不同血液静化方式治疗终末期肾病的效果观察

目的：探讨高通量血液透析与血液透析滤过两种血液静化方式治疗终末期肾病的临床效果和临床推广价值。方法选取2012年1月～2014年6月中国人民解放军153中心医院收治的终末期肾病患者120例,随机分为观察组和对照组,每组60例,观察组患者运用高通量血液透析方法进行治疗,对照组采用血液透析滤过方法对患者进行治疗,观察对比2组患者的血压、血管紧张素2、甲状旁腺激素、肾功能水平的差异。结果治疗后,观察组患者的血压、血管紧张素2、甲状旁腺激素、肾功能水平（肌酐、血清尿素）均明显优于对照组（P＜0．05）。结论高通量血液透析在对终末期肾病患者的治疗中,效果明显优于血液透析滤过,值得临床推广应用。     

间充质干细胞治疗糖皮质激素耐药性慢性移植物抗宿主病临床疗效观察

Objective To assess whether treatment with mesenchymal stem cells (MSCs) is an effective adjunct therapy for refractory extensive chronic graft-versus-host disease (GVHD) resistant to conventional therapy. Methods 12 patients with steroid-resistant extensive chronic GVHD were treated with MSCs. One patient received one dose, 10 received two doses, and the remaining three doses. The MSCs were obtained from HI,A-identical sibling donors (n = 14), haploidentical donors (n = 2), unrelated mismatched donor (n = 1) and third-party HLA-mismatched donors (n = 7). Of the 11 patients treated with multiple infusions, 5 received cells derived from two donors. The median first dose of MSCs was 1.0 (0. 4-2. 1) × 106/kg , the median second dose was 1.2(0. 8-1.9) × 106/kg , and the third dose in one patient was 1.1 × 106/kg. Meanwhile the proportion of CD3+ ,CD4+,CD8+ ,CD19+,CD4+ CD25+ ,FOXP3+,FOXP3+CD4+ and FOXP3+ CD25+ was determined with double fluorescent-labeled antibodies and flow cytometry before and 4 weeks after the MSCs infusion. Results No patients had side-effects during or immediately after the infusions of MSCs. After a treatment course of one to three doses, 3 patients had complete response(CR), 6 showed partial response(PR) and 3 did not respond; the total effective rate was 75% (9/12). Complete resolution was seen in the involvement of skin (3/12), lung (1/3), joints (1/5), liver (3/10), oralcavity (4/12) and eye (2/7). Response rate was not related to donor HLA-match. 3 CR patients discontinued all of the immunosuppressive agents without relapse 100 to 292 days after the MSC infusion and 6 PR patients taped all immunosuppressive agents after 60 to 79 days. Mean follow-up period was 1152(795-1914) days, leukemia free survival rate was 91.7% (11/12) and the overall survival rate was 75% (9/12). The ratio of CD4/CD8 and the proportion of regulatory T cells were significantly higher than that before MSCs treatment. Conclusion Third-party MSCs were as effective as HLA-identical or haploidentical cells. This finding has practical implications and suggests that third-party cells can be prepared and stored frozen to be used for steroid-resistant extensive chronic GVHD therapy. It is concluded that MSCs may prevent the lethal cGVHD after allogeneic hematopoietic stem cell transplantation and raise the survival rate by increasing the ratio of CD4/CD8 and proportion of regulatory T cells in vivo.     

自体造血干细胞移植可改善多发性骨髓瘤患者的临床状态

目的 探究蛋白酶体抑制剂和来那度胺治疗下,自体造血干细胞移植（ASCT）对初发多发性骨髓瘤（MM）患者缓解深度和生存的影响。方法 回顾性收集2015年1月~2019年12月在南方医科大学南方医院接受蛋白酶体抑制剂和或来那度胺治疗的初发及适合移植的MM患者临床资料,按照患者是否接受自体干细胞移植分为移植组及未移植组。移植组纳入接受4~6疗程蛋白酶体抑制剂和或来那度胺为基础的诱导治疗后序贯ASCT的患者,未移植组纳入仅接受8疗程以上的蛋白酶体抑制剂和或来那度胺为基础的诱导及巩固的患者,比较两组患者的治疗疗效及生存的差异。结果 总共105例患者纳入研究,移植组48例 （45.7%）、未移植组57例（54.3%）,两组患者在性别、年龄及4疗程诱导治疗后疗效等方面相似（P>0.05）。两组患者在首次复发前获得过的最佳缓解程度有统计学差异（P<0.001）,移植组获得完全缓解（85.4% vs 54.4%,P=0.001））和完全缓解+非常好的部分缓解（95.8% vs 73.7%,P=0.002）的比例高于未移植组;截止2020年12月31日末次随访时,移植组和未移植组的中位无进展生存期（PFS）分别为未达到和 29 月（P=0.013）,两组患者的中位总生存期（OS）均未达到,但移植组 OS 优于未移植组（P= 0.022）。结论 在新药时代,ASCT仍能进一步提高初发MM患者的缓解深度并改善患者的生存。     

急性氨茶碱中毒引起双重性心动过速1例

双重性心动过速为同时存在两种快速心律失常,病因多见于洋地黄中毒,临床较为少见。急性氨茶硷中毒所致双重性心动过速似未见报道,现报告我院最近遇到的1例。     

间充质干细胞治疗糖皮质激素耐药性慢性移植物抗宿主病临床疗效观察

Objective To assess whether treatment with mesenchymal stem cells (MSCs) is an effective adjunct therapy for refractory extensive chronic graft-versus-host disease (GVHD) resistant to conventional therapy. Methods 12 patients with steroid-resistant extensive chronic GVHD were treated with MSCs. One patient received one dose, 10 received two doses, and the remaining three doses. The MSCs were obtained from HI,A-identical sibling donors (n = 14), haploidentical donors (n = 2), unrelated mismatched donor (n = 1) and third-party HLA-mismatched donors (n = 7). Of the 11 patients treated with multiple infusions, 5 received cells derived from two donors. The median first dose of MSCs was 1.0 (0. 4-2. 1) × 106/kg , the median second dose was 1.2(0. 8-1.9) × 106/kg , and the third dose in one patient was 1.1 × 106/kg. Meanwhile the proportion of CD3+ ,CD4+,CD8+ ,CD19+,CD4+ CD25+ ,FOXP3+,FOXP3+CD4+ and FOXP3+ CD25+ was determined with double fluorescent-labeled antibodies and flow cytometry before and 4 weeks after the MSCs infusion. Results No patients had side-effects during or immediately after the infusions of MSCs. After a treatment course of one to three doses, 3 patients had complete response(CR), 6 showed partial response(PR) and 3 did not respond; the total effective rate was 75% (9/12). Complete resolution was seen in the involvement of skin (3/12), lung (1/3), joints (1/5), liver (3/10), oralcavity (4/12) and eye (2/7). Response rate was not related to donor HLA-match. 3 CR patients discontinued all of the immunosuppressive agents without relapse 100 to 292 days after the MSC infusion and 6 PR patients taped all immunosuppressive agents after 60 to 79 days. Mean follow-up period was 1152(795-1914) days, leukemia free survival rate was 91.7% (11/12) and the overall survival rate was 75% (9/12). The ratio of CD4/CD8 and the proportion of regulatory T cells were significantly higher than that before MSCs treatment. Conclusion Third-party MSCs were as effective as HLA-identical or haploidentical cells. This finding has practical implications and suggests that third-party cells can be prepared and stored frozen to be used for steroid-resistant extensive chronic GVHD therapy. It is concluded that MSCs may prevent the lethal cGVHD after allogeneic hematopoietic stem cell transplantation and raise the survival rate by increasing the ratio of CD4/CD8 and proportion of regulatory T cells in vivo.     

间充质干细胞治疗糖皮质激素耐药性慢性移植物抗宿主病临床疗效观察

Objective To assess whether treatment with mesenchymal stem cells (MSCs) is an effective adjunct therapy for refractory extensive chronic graft-versus-host disease (GVHD) resistant to conventional therapy. Methods 12 patients with steroid-resistant extensive chronic GVHD were treated with MSCs. One patient received one dose, 10 received two doses, and the remaining three doses. The MSCs were obtained from HI,A-identical sibling donors (n = 14), haploidentical donors (n = 2), unrelated mismatched donor (n = 1) and third-party HLA-mismatched donors (n = 7). Of the 11 patients treated with multiple infusions, 5 received cells derived from two donors. The median first dose of MSCs was 1.0 (0. 4-2. 1) × 106/kg , the median second dose was 1.2(0. 8-1.9) × 106/kg , and the third dose in one patient was 1.1 × 106/kg. Meanwhile the proportion of CD3+ ,CD4+,CD8+ ,CD19+,CD4+ CD25+ ,FOXP3+,FOXP3+CD4+ and FOXP3+ CD25+ was determined with double fluorescent-labeled antibodies and flow cytometry before and 4 weeks after the MSCs infusion. Results No patients had side-effects during or immediately after the infusions of MSCs. After a treatment course of one to three doses, 3 patients had complete response(CR), 6 showed partial response(PR) and 3 did not respond; the total effective rate was 75% (9/12). Complete resolution was seen in the involvement of skin (3/12), lung (1/3), joints (1/5), liver (3/10), oralcavity (4/12) and eye (2/7). Response rate was not related to donor HLA-match. 3 CR patients discontinued all of the immunosuppressive agents without relapse 100 to 292 days after the MSC infusion and 6 PR patients taped all immunosuppressive agents after 60 to 79 days. Mean follow-up period was 1152(795-1914) days, leukemia free survival rate was 91.7% (11/12) and the overall survival rate was 75% (9/12). The ratio of CD4/CD8 and the proportion of regulatory T cells were significantly higher than that before MSCs treatment. Conclusion Third-party MSCs were as effective as HLA-identical or haploidentical cells. This finding has practical implications and suggests that third-party cells can be prepared and stored frozen to be used for steroid-resistant extensive chronic GVHD therapy. It is concluded that MSCs may prevent the lethal cGVHD after allogeneic hematopoietic stem cell transplantation and raise the survival rate by increasing the ratio of CD4/CD8 and proportion of regulatory T cells in vivo.     

恶性血液病患者合并感染性休克的临床特点

目的:分析恶性血液病并脓毒血症患者发生感染性休克时的临床特点及治疗措施,为临床诊疗提供参考.方法:回顾性分析170例伴有脓毒血症的恶性血液病患者中,发生感染性休克43例患者的诊治过程及相关影响因素.结果:感染性休克发生率为25.3%,纠正率为46.5%,死亡率为53.5%,致病菌以革兰氏阴性(G-)菌为主(83.0%),休克1 h内快速补液和经验性应用抗生素与药敏结果相符利于纠正休克,碳青霉烯类抗生素与药敏符合率最高.结论:恶性血液病患者极易合并脓毒血症及感染性休克,死亡率高,早期诊断并及时给予个体化抗感染、抗休克治疗能够显著提高患者生存率.     

异基因造血干细胞移植后的免疫重建

异基因造血干细胞移植(alloHSCT)后由于免疫重建延迟,面临移植后感染而致高死亡率。alloHSCT后的免疫重建是一个十分复杂的过程,它依赖于移植前后的一系列因素。免疫重建的研究对于移植后感染的防治以及免疫治疗有重要意义,本文对alloHSCT后的免疫重建研究进展进行综述。     

异基因造血干细胞移植治疗慢性粒细胞白血病长生存分析

目的:评价异基因造血干细胞移植(allo-HSCT)治疗慢性粒细胞白血病(CML)的疗效,并分析影响CML长生存的预后因素。方法:118例CML患者包括慢性期88例、加速期8例、急变期22例,其中83例接受相关移植、35例无关移植。预处理方案:36例患者用全身照射(TBI)联合环磷酰胺联合(Cy)、82例改良BuCy(白消安、环磷酰胺和阿糖胞苷)。移植物抗宿主病(GVHD)预防:68例相关人类白细胞抗原(HLA)全相合移植用环孢素(CsA)和甲氨蝶呤(MTX),50例无关供者及相关1个以上位点不合者采用CsA、MTX、抗胸腺细胞球蛋白(ATG)或麦考酚酸酯(MMF)。Cox模型分析影响长生存的因素。结果:118例患者除3例死于预处理相关毒性(RRT)外其余均获造血重建。移植后5年累计感染发生率为42.6%,巨细胞病毒血症累计阳性率为41.6%。Ⅱ～Ⅳ度急性GVHD累计发生率为33.3%,其中相关全相合供者(MSD)和无关、相关不相合供者(MRD/URD)发生率分别为23.1%和46.9%(P=0.01);1年累计慢性GVHD发生率为47.8%,其中MSD和MRD/URD慢性GVHD发生率分别为51.4%和42.2%(P=0.260)。GVHD致死率为18.3%。移植后5年白血病累计复发率为17%,其中MSD和MRD/URD复发率分别为12.5%和23.9%%(P=0.228)。5年累计总生存(OS)和无病生存(DSF)率分别为69.5%和62.6%,其中MSD与MRD/URD的5年OS率和DSF率分别为78.5%比57.2%和72.7%比48.3%(P=0.018,P=0.017)。慢性期与加速/急变期的5年OS率和DSF率分别79.9%、36.7%和72.4%、32.6%(P<0.001)。多因素Cox模型分析显示,Ⅱ～Ⅳ度急性GVHD、HLA不相合、诊断至移植时间≥1年为OS的独立危险因素。加速期、急变期和三联、四联GVHD预防方案为影响DSF的独立危险因素。结论:影响CML-allo-HSCT长生存的主要因素是移植的时机、疾病状态、HLA相合程度和移植后GVHD。GVHD是移植后死亡的主要原因。