儿童急性白血病细胞周期蛋白D3、E的表达

目的 探讨细胞周期蛋白D3、E的表达与儿童急性白血病(AL)的关系。方法 采用免疫组织化学法，对广西医科大学第一附属医院儿科2002年1月至2004年5月收治的50例初发或复发儿童AL，其中急性淋巴细胞白血病(ALL)30例(高危ALL 12例，标危ALL 18例)，急性非淋巴细胞白血病(ANLL)20例，和26例完全缓解AL(AL CR)患儿，以及23例同期住院的非恶性疾病患儿(对照组)，检测其骨髓细胞中细胞周期蛋白D3、E的表达情况。结果 AL组中细胞周期蛋白D3、E阳性率分别为54%和46%，高于AL-CR组和对照组(P<0.01)；在ALL和ANLL间差异无显著性(P>0.05)。高危ALL细胞周期蛋白D3阳性率明显高于标危ALL(P<0.01)。化疗前细胞周期蛋白D3、E表达阳性率明显高于化疗缓解后(P<0.01)。细胞周期蛋白D3、E在AL组中的表达呈正相关(r=0.298，P<0.01)。结论 细胞周期蛋白D3、E与儿童AL发病有关，它们的表达存在相关性，可作为疗效观察的指标；细胞周期蛋白D3可能与患儿不良预后有关。 Abstract Objective To investigate the relationship between the expression of cyclin D3，cyclin E and childhood acute leukemia(AL).Methods The expression of cyclin D3 and cyclin E was detected in bone marrow cells from 50 cases of newly diagnosed or relapsing AL，in whom there were 30 cases of acute lymphoblastic leukemia(ALL，including 12 cases of high risk ALL and 18 cases of standard risk ALL ) and 20 cases of acute non lymphocytic leukemia(ANLL)，26 cases of complete remission AL(AL CR) patients and 23 cases of control group(no malignant disease) using immunohistochemical assay.Results 54% AL cases were positive for cyclin D3，and 46% for cyclin E，both being remarkably higher than that of AL CR group and control group(P<0.01).There was no difference between ALL and ANLL in the expression of cyclin D3 and cyclin E(P>0.05).The positive expression of cyclin D3 was higher in high risk ALL than that in standard risk ALL(P<0.01).The expressions of cyclin D3 and cyclin E before chemotherapy were significantly higher than that after remission using chemotherapy(P<0.01).There was significantly positive correlation between the expression of cyclin D3 and cyclin E in AL (r=0.5298，P<0.01).Conclusion In childhood AL，the expression of cyclin D3 and cyclin E is quite high，which is related to the development of AL and might be index of treatment effect.There is positive relation between cyclin D3 and cyclin E.Cyclin D3 might be related to poor prognosis. Key words Acute leukemia;Cyclin;Immunohistochemistry     

反复呼吸道感染儿童血清甘露聚糖结合凝集素水平及54密码子基因突变筛查

目的 了解反复呼吸道感染(RRTI)儿童血清甘露聚糖凝集素(MBL)水平及第一外显子54密码子的突变率，探讨血清MBL水平与RRTI的关系。方法 用ELISA方法检测2000~2003年在重庆医科大学附属儿童医院就诊的65例RRTI儿童和238名正常儿童血清MBL水平，测定其中11例低MBL血症的RRTI儿童的免疫学指标(IgG、IgA、IgM、C3、C4)，并用聚合酶链反应(PCR) 限制性内切酶片段长度多态性分析(RFLP)方法与55名正常儿童MBL第一外显子54密码子基因多态性进行分析。结果RRTI儿童出现低血清MBL水平频率明显多于正常儿童(χ2=6.96,P<0.05)，其MBL 54密码子突变率亦明显增高(P<0.05)，低血清MBL血症导致RRTI主要在2岁以前，血清MBL水平越低，感染频率越高，其C3、C4水平也越高。结论 儿童MBL 54密码子突变导致低MBL血症在2岁以前有反复呼吸道感染的倾向，MBL水平越低，感染机率越高。 Abstract Objective To detect the mannose binding lectin (MBL) serum levels and the mutation on code 54 of MBL in children with recurrent respiratory tract infections(RRTI),and to find the relationship between MBL serum levels and recurrent respiratory tract infections(RRTI).Methods To detect the serum MBL level of 238 normal people and 65 children with RRTI through the methods of enzyme linked immunoadsordent assay,then compare the immune data(IgG,IgA,IgM,C3,C4) of 11 children with low serum MBL level and compare the rate of the mutation on code 54 through the methods of polymerase chain reaction(PCR) restriction fragment length polymorphism (RFLP) with 55 normal children.Results The rate of low serum MBL level in the children with RRTI was higher than that in the normal population(χ2=6.96,P<0.05),the same went for the frequency of mutation of code 54 (P<0.05).RRTI caused by low serum MBL level occurred mostly among children under 2 years of age,and the rate of respiratory tract infection in the individuals with MBL level under 100μg/L was more than that in children with levels ranged from 100μg/L to 200μg/L (P<0.05),and was associated with reverse chang of serum levels of C3,C4(P<0.05).Conclusion Under 2 years of age,the children with the low serum MBL levels caused by mutation on MBL 54 show the susceptivity to IRRTI,and the low serum MBL level is parallel to high serum levels of C3，C4，and the lower the level the more possible infection. Key words Mannose binding lectin;Repeated respiratory tract infections;Gene;Polymorphism;Child     

急性淋巴细胞白血病患儿化疗时脑脊液神经元特异性烯醇化酶的变化及意义

目的 探讨大剂量甲氨蝶呤静滴+鞘内注射治疗急性淋巴细胞白血病(ALL)患儿时中枢神经系统损伤的监测指标。方法 2003年1~12月在青岛大学医学院附属医院收治的42例标危ALL患儿中。在行大剂量甲氨蝶呤静滴+鞘内注射化疗前及化疗后15、30、45d腰穿留取脑脊液(CSF)各1mL,用双抗体夹心酶联免疫法测定CSF中神经元特异性烯醇化酶(NSE)的质量浓度。结果 化疗后，CSF中NSE质量浓度升高,于第15天达峰值,化疗30d NSE质量浓度下降，与化疗前比较差异有统计学意义；化疗45d后NSE质量浓度与化疗前比较差异无统计学意义。结论 CSF中NSE是ALL患儿行大剂量甲氨蝶呤静滴+鞘内注射化疗时，神经细胞急性损伤的一个有价值的预报因子。 Abstract Objective To investigate the monitoring factors for the central nervous system from intrathecal injections and high dose methotrexate therapy (HDMTX+IT) given during treatment for acute lymphoblastic leukemia in children.Methods Forty two children aged from 5 to 11 years with ALL participated in the study.children had the history of ALL less than one year,while twenty two children had ALL more than one year.CSF was sampled for analyses of NSE on four occasions.Results No difference was found between the NSE concentration of the children who had ALL more or less than one year.The NSE content in the CSF samples increased from (3.9±0.5) ng/mL before the start of treatment to (6.5±1.1) ng/mL at day 15 and then gradually decreased to (4.3±0.9) ng/mL at day 30 and to (4.0 0.7) ng/mL at day 45.Conclusion NSE is a useful marker for acute brain damage in acute lymphoblastic leukemia children. Key words Leukemia,lymphoblastic,acute;Children;Methotrexate;Neuron-specific enolase     

儿童急性白血病SODD和P65蛋白的表达及临床意义

目的 探讨儿童急性白血病SODD和P65蛋白的表达及其临床意义。 方法 2004年3~11月采用免疫组化SABC法，检测华中科技大学同济医学院附属同济医院儿科住院急性白血病(AL)患儿骨髓涂片中SODD、P65蛋白表达。 结果 33例AL中，SODD和P65表达阳性率分别为54.5%(18/33)和45.5%(15/33)，与正常对照组相比差异有显著性(P<0.05)；25例急性淋巴细胞白血病(ALL)中，SODD和P65表达的阳性率分别为56.0%(14/25)和48.0%(12/25)，与正常对照组相比差异有显著性(P<0.05)。ALL高危病例组中SODD阳性表达率为75.0%(12/16)，较标危病例组阳性率高，差异有显著性(P<0.05)。33例AL患儿中SODD和P65均为阳性12例，均阴性16例，表达一致符合率为84.8%(28/33)，两者的表达呈正相关(P<0.01,r=0.69)。 结论 SODD和P65均参与了AL的发生发展；SODD过表达与儿童ALL的发生、临床分型以及预后均有密切关系。     

小儿复杂上尿路感染的因素及致病菌分析

目的 了解小儿复杂上尿路感染的因素及致病菌的耐药现状。方法 1999年1月至2004年3月在复旦大学附属儿科医院住院治疗的复杂上尿路感染患儿178例，分析其尿培养阳性的因素、致病菌分布及其对抗生素的耐药性。结果 复杂上尿路感染患儿的年龄以≤1岁为主，占46.6%。致病因素中以膀胱输尿管反流为主，占61.8%,40例肾瘢痕患儿中有92.5%存在反流。复杂上尿路感染致病菌中以大肠埃希菌为主，占33%，但与单纯上尿路感染相比所占比例明显下降(P<0.001)；克雷白杆菌与绿脓假单孢菌感染所占比例明显高于单纯上尿路感染所占比例(分别P<0.01,P<0.05)。产超广谱β-内酰胺酶(ESBLs)菌株占革兰阴性杆菌的28%，以大肠埃希菌易产生ESBLs。革兰阴性杆菌对未加β-内酰胺酶抑制剂的青霉素类及第1、2、3代头孢菌素类抗生素耐药率均高，而ESBLs菌株交叉耐药情况更为严重。结论 复杂上尿路感染以婴儿期多见，膀胱输尿管反流是复杂上尿路感染及肾瘢痕的主要因素，大肠埃希菌仍是其主要致病菌，但克雷白杆菌、绿脓假单胞菌比例明显上升，致病菌耐药性高，产ESBLs菌株多重耐药严重。 Abstract Objective To investigate the factors and resistance of the pathogens of complicated upper urinary tract infection (UTI) in children.Methods Distribution and resistance of pathogens,complicated factors in 178 urinary culture positive UTI patients hospitalized from 1999 to 2004 were analyzed.Results Infants with complicated upper UTI accounted for 46.6%.Among the complicated factors,vesicoureteric reflux (VUR) accounted for 61.8%,and 37 of 40 children with venal scar had VUR.E.coli in the complicated upper UTI accounted for 33% of all the pathogens,which was significantly lower than in simple upper UTI (P<0.001)However,Klebsiella and Pseudomonas aeruginosa accounted for 15.8% and 8.1% respectively,which were significantly higher than in simple upper UTI (5.6% and 2.4% respectively,P<0.01 and 0.05 respectively).Nearly 28% of the Gram negative bacilli were the ESBLs producing strain,most of which were E.coli.Gram negative bacilli had a high resistance rate towards not only the penicillin uncombined with the beta lactamases inhibitors but also the first,second and third generations of cephalosporins.Furthermore,the multi cross resistance of the ESBLs strains was even more serious.Conclusion The complicated upper UTI is predominant in infants and VUR induces complicated upper UTI and renal scar.E.coli is still the major pathogen,while the proportion of Klebsiella,Pseudomonas aeruginosa are significantly increasing.The pathogens have high drug resistance and the ESBLs producing strains have serious multi resistance. Key wordsUpper urinary tract infectionPathogenResistance     

大剂量维生素C对川崎病急性期肱动脉血流介导扩张反应影响的临床观察

目的 观察大剂量维生素C(VitC)对川崎病(KD)急性期肱动脉血流介导的扩张反应(FMD)的影响，探讨VitC对KD急性期血管内皮功能障碍是否有改善作用。方法 采用高分辨率多普勒超声仪测定2001年1月至2002年12月在华中科技大学同济医学院附属同济医院儿科住院的36例KD急性期患儿(KD组)及15名健康儿童(正常对照组)肱动脉FMD，并比较KD组静脉滴注大剂量VitC(200mg/kg，最大量为4g)和安慰剂(10%葡萄糖)前后肱动脉FMD的变化。结果 KD组肱动脉FMD明显低于正常对照组(P<0.001)；KD组静滴大剂量VitC后肱动脉FMD明显增加(P<0.01)，静滴安慰剂后肱动脉FMD无明显增加(P>0.05)。结论 大剂量VitC能明显改善KD急性期肱动脉FMD，其对KD急性期血管内皮功能障碍可能有显著改善作用。 Abstract Objective To observe the effect of high dose vitamin C on flow mediated vasodilation(FMD) of brachial artery in acute phase of Kawasaki disease(KD) and investigate whether high dose vitamin C could improve vascular endothelial dysfunction in KD.Methods Using high resolution vascular ultrasound,we measured FMD of the brachial artery of 36 patients who were admitted to our hospital from Jan.2001 to Dec.2002. in acute phase of KD and 15 matched healthy subjects as controls.Studies were performed before and after intravenous infusion of high dose vitamin C (200mg/kg，max≤4g) or placebo in KD group.Results The FMD of the brachial artery in KD group was significantly lower than that in the control group (3.55±3.00% vs 10.34±4.29%，P<0.001).Intravenous infusion of vitamin C significantly increase the FMD of the brachial artery in 18 KD patients (6.97±2.93% vs 3.51±2.01%，P<0.01),while after administration of placebo in the other 18 patients,there was no significantly increased in the FMD(4.12±2.21% vs 3.75±3.00%，P>0.05).Conclusion Intravenous infusion of high dose vitamin C can increase the FMD of the brachial artery,and it can improve vascular endothelial dysfunction in KD. Key words Kawasaki disease;Vitamin C;Flow mediated vasodilation;Endothelial dysfunction     

短程结构式游戏对学习困难儿童生活质量心理干预的研究

目的 改善与提高学习困难儿童的生活质量。方法 2003年2~8月采用短程结构式游戏对学习困难儿童进行生活质量心理干预，并用程灶火编制的儿少主观生活质量问卷(ISLQ)对学习困难儿童干预前后的生活质量进行检查评定。采用整群随机抽取湛江市2所小学4年级儿童共750名，按标准筛选出学习困难儿童83名，分为观察组与对照组，同时从该2所小学同年级学习成绩在中等或以上水平的学生中随机抽取50名，作为正常组。结果 按随机抽样原则经过短程结构式游戏干预后观察组生活质量的总分和认知、情感两个成分的分值均高于对照组，差异具有显著性(P<0.01)。其中家庭生活、同伴交往、学校生活、自我认识和抑郁体验5个方面明显高于对照组，差异具有显著性(P<0.01)。结论 短程结构式游戏是改善学习困难儿童生活质量的一种有效心理干预方法。 Abstract Objective To evaluate the life quality of the children with learning disability.Methods The quality of life were assessed in children with learning disability pre and post psychological intervention with short time programmed game by Inventory of Subjective Life Quality for children and adolescent(ISLQ) edited by Cheng Zhaohuo.Results The levels of total score,recognition score and emotion score were higher in experimental group than that in control group(P<0.01) after psychological intervention,in which the scores of family life,school life,self cognition and depression practice are significantly higher than that in control(P<0.01).Conclusion Short time programmed group game is an effective psychological intervention method to improve the life quality of children with learning disability. Key words Children;Learning disability;Quality of life     

新生儿肺部疾病支气管肺泡灌洗液肺表面活性蛋白A的检测及意义

目的 探讨新生儿常见肺部疾病支气管肺泡灌洗液肺表面活性蛋白A(BAL SP-A)水平及其与临床的关系。方法 收集2000年1月至2003年2月在广州市儿童医院新生儿重症监护室住院的需行机械通气治疗的新生儿重症肺炎、胎粪吸入综合征(MAS)、急性呼吸窘迫综合征(ARDS)以及新生儿呼吸窘迫综合征(RDS)患儿共57例。测定其BAL SP-A水平，监测血气、PaO2/FiO2水平。结果重症肺炎组与MAS组患儿BAL SP-A水平无明显差异，但MAS组患儿PaO2、PaCO2及PaO2/FiO2水平较重症肺炎组明显降低(P值<0.01,<0.05,<0.05)；ARDS及RDS组患儿BAL SP-A水平均较上述两组低(P值均<0.001)，而RDS组患儿BAL SP-A水平较ARDS组低(P<0.001)，但ARDS组患儿PaO2水平较RDS组患儿低(P<0.05)。PS治疗组患儿的病死率较非PS治疗组明显降低(P=0.049)，其PaO2/FiO2与BAL SP-A水平密切相关(r=0.741,P=0.000)。结论 与重症肺炎患儿比较胎粪吸入综合征患儿BAL SP-A水平无明显降低；ARDS及RDS患儿BAL SP-A水平明显降低；BAL SP-A水平能反映新生儿肺损伤的严重程度，对于新生儿肺部疾病预后的判断有一定意义。 Abstract ObjectiveTo investigate the bronchoalveolar lavage (BAL) SP-A concentrations from newborn infants with lung disease,and to study the relationship between BAL SP-A and clinical outcome.Methods 57 cases of newborn infants with lung disease were admitted in our NICU between Jan.2000 and Feb.2003.BAL SP-A concentrations,PO2 value,PCO2 value,and PaO2/FiO2 ratio were measured.ResultsBAL SP-A concentrations did not differ between severe pneumonia group and MAS group,but the value of PaO2、PaCO2 and PaO2/FiO2 ratio in MAS group were significantly lower than that in severe pneumonia group (p respectively<0.001,<0.05,<0.05).BAL SP-A concentrations in RDS and ARDS groups were significantly lower than that in aforesaid groups ( all P<0.05).BAL SP-A concentrations in RDS group were significantly lower than that in ARDS group,but PaO2 value in ARDS group was lower significantly than that in RDS group( P<0.05).The mortality of infants treated with PS was significantly lower than that of infants treated without PS (P=0.049).PaO2/FiO2 ratio for the cohort was related to their BAL SP A concentrations ( r=0.741,P=0.000).Conclusion Surfactant protein A content in MAS is not different from that of severe pneumonia.BAL SP-A concentrations of neonates with ARDS or RDS decrease significantly.BAL SP-A concentrations can evaluate the severity of lung injury and the prognosis of neonatal lung disease. Key wordsInfant,newbornLung disease;Bronchoalveolar lavae;Surfactant protein A     

Analysis of the human zona pellucida during culture: Correlation with diagnosis and the preovulatory hormonal environment

Purpose: The objective of this study was to analyze sequentially the human zona pellucida changes in an in vitro fertilization program as it relates to several variables. Methods: The zona pellucida thickness was measured daily in zygotes and cleavage-stage embryos on a Nikon inverted microscope equipped with Hoffman modulation contrast optics, using an ocular micrometer. A total of 512 embryos from 96 patients was evaluated. Results: There was a highly significant direct correlation between zona thickness and preovulatory estradiol and basal day 3 FSH levels (P < 0.02 andP < 0.0006, respectively). This relationship showed a rapid reversal following 48 hr of culture; embryos from patients with the highest FSH levels had thinner zonae prior to transfer (P < 0.0007). The zonae from patients with unexplained infertility were thicker (19.4 ± 2.7 μm) than those from patients with endometriosis (17.7 ± 2.2 μm), tubal (17.5 ± 2.4 μm), or male-factor infertility (16.4 ± 2.7 μm) (P < 0.0001) on the first day of culture. Conclusions: We hypothesize that the thickness of the human zona pellucida is influenced by the preovulatory hormonal environment and diagnosis. These factors should be considered as part of the embryo quality evaluation prior to transfer or when assessing the possibility of using assisted hatching. More studies are needed to understand the factors regulating the thickness of the human zona pellucida.     

地塞米松、γ-干扰素对毛细支气管炎患儿免疫调节作用的观察

目的 观察地塞米松、γ-干扰素对毛细支气管炎患儿T细胞细胞免疫和T细胞体液免疫比值(TH1/TH2)的作用。方法将60例2002年11月至2004年4月在青岛市第八人民医院儿科住院的毛细支气管炎患儿，按入院顺序分成地塞米松组和γ-干扰素组，并选择15例健康婴儿为正常对照组。检测毛细支气管炎患儿治疗前血清IgE水平及细胞因子IFN-γ、IL-4水平，然后分别用地塞米松、γ-干扰素治疗，出院时复查血清IgE、IFN-γ及IL-4水平。结果 正常对照组和毛细支气管炎组血清IgE水平及细胞因子IFN-γ、IL-4、IFN-γ/IL-4水平差异有非常显著意义(P<0.001)。γ-干扰素组和地塞米松组治疗前血清IgE和细胞因子IFN-γ、IL-4、IFN-γ/IL-4差异均无显著性意义(P>0.05),但治疗后,以上指标差异均有非常显著意义(P<0.001)。出院后随访12个月，统计喘息反复发生的例数，γ-干扰素组3例，地塞米松组10例，经卡方检验差异有显著意义(P<0.05)。结论 毛细支气管炎患儿血清IgE水平高，TH1/TH2失衡。地塞米松短期内可起到抗炎、平喘作用，止喘起效快，但TH1/TH2治疗前后无差异，反复感染、喘息反复出现、容易发展成婴幼儿哮喘。 Abstract Objective To observe the effect of dexamethasone and IFN γ on the function of TH1/TH2 in lower respiratory tract infections.Methods Sixty patients with lower respiratory tract infections were divided randomly into 2 groups:group I with dexamethasone treatment,group II with IFN γ treatment.Normal group of 15 cases was as control.Serum levels of IgE,IFN γ and IL 4 were detected before and after treatment.Results Compared with normal control,there was significant difference in the serum level of IgE,IFN γ,IL 4,IFN γ/IL 4 in group Ⅰ and group Ⅰ,P<0.001.There was no difference in the serum level of IgE,IFN γ,IL 4,IFN γ/IL 4 between group I and group Ⅱ before treatment(P>0.05).But there was significant difference after treatment(P<0.001).After being followed up for 12 months,3 cases suffered from asthma in group Ⅰ,10 cases in group Ⅱ.There were outstanding meanings by square examination,P<0.05.Conclusion In patients with lower respiratory tract infections,the serum level of IgE rises.Humoral immunity is relatively increased and cell immunity decreased.So the TH1/TH2 is out of balance.With the treatment of dexamethasone,the body’s immune system is suppressed.In short time,the infection and asthma can be controlled,but TH1/TH2 can’t change after treatment.IFN- γ can interfere the duplication of virus,increase the level of IFN-γ in body,furthermore it can strengthen the cell immune function,lower cell immunologial answer of TH2 and recover the balance of TH1/TH2 The follow up suggests IFN γ has an important meaning in preventing infant asthma. Key wordsLow respiratory tract infections;IFN dexamethasone;Cell immunity;Humoral immunity     

Daxx和NF-κB在儿童急性白血病中的表达及其相关性

目的探讨Daxx在儿童急性白血病(AL)骨髓细胞中的表达及其与NF-κB的相关性，同时观察其与AL临床分型和预后的关系。 方法骨髓涂片取自华中科技大学同济医学院附属同济医院2005—2006年收治的AL患儿和骨髓正常的非恶性血液病患儿,应用免疫组织化学链霉素 亲和素-生物素-过氧化酶复合物(SABC)方法检测50例儿童AL骨髓细胞Daxx和NF-κB的表达，对照组为20例非恶性血液病且骨髓正常患儿。 结果在50例AL患儿中，Daxx和NF-κB蛋白阳性表达率分别为38.0%和56.0%，显著高于正常骨髓组织中的表达(P<0.05)；Daxx与NF-κB表达呈强 相关(P<0.05)；急性淋巴细胞白血病(ALL)患儿高危组Daxx和NF-κB的表达率分别为55.6%和77.8%，标危组分别为0和16.7%，两组之间差异均有 显著性(P<0.05)。 结论Daxx、NF-κB在儿童AL中过度表达，在白血病细胞凋亡和增殖的调控过程中可能起协同作用，且与AL的某些临床特征、疗效和预后密切相 关。     

急性白血病患儿Notch1蛋白表达及其临床意义研究

摘要：目的　探讨儿童急性白血病（AL）骨髓细胞中Notch1蛋白表达及其与免疫分型、治疗效果的关系。方法　收集2007年1月至2009年1月华中科技大学同济医学院附属同济医院初诊49例AL患儿和20例非恶性血液病患儿骨髓涂片,采用免疫组织化学链霉素亲和素-生物素-过氧化酶复合物（SABC）方法检测骨髓细胞中Notch1蛋白表达情况;流式细胞仪确定白血病细胞免疫分型;标准化疗方案用于AL患儿的治疗。结果　Notch1在T淋巴细胞性白血病（T-ALL）患儿阳性表达率为77.8%,显著高于B淋巴细胞白血病（B-ALL）患儿（31.0%,P < 0.05）及对照组骨髓组织（15.0%,P < 0.05）。急性非淋巴细胞白血病（ANLL）Notch1蛋白阳性表达率为63.6%,显著高于对照组（15.0%,P < 0.05）。在T-ALL 和ANLL中,Notch1与治疗效果无明显相关性;但在随访半年以上的B-ALL中,治疗效果好组（完全缓解无复发）Notch1阳性表达率为21.4%,效果差组（死亡或复发）Notch1阳性表达率为80.0%,两者比较差异有统计学意义（P < 0.05）。结论　Notch1在儿童AL中的异常表达与免疫分型关系密切。Notch1蛋白在B-ALL中虽然表达率不高,但可能是预后不良的因素。     

髓系抗原阳性儿童急性淋巴细胞白血病临床特点及预后

目的分析髓系抗原阳性儿童急性淋巴细胞白血病(ALL)的临床特点及预后关系。 方法根据国际白血病欧洲协作组(EGIL)标准将1999—2004年上海交通大学医学院附属上海儿童医学中心收治的33例髓系抗原阳性表达的ALL (My+ALL)分为双表型、双系列型给予正规治疗。对其预后进行观察。 结果(1)My+ALL患儿，双表型26例(78.8%，26/33)，其中B系ALL伴髓系表达17例(65.4%，17/26)，T系ALL伴髓系表达6例(23.1%,6/26)，T系B系 伴髓系表达3例(11.5%,3/26)。双系列ALL患儿7例(21.2%,7/33)。(2)26例双表型ALL患儿治疗35d，缓解率80.7%。7例双系列型ALL仅1例达缓解 (14.3%)。(3)生存状态：双表型26例中20例处于缓解状态(76.9%)，双系列型7例中仅1例(14.3%)。(4)复发情况：双表型6例复发(23.1%，6/26) ，双系列7例中6例复发(85.7%)。 结论髓系抗原阳性表达在儿童ALL时不能作为预后不良的因素，但双系列白血病患儿预后差，复发率高，长期生存机会少。     

p21~(WAF1/CIP1)和P53蛋白在子宫平滑肌肿瘤的表达和意义

目的 :探讨p2 1WAF1/CIP1和P5 3蛋白在子宫平滑肌肿瘤 (USMTs)的表达和意义。方法 :应用免疫组织化学法检测 2 0例普通型子宫平滑肌瘤 (UL) ,18例子宫平滑肌肉瘤 (LMS)及 70例交界性子宫平滑肌瘤 (BLM) :包括 4 0例富于细胞型子宫平滑肌瘤 (CL)、13例奇异型子宫平滑肌瘤 (BL)、4例核分裂活跃型子宫平滑肌瘤 (ML)、10例不典型子宫平滑肌瘤 (AL)及 3例恶性潜能未定型子宫平滑肌瘤 (STUMP)的p2 1WAF1/CIP1和P5 3蛋白的表达。结果 :LMS组p2 1WAF1/CIP1蛋白表达阳性率明显高于UL组 (P <0 .0 1)和BLM组 (P<0 .0 1) ;LMS组P5 3蛋白表达阳性率显著高于UL组 (P <0 .0 1)和BLM组 (P <0 .0 1)。结论 :LMS的发病机制涉及P5 3基因功能的丧失 ;p2 1WAF1/CIP1在USMT细胞的增殖和灭活中可能起到不同的作用     

干/髓系免疫表型对儿童T-急性淋巴细胞白血病预后影响研究

探讨干/髓系表面抗原标记对儿童T-急性淋巴细胞白血病的预后影响。方法　回顾性分析2002-01-01至2008-12-31上海交通大学医学院附属儿童医学中心收诊的57例T细胞型急性淋巴细胞白血病（ALL）和伴有骨髓转移的T细胞性淋巴母细胞型非霍奇金淋巴瘤（NHL）患儿干/髓系表面抗原表达情况,将其分为T-ALL伴有髓系表达组（T/My+ALL）和无髓系表达组（T/My-ALL）,分析其与预后的相关性。结果　T/My+ALL组31例（54.6%）和T/My-ALL组26例（45.4%）,两组细胞形态学、遗传学及临床特征差异均无统计学意义（P > 0.05）;近期疗效中,泼尼松诱导实验差异无统计学意义（P > 0.05）,19d骨髓象及第1疗程完全缓解率T/My+ALL组均较T/My-ALL组低,差异有统计学意义（P 值分别为0.002和0.006）;T/My+ALL组和T/My-ALL组的初治完全缓解率分别为90.3%和96.2%,5年无事件生存率分别为35.4%和65.7%。虽结果提示T/My+ALL组预后较T/My-ALL组差,但差异无统计学意义（P = 0.209）。结论　T-ALL/NHL伴有干/髓系表面抗原表达时预后差,但未达到统计学有效意义,目前尚不能将之作为儿童T系淋巴细胞白血病的预后因素。     

儿童急性淋巴细胞白血病化疗前后血清生化指标测定及其意义

探讨同型半胱氨酸（p-Hcy）、超敏C反应蛋白（hs-CRP）、乳酸脱氢酶（LDH）及肿瘤特异性生长因子（TSGF）在儿童急性淋巴细胞白血病（ALL）患者外周血中的表达及临床意义。方法　郑州大学第一附属医院2009年1月至2010年7月儿科血液病区收治的ALL患儿68例,其中男36例,女32例。所有患儿确诊后均进行正规化疗,其中完全缓解56例（缓解组）,复发12例（复发组）。另选取门诊健康体检儿童46名作为对照组。测定ALL患儿化疗前、缓解后、复发后及对照组儿童外周血p-Hcy、hs-CRP、LDH和TSGF。结果　缓解组化疗前和缓解后p-Hcy、hs-CRP、LDH和TSGF高于对照组,且缓解后低于化疗前,差异均有统计学意义（P值分别为 < 0.01、 < 0.05）。复发组复发后各项指标高于缓解组缓解后和对照组,差异有统计学意义（P < 0.05）,但与缓解组化疗前比较,差异无统计学意义（P > 0.05）。缓解组化疗前p-Hcy与TSGF呈正相关（r = 0.72,P < 0.05）,p-Hcy与LDH呈正相关（r = 0.82,P < 0.01） ,p-Hcy与hs-CRP呈正相关（r = 0.82,P < 0.01）。结论　动态监测外周血中p-Hcy、LDH、hs-CRP及TSGF的表达,于明确儿童ALL化疗疗效及辅助诊断有一定参考价值。     

儿童双表型白血病的临床特征及预后分析

目的分析儿童双免疫表型白血病的临床及生物学特征，评价儿童急性白血病双免疫表型与治疗相关因素及预后的临床重要性。方法自1998年1月1日至2003年5月31日进入XH 99治疗方案的所有新诊治的急性白血病(AL)患儿，诊断采用MICM分型诊断，治疗分别按AML XH 99、ALL XH 99危险度分类标准进行分层治疗。用流式细胞仪进行免疫表型分析，根据免疫表型结果将患儿分为4组，伴有/无髄系相关抗原表达的急性淋巴细胞白血病(My+ALL/My-ALL)以及伴有/无淋系相关抗原表达的急性髓系白血病(Ly+AML/Ly-AML)。生存分析采用Kaplan Meier方法；生存率之间的比较采用log rank检验；临床及生物学特征与治疗相关因素的分析采用χ2检验或Fisher精确概率法(双尾)。结果①174例提供免疫分型的ALL患儿中，My+ALL患儿34例，占19.54%，其与My-ALL组患儿除在B ALL组患儿达缓解时间有统计学差异外(P<0.05)，其它临床、生物学特征及治疗反应均无统计学差异(P>0.05)；两组患儿5年无事件生存(EFS)率分别为\[(61.76±8.33)%与(68.03±5.55)%\],log rank检验两组患儿5年EFS率无统计学差异(P=0.0526)。②74例提供免疫分型结果的AML患儿中，Ly+AML患儿18例，占24.32%，其与Ly-AML组患儿临床、生物学特征及治疗反应无统计学差异(P>0.05)；两组患儿5年EFS率分别为\[(39.82±13.59)%与(51.29±9.70)%\],log rank检验两组患儿5年EFS率无统计学差异(P=0.3164)。结论双免疫表型对儿童白血病预后无明显影响，可用同样现行的化疗方案治疗这部分患儿。