长春地辛和长春新碱治疗儿童急性淋巴细胞白血病比较

目的回顾性分析比较长春碱类抗肿瘤药物长春地辛(VDS)与长春新碱(VCR)治疗儿童初发急性淋巴细胞白血病(ALL)的疗效、不良反应及成本效益。方法 105名初诊ALL患儿加入CCLG-2008化疗方案组(VDS组48人、VCR组57人),于诱导期及强化期接受VDS 3 mg/m~2或VCR 1.5 mg/m~2,每周1次的治疗。结果 VDS与VCR两组完全缓解率分别为91.7%和94.7%(P=0.53),5年总生存率(OS)分别为91.7%±3.9%和87.7%46.9(P=0.603),无事件生存率(EFS)79.2%±4.0%和78.9%±3.4%(P=0.799),两组差异均无显著性。持续缓解期间治疗相关死亡率(TRM)VDS组较VCR组低(2.2%vs 14.2%,P=0.04)。共199人次在治疗中出现不良反应,其中VDS组113人次、VCR组86人次。VDS组外周神经毒性、贫血及血小板减少发生率均低于VCR组,且Ⅲ级及以上贫血、血小板减少发生率较VCR组均更低(P值均0.05)。另外,VCR组中2名患儿出现严重感觉异常及运动障碍,换用VDS后症状消失。VDS组平均住院费用亦低于VCR组(25,996元/人vs 34,244元/人,P=0.002)。结论 VDS与VCR治疗儿童ALL的近期和远期疗效相当,但VDS较VCR不良反应发生率低,持续缓解期TRM低,且能减少住院成本,值得临床推广研究。     

儿童骨髓增生异常综合征/骨髓增殖性疾病的再认识

骨髓增生异常综合征(MDS)/骨髓增殖性疾病(MPD)是一组起源于造血干/祖细胞的异质性、克隆性疾病,兼具骨髓增生异常和慢性骨髓增殖性疾病的双重特点。此类疾病在儿科发病率较低,缺乏统一的诊断分类标准。因此临床工作中,常发生漏诊或误诊。本文根据近年国际上对     

Expression of histone H2AX phosphorylation and its potential to modulate adriamycin resistance in K562/A02 cell line

DNA repair processes play a role in the development of drug resistance which represents a huge obstacle to leukemia chemotherapy. Histone H2AX phosphorylation (ser139) (γH2AX) occurs rapidly at the onset of DNA double strand break (DSB) and is critical to the regulation of DSB repair. If DNA repair is successful, cells exposed to anti-neoplastic drugs will keep entering the cycle and develop resistance to the drugs. In this study, we investigated whether γH2AX can be used as an indicator of tumor chemosensitivity and a potential target for enhancing chemotherapy. K562 and multi-drug resistant cell line K562/A02 were exposed to adriamycin (ADR) and γH2AX formed. Flow cytometry revealed that percentage of cells expressing γH2AX was increased in a dose-dependent manner and the percentage of K562/A02 cells was lower than that of K562 cells when treated with the same concentration of ADR. In order to test the potential of γH2AX to reverse drug resistance, K562/A02 cells were treated with PI3K inhibitor LY294002. It was found that LY249002 decreased ADR-induced γH2AX expression and increased the sensitivity of K562/A02 cells to ADR. Additionally, the single-cell gel electrophoresis assay and the Western blotting showed that LY249002 enhanced DSBs and decreased the expression of repair factor BRCA1. These results illustrate chemosensitivity can partly be measured by detecting γH2AX and drug resistance can be reversed by inhibiting γH2AX.     

树突状细胞与细胞因子诱导的杀伤细胞共培养细胞过继免疫治疗儿童急性白血病

目的观察树突状细胞(DC)与细胞因子诱导的杀伤细胞(CIK)共培养细胞(DC-CIK)过继免疫治疗儿童急性白血病的作用及安全性。方法回顾分析2005年5月-2011年5月本院确诊经联合化疗后达完全缓解的47例急性白血病患儿临床资料,观察DC-CIK过继免疫治疗过程中细胞采集、细胞培养、细胞回输的安全性,随访过程中通过定期检测其血常规、肝肾功能、心电图等来评估其远期安全性;DC-CIK过继免疫治疗后通过定期进行患儿骨髓细胞学、微小残留病(MRD)检测,初步评判其疗效。结果47例患儿接受DC-CIK治疗后44例患儿持续完全缓解(CCR),CCR率达93.62%;治疗前MRD阳性的9例患儿,8例治疗后转阴。47例患儿共接受DC-CIK过继免疫治疗61例次,不良反应轻微,单个核细胞采集术后局部有轻微疼痛,且均在术后2 h左右自行缓解。细胞培养过程中进行3次病原体检测,仅1例次培养出毛霉菌。细胞回输过程中23例次出现发热,10例次出现皮疹。中位随访41(5～72)个月未见心、肝、肾等重要器官功能损害,未见感染性疾病、第二肿瘤等的发生。结论 DC-CIK过继免疫治疗儿童急性白血病操作流程简便易行、安全性好,获得了满意疗效。     

MicroRNA在红细胞生成及血液系统疾病中的作用

<正>MicroRNA(miRNA)是一种内源性长约19～24个碱基的非编码单链小分子RNA,在动植物体内广泛存在,作为控制幼虫发育的时序基因首先在线虫体内被发现。随着生物信息学和基因克隆技术的迅速发展,现已在人类发现541个miRNA,记录     

中国先天性心脏病患者TBXl基因突变的研究

目的 检测中国先天性心脏病患者TBX1基因突变以探讨TBX1基因突变与非综合征心脏畸形发生的相关性.方法 应用聚合酶链反应-单链构像多态性(PCR-SSCP)技术对73例先天性心脏病患者和70例健康人样本的TBX1基因进行突变分析.结果 先天性心脏病患者和对照组中均检测到928G→A核苷酸变异和933A→G核苷酸变异,经X2检验,928G→A和933A→G核苷酸变异的频率在先天性心脏病患者和对照组之间差异均无统计学意义.结论 在非综合征心脏畸形的发病机制中,TBX1基因突变可能不占主导地位.