COX回归模型在临床疗效分析中的应用

本文应用COx回归模型,130例职业性白细胞减少症患者进行疗效分析.从10个因子中确定治疗方法、疾病分类和住院次数对近期疗效有明显影响.远期疗效则主要取决于出院时白细胞的多少。最后对Cox模型的应用问题作了简略讨论。     

Hematologic abnormalities in children with down syndrome

We compared the hematologis parameters of 18 otherwise healthy children with Down syndrome (DS) in the age range of 2–6 years to those of 18 healthy non-DS controls matched for age and gender. The children with DS had MCVs and hematocrits increased significantly compared to controls and decreased WBCs compared to controls; 66% of the children with DS compared to 11% of non-DS controls had MCVs greater than the 97th percentile for age (P <0.0001); the mean MCVs were 86.9 and 80.6, respectively. Although hematocrits were within normal limits for age for all DS and non-DS subjects, the DS patients had significantly higher hematocrits (39.1% vs. 36.9%, P <0.014). We also found that 33% of the children had WBCs <5% for age compared to 6% of controls. To determine whether folate deficiency contributed to these observations, we measured serum and RBC folate concentrations: these were not significantly different between the 2 groups. We conclude that macrocytosis and leukopenia are common in children with DS. © 1993 Wiley-Liss, Inc.     

升血胶口服液治疗白细胞减少症（附38例疗效观察）

应用升血胶口服液治疗由药物、化学药品以及化疗、放疗所致的白细胞减少症３８例，结果：有效１４例，显效２２例，无效２例，总有效率９４．７４％；而采用常规药物治疗２０例同类患者，有效率为６０％。故认为升血胶口服液在治疗此类白细胞减少症有显著疗效。     

不同治则组方治疗化疗白细胞减少临床疗效差异性研究

目的 :探讨益气养血、补肾益精及健脾补肾三种治则组方在防治化疗白细胞减少中的差异及合理应用。方法 :160例肿瘤患者随机分为4组,根据患者病情给予规律化疗,空白组、补肾益精组、益气养血组及健脾补肾组在化疗同期分别口服不同中药汤剂;各组患者在化疗第1天及第7天检查血细胞分析患者白细胞变化情况;各组患者在第1周期化疗第1天及第2周期化疗第7天检测血清G-CSF及IL-3水平。结果:在维持白细胞计数水平、刺激G-CSF分泌、IL-3分泌方面,空白组与补肾益精组、益气养血组、健脾补肾组比较,差异有统计学意义(P0.05),补肾益精组与益气养血组比较(P0.05),补肾益精组与健脾补肾组比较(P0.05),益气养血组与健脾补肾组比较(P0.05),补肾益精组效果较好,健脾补肾组次之,益气养血组最次,三组与空白组比较均具有明显的升高白细胞,刺激G-CSF、IL-3分泌作用。结论:不同治疗原则组方均可减轻化疗白细胞减少,以补肾益精为原则组方疗效更好。     

A cross-sectional and follow-up study of leukopenia in tuberculosis patients: prevalence,risk factors and impact of anti-tuberculosis treatment

Background

To investigate the prevalence of and risk factors for leukopenia in tuberculosis patients and the impact of anti-tuberculosis regimens on the occurrence of leukopenia in newly treated tuberculosis patients.

Methods

A total of 1,904 tuberculosis patients were included in the study. A cross-sectional survey of the prevalence of leukopenia was initially conducted, and then factors influencing leukopenia were identified using Logistic regression analysis. Non-treatment factors influencing peripheral blood leukocyte counts were analyzed using univariate COX proportional hazards models. Covariate analysis was used to assess the independent effect of different anti-tuberculosis regimens on peripheral blood leukocyte counts.

Results

Being female, advanced age and longer duration of previous anti-tuberculosis treatment (>6 month) were risk factors for leukopenia in tuberculosis patients, while secondary pulmonary tuberculosis, higher body mass index (BMI: 24−27.9 kg/m²), and higher degree of education (senior high school or above) were protective factors. Gender, vegetable consumption, drinking, pulmonary infection, other chronic diseases, and use of antibiotics were significantly associated with the development of leukopenia in patients on anti-tuberculosis treatment. In tuberculosis patients treated with anti-tuberculosis regimens not containing antibiotics, peripheral blood leukocyte levels gradually declined with the prolongation of treatment duration. In tuberculosis patients treated with anti-tuberculosis regimens containing antibiotics, peripheral blood leukocyte levels showed a declining trend.

Conclusions

Female patients, patients at advanced age and recurrent tuberculosis patients having longer previous anti-tuberculosis treatment are high-risk populations for leukopenia. Attention should be paid to the influence of vegetable consumption and drinking, co-morbidities and use of antibiotics during anti-tuberculosis treatment.     

去甲斑蝥素对环磷酰胺诱导的白细胞减少症模型大鼠骨髓造血功能的影响

目的:探讨去甲斑蝥素(NCTD)对环磷酰胺(CTX)诱导的白细胞减少症模型大鼠骨髓造血的影响及机制。方法:采用CTX腹腔注射法复制白细胞减少症模型,以NCTD干预模型大鼠,全自动血细胞分析仪检测外周血白细胞(WBC)数量,骨髓组织作切片HE染色观察病理改变,流式细胞术检测骨髓细胞增殖周期、凋亡率,免疫组织化学法检测骨髓组织中凋亡相关蛋白BCL-2、BAX的表达。结果:NCTD干预白细胞减少症模型后,外周血WBC显著升高;模型大鼠骨髓骨髓组织结构破坏,造血细胞明显减少,NCTD干预后促进骨髓组织细胞结构显著恢复;NCTD可促使白细胞减少症模型大鼠骨髓细胞增殖及周期的转化,显著抑制CTX所诱导的骨髓细胞凋亡与坏死,上调抑凋亡蛋白BCL-2表达,下调促凋亡蛋白BAX的表达。结论:NCTD可刺激CTX诱导的白细胞减少症模型大鼠骨髓造血,促进外周血白细胞水平的恢复,其机制可能与NCTD调控骨髓细胞周期、抑制细胞凋亡等有关。     

中药治疗恶性肿瘤放化疗后骨髓抑制的临床研究

目的：观察中药治疗恶性肿瘤放化疗后骨髓抑制的临床疗效。方法：将186例患者,随机分为对照组和治疗组。治疗组在白细胞下降后或停止化疗后第3天口服中药,每日1剂,至白细胞正常或下周期化疗开始时停用。对照组采用国产重组人粒细胞集落刺激因子（G-CSF）150μg,皮下注射,每日1次,至白细胞正常停用。结果：两组对比无显著性差异。结论：两组治疗效果无明显差异,治疗组疗效持久,价格低廉,使用方便。     

Risk factors for leukopenia in patients with gastrointestinal fistula

Background White blood cell count is an important index to the outcome of patients. In hospital, leukopenia is accompanied by high mortality, morbidity and treatment costs. However, in infectious diseases, the reasons responsible for leucopenia was not well elucidated. We investigated patients with gastrointestinal fistula to find risk factors for leukopenia.Methods A prospective case control investigation was carried out in the Gastrointestinal Fistula Center, General Surgical Institute of Jinling Hospital. Cases included gastrointestinal fistula patients with leukopenia （n=98） and controls composed of gastrointestinal fistula patients with normal white blood cell count （n=78）. The two groups were compared for risk factors of leucopenia by statistical analysis.Results Factors associated with an increased risk for leukopenia included bacterial infection （25.5%） and hypoalbuminaemia （61.2%）. Multivariable Logistic regression analysis identified bacterial infection （80%）, urinary catheter （70%） and central vein catheter （60%） as the independent determinants for mortality in cases.Conclusions In patients with gastrointestinal fistula, two independent factors for leukopenia and three significant predictors of mortality were elucidated. We suggest that clinicians give patients more supportive management and apply prevention strategies to treat and prevent leukopenia.     

益气温阳汤治疗肿瘤化疗引起白细胞减少临床研究

目的:观察益气温阳汤治疗消化道肿瘤化疗引起白细胞减少的疗效。方法:将137例患者随机分为治疗组67例和对照组70例,治疗组服用益气温阳汤,对照组口服利可君,治疗3周后,观察外周血白细胞变化。结果:治疗组:痊愈51例,有效13例,总有效率95.5%;对照组:痊愈44例,有效12例,总有效率80.0%。结论:采用益气温阳汤治疗消化道肿瘤化疗后白细胞减少具有较好疗效。     

补肾健脾方治疗白细胞减少症疗效观察

目的:观察补肾健脾方治疗白细胞减少的疗效。方法:将94例白细胞减少症患者随机分为3组。中药组32例,给予补肾健脾方125mL口服2/天;成药组28例,地榆升白片3片口服3/天+利血生片20mg口服3/天;中西组为中药组+成药组。对比3组的临床疗效。结果:总有效率及3组治疗后外周血白细胞计数比较,中西组、中药组优于成药组(P0.05),而中西组与中药组疗效无显著性差异(P0.05)。结论:单用中药组与中西组疗效相当,且疗效肯定,无不良反应,并且经济,值得推广使用。