霉酚酸酯治疗弥漫增生性狼疮肾炎的临床观察

目的 :评估霉酚酸酯联合强的松治疗弥漫增生性狼疮肾炎的疗效及其安全性。方法 :4 6例患者随机分成 2组 ,治疗组口服霉酚酸酯加强的松 12个月 ;对照组静滴环磷酰胺加口服强的松 6个月 ,之后给予强的松和硫唑嘌呤 6个月。结果 :治疗组的 2 5个病人中的 80 %完全缓解 ,对照组中 76 %完全缓解 ,而治疗组、对照组病人部分缓解率分别为 17%和 14 %。每组各有 1个病人因副作用中断治疗 ,治疗过程中治疗组有 2 0 % ,对照组有 33%病人出现感染 (P =0 .2 9)。同时观察到仅对照组病人中出现闭经 (占病人中的 2 3% )、脱发 (19% )、白细胞减少 (10 % )及死亡(10 % )等副反应。治疗组、对照组复发率分别为 13%和 11%。结论 :对于弥漫增生性狼疮肾炎的治疗 ,霉酚酸酯和强的松联合治疗的方案与环磷酰胺和强的松治疗后序贯使用硫唑嘌呤的方案效果相同 ,而前者的副作用较少     

弥漫型恶性腹膜间皮瘤的MDCT征象分析及其鉴别诊断

目的 探讨多排螺旋CT(MDCT)对弥漫型恶性腹膜间皮瘤(MPM)诊断,以及与结核性腹膜炎、腹膜转移癌鉴别诊断的价值.方法 回顾性分析10例经病理证实的弥漫型MPM(组1)、14例结核性腹膜炎(组2)及17例腹膜转移癌(组3)的MDCT资料,对照分析3组病例的发病年龄,病变分布,腹膜、大网膜、肠系膜改变的形态学特点,腹部淋巴结、脏器转移及腹腔积液等MDCT表现. 结果 弥漫型MPM组与结核性腹膜炎组在腹膜、大网膜、肠系膜的形态学改变上差异有统计学意义(P＜0.05);弥漫型MPM组与腹膜转移癌在腹部淋巴结、脏器转移上的差异有统计学意义(P＜0.05).结论 弥漫型MPM MDCT表现为腹膜、大网膜、肠系膜不规则增厚并明显强化,可呈结节状或团块状;结合其形态学特点,有无脏器转移、淋巴结肿大和临床资料等可与结核性腹膜炎及腹膜转移癌鉴别.     

弥漫性肺泡出血

弥漫性肺泡出血是以咯血、缺铁性贫血和胸片以暂时性弥漫肺泡浸润或实变为特征的临床综合征。此综合征可见于一组各种各样的异质性疾病，其中许多疾病还共有肾小球肾炎的临床表现，并可表现为Good-pasture综合征而增加诊断的复杂性和治疗的难度，本文对弥漫性肺泡出血的分类和Good—pasture综合征诊断的主要问题进行了评述。     

Leflunomide-related lung injury in patients with rheumatoid arthritis: imaging features

Imaging findings of 26 cases of leflunomide (Arava)-related acute lung injury were analyzed. Thirteen cases had pre-existing interstitial pulmonary disease on chest X-ray or computed tomography. The main features of clinically determined leflunomide-induced acute lung injury were similar to those caused by other drugs: diffuse or widespread patchy ground-glass opacities and/or consolidation, frequently accompanied by septal thickening and intralobular reticular opacities. We categorized these findings into four patterns: diffuse alveolar damage (DAD), acute eosinophilic pneumonia, hyperreaction, and cryptogenic organizing pneumonia. The DAD group had a higher mortality rate, but statistically not a significant one. It is impossible to exclude infectious disease such as pneumocystis carinii pneumonia based on imaging findings, and detailed correlation of imaging findings with clinical and laboratory findings is essential in order to make a correct diagnosis.     

MRI弥散加权成像对弥漫性轴索损伤的诊断价值

目的探讨MRI弥散加权成像（difussion—weighted imaging,DWI）在诊断脑弥漫性轴索损伤（diffuse axonal in—iury,DAI）中的价值。方法回顾性分析16例经临床及影像学诊断为DAI患者的常规MRI和DWI的资料,分别比较DWI、T1加权像（T1 weightedimaging,TlwI）、T2加权像（T2 weighted imaging,T2WI）、液体衰减反转恢复（fluidat—tenuated inversion recovery,FLAIR）序列对DAI病灶的检出数目,并分析其分布特点和信号特征。结果DAI病灶主要分布在白质、皮髓交界区、基底节、胼胝体、脑干及小脑等区域。DWI对DAI病灶的检出率最高。与其它序列的差异有统计学意义（P〈0．05）。结论常规序列和DWI联合应用为临床DAI诊断提供可靠的影像学依据,应作为MRI检查DAI的常规和首选序列。     

尼莫地平对弥漫性轴索损伤大鼠学习记忆改变及海马NF-κB蛋白表达的影响

目的研究尼莫地平(Nimodipine,NM)对弥漫性轴索损伤(Diffuse axonal injury,DAI)大鼠学习记忆改变及海马NF-κB蛋白表达的影响,探讨尼莫地平对DAI大鼠的脑保护机制。方法将36只大鼠随机分为正常对照组(NC组)、DAI组和NM组,每组12只,通过Morris水迷宫定位航行实验及空间探索实验,观察大鼠行为学改变,并用免疫组化和Western blot方法测定NF-κB蛋白的表达。结果 Morris水迷宫定位航行实验:与NC组比较,DAI组大鼠第1~3天逃避潜伏期明显延长(P<0.05);与DAI组比较,NM组大鼠第1~3天逃避潜伏期明显缩短(P<0.05)。空间探索实验:与NC组比较,DAI组大鼠2 min内穿越平台次数明显减少(P<0.05);与DAI组比较,NM组大鼠2 min内穿越平台区域的次数明显增加(P<0.05)。与NC组比较,大鼠DAI后NF-κB蛋白表达增加(P<0.05);与DAI组比较,NM干预后NF-κB蛋白表达明显降低(P<0.05)。结论 DAI大鼠学习记忆能力受损,主要表现为Morris水迷宫中逃避潜伏期延长,平台穿越次数减少。大鼠DAI后NF-κB蛋白表达增加,可能与轴索继发性损伤有关,NM可能通过抑制NF-κB蛋白的活化来实现其神经保护作用。     

血清外泌体miR-451a在弥漫大B细胞淋巴瘤治疗监测中的意义

目的 探索血清外泌体miR-451a在弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma, DLBCL）中的水平及其在治疗监测中的价值。方法 本研究共纳入56例DLBCL患者,56例健康对照者。收集新发DLBCL患者治疗前、化疗2~4疗程及化疗结束后血清样本,并同时收集健康人血液标本, 提取血清中的外泌体RNA,并进行实时荧光定量PCR（quantitative real time polymerase chain reaction, qRT-PCR）,用受试者工作特征（receive operator characteristic, ROC）曲线判定miR-451a的诊断效能,用各时点收集的血清样本动态分析血清外泌体miR-451a水平与化疗效果之间的关系。结果 56例DLBCL患者与56例健康对照者相比,DLBCL患者血清外泌体miR-451a水平下降（P<0.000 1）,在两组受试者间用miR-451a诊断DLBCL的曲线下面积(AUC)为0.737（95%CI0.645~0.816）。在随访到的43例DLBCL患者中,化疗后获得完全缓解或者部分缓解的患者其血清外泌体miR-451a水平较化疗前有所上升（P<0.05）,与配对的健康人水平差异无统计学意义（P>0.05）;化疗后未获得缓解的患者,其血清外泌体miR-451a水平较化疗前无明显变化（P>0.05）,且仍然低于配对的健康人水平（P<0.05）;化疗完成后在未缓解者与缓解者之间进行鉴别,血清miR-451a的AUC为0.867（95%CI0.728~0.951）。结论 血清外泌体miR-451a水平动态监测有助于DLBCL化疗过程中的疗效（是否缓解）判断。     

Two cases of debulking surgery for lower limb diffuse plexiform neurofibroma with transcatheter arterial embolisation

IntroductionDiffuse plexiform neurofibroma (DPN) in patients with neurofibromatosis type 1 (NF1) causes motility dysfunction in severe cases. Transcatheter arterial embolisation (TAE) is an effective haemorrhage control method in vascular tumour surgery.Presentation of caseWe performed debulking surgery for DPN in the buttock and posterior thigh of two NF1 patients. Preoperative TAE with gelatine particles to tumour feeder vessels was conducted in both cases. Operative bleeding volumes were 500 and 4970 mL, respectively. In the latter case, the resection area extended to the upper poles of the buttocks, and the tumour invaded deeply into the surrounding tissues. Massive haemorrhage occurred, and internal iliac arterial balloon was inflated temporarily to further suppress the bleeding. Delayed wound healing due to TAE occurred; debridement and wound closure were required. Motor function improvement was confirmed in both patients.DiscussionBleeding volumes varied because of highly developed collateral pathways and tumour invasiveness. As the upper pole of the buttock was perfused by the superior gluteal artery and its numerous collateral vessels, complete haemostasis was difficult despite adequate TAE. Because delineating the tumour border from the normal tissue was impossible due to the high tumour invasiveness, cutting into the hypervascular tumour was inevitable. As gelatine particles were absorbed but remained within the vessels, prolonged wound ischaemia and delayed healing occurred.ConclusionAlthough TAE with gelatine particles and balloon occlusion were reliable haemorrhage control methods in debulking surgery for lower limb DPN, optimal haemorrhage control technique, compatible with haemostasis and wound healing, was desired.