(76.5%),ORR为23.5%。地西他滨联合预激组的有效率明显高于传统治疗组,差异有统计学意义(P0.05)。2组患者治疗前骨髓原始细胞数对于缓解与否无差异(P0.05)。2组患者出现的不良反应主要是骨髓抑制、肺部感染、恶心呕吐、肝功能损害和心力衰竭,经过输血和抗感染等支持治疗均可以耐受,2组不良反应发生率比较差异无统计学意义(P0.05)。随访至2013年9月,地西他滨联合预激组和传统治疗组的中位生存分别是15个月和2个月,差异有统计学意义(P0.05)。结论:地西他滨联合预激方案治疗老年转化性AML患者的临床疗效显著,不良反应可以耐受,可作为老年转化性AML的首选方案。     

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     

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.     

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…     

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.     

Myoclonic Epilepsy with Ragged-red Fibers with Intranuclear Inclusions

We herein report a case of myoclonic epilepsy with ragged-red fibers (MERRF) harboring a novel variant in mitochondrial cysteine transfer RNA (MT-TC). A 68-year-old woman presented with progressive myoclonic epilepsy with optic atrophy and peripheral neuropathy. A skin biopsy revealed p62-positive intranuclear inclusions. No mutations were found in the causative genes for diseases known to be related to intranuclear inclusions; however, a novel variant in MT-TC was found. The association between intranuclear inclusions and this newly identified MERRF-associated variant is unclear; however, the rare complication of intranuclear inclusions in a patient with typical MERRF symptoms should be noted for future studies.