非清髓异基因外周造血干细胞移植治疗老年重型再障报告

目的 :探讨非清髓异基因外周造血干细胞移植 (NAST)治疗老年重型再生障碍性贫血 (SAA)的方法及疗效。方法 :采用非清髓预处理的异基因外周造血干细胞移植治疗老年 SAA患者1例。供受者 HL A配型及红细胞 ABO血型完全相合。预处理方案主要由环胞霉素 A(Cs A)、抗淋巴细胞球蛋白 (ATG)和环磷酰胺组成。用环胞霉素 A和霉酚双酯 (MMF)预防移植物抗宿主病(GVHD)。采用 STR- PCR定量方法检测供者细胞植入情况。结果 :该例老年 SAA患者顺利度过移植后造血抑制期 ,于移植后第 8天外周血 WBC升至 0 .8× 10 9/ L,第 14天血象三系恢复 ,于移植后第 14天、30天、90天及 180天时检测供者细胞植入率均为完全植入。患者未出现移植物抗宿主病 ,现己无病存活 31个月。结论 :非清髓异基因外周造血干细胞移植简便安全 ,并发症少 ,疗效好 ,为老年 SAA的治疗提供了新手段     

补髓生血冲剂对慢性再生障碍性贫血患者骨髓造血干细胞bax、C-myc、Bcl-2基因表达水平影响的实验研究

目的 :探讨补髓生血冲剂对慢性再生障碍性贫血 (CAA)患者造血干细胞bax、C -myc和Bcl- 2基因表达水平影响和疗效机理。方法 :应用免疫组化染色法和酶联免疫测定法检测补髓生血冲剂治疗前后CAA患者造血干细胞bax、C -myc和Bcl- 2基因表达水平。结果 :治疗后CAA患者的bax基因阳性表达率下降 ,与对照组相比有显著性差异 (P <0 .0 1,P <0 .0 5 )。而C -myc及Bcl- 2基因阳性表达率与对照组相比无显著性差异 (P >0 .0 5 )。结论 :补髓生血冲剂的作用机制之一可能是通过降低bax和C -myc基因的阳性表达率以抑制细胞凋亡 ,而并非在于促进调亡抑制基因Bcl- 2表达所致。     

健脾补肾活血治疗再生障碍性贫血探讨

认为再生障碍性贫血的病因病机主要是脾肾亏虚、髓海瘀阻 ,是一个虚实夹杂的病理过程。治疗上应根据其病机特点 ,采用健脾益气、补肾填精、活血化瘀法     

异基因外周造血干细胞移植与免疫抑制治疗重型再生障碍性贫血的临床比较

目的 比较异基因外周造血干细胞移植(Allo-PBSCT)与免疫抑制治疗(IST)重型再生障碍性贫血(SAA)的疗效与并发症.方法 25例SAA患者接受了两种方法治疗:PBSCT组12例接受了同胞HLA全相合的PBSCT,预处理方案为:环磷酰胺(Cy)联合兔抗人胸腺免疫球蛋白(ATG);IST组13例治疗方案为:ATG/环孢素A(CsA).比较两种治疗方法的近期疗效、远期疗效与并发症.结果 PBSCT组的中性粒细胞计数、Pt和Hb的恢复时间[分别为(13.5±2.3)、(23.5±4.1)、(82.7±6.1)d]快于IST组[分别为(32.6±3.5)、(73.8±6.2)、(296.4±12.5)d](P<0.05),但1年的近期疗效比较差异无统计学意义(P>0.05).两组3年生存率和总生存率比较差异均无统计学意义(P>0.05),总复发率比较差异有统计学意义(P<0.05).结论 Allo-PBSCT和IST都是治疗SAA的有效手段,但Allo-PBSCT具有造血重建快、复发率低、并发症并没有增加等特点,临床上可作为优先选择.     

小儿脑水肿与颅内高压征中西医结合治疗的进展

小儿脑水肿与颅内高压征中西医结合治疗的进展虞佩兰脑水肿是脑实质的水、钠增加，导致脑容积与重量增加，由于颅内容积增加达到一定程度，容积压力代偿功能失调，而导致颅内高压（１，２）。严重颅内高压可致脑疝、脑组织缺血、缺氧而致死亡或致残，它的危害有时比原发性...     

Incidence of aplastic anemia in Turkey: A hospital-based prospective multicentre study

The incidence of aplastic anemia among hospitalized adult patients was prospectively determined in this first study in Turkey. New cases of aplastic anemia among patients 14 years and older who were admitted to the study centers were included in a 3 year survey. Seventy-three patients fulfilled the diagnostic criteria, yielding a mean annual incidence rate of 1.14 cases in 10³ admissions. The male-to-female ratio of the cases (1.6:1) differed from the almost equal ratio of the larger population of Turkey. The median age was 30 years and females were younger at diagnosis. The age distribution of the cases was different from that of the population; showing two incidence peaks in both sexes. The majority of the patients (89%) had severe disease.     

Antihypertensive drugs and the risk of idiopathic aplastic anaemia

AIMS: A recent report has raised concern that nifedipine may be associated with an increased risk of aplastic anaemia. This large population-based study evaluated the risk of idiopathic aplastic anaemia in users of calcium channel blockers compared with that of other antihypertensive drugs. METHODS: The study was based on information derived from the General Practice Research Database. We conducted a follow-up study with a nested case-control analysis of 322 448 subjects who received antihypertensive drugs. Cases were people who had a first-time diagnosis of aplastic anaemia during January 1, 1988 through September 30, 1997. The risk estimate of aplastic anaemia was calculated for all antihypertensive drugs. For the nested case-control analysis, six controls were matched to each case on age, sex and general practice attended. Odds ratios compared the risk of idiopathic aplastic anaemia for all antihypertensive drugs relative to nonusers. RESULTS: There were 13 cases of newly diagnosed idiopathic aplastic anaemia. The estimated risk of aplastic anaemia per 100 000 users was 0.8 (95% CI 0.1, 4.7) for calcium channel blockers, 1.4 (95% CI 0.5, 4.1) for beta-adrenoceptor blockers, 2.3 (95% CI 0.6, 8.6) for angiotension-converting enzyme (ACE) inhibitors and 5.9 (95% CI 1.6, 21.5) for users of other antihypertensive drugs. In the case-control analysis of 13 cases and 77 controls, the odds ratio was 0.3 (95% CI 0.02, 3.3) for calcium channel blockers, 0.5 (95% CI 0.1, 2.5) for beta-adrenoceptor blockers, 0.7 (95% CI 0.1, 5.6) for ACE inhibitors, 1.2 (95% CI 0.1, 11.8) for users of other antihypertensive drugs and 0.7 (95% CI 0.1, 7.2) for users of multiple drugs with a calcium channel blocker compared with nonusers. CONCLUSIONS: The present study suggests that the use of calcium channel blockers is not associated with an increased risk of aplastic anaemia.     

再生障碍性贫血患者骨髓单个核细胞中细胞周期蛋白D的表达及意义

目的 观察再生障碍性贫血患者骨髓单个核细胞中细胞周期蛋白D(CyclinD)不同亚型的表达，以探讨其发病机制。方法 抽取再生障碍性贫血患者及正常对照组骨髓标本，用淋巴细胞分离液分离出骨髓单个核细胞，按Trizol-氯仿-异丙醇一步法提取细胞总RNA，用RT-PCR方法检测Cyclin D不同亚型(D1、D2、D3)的表达。结果 Cyclin D1在两组标本中都没有表达，而Cyclin D2、Cyclin D3有表达，且再生障碍性贫血患者的表达率及表达水平都显著低于正常对照组。结论 再障患者骨髓单个核细胞中Cyclin D的表达显著降低可能是再障造血抑制、骨髓衰竭的原因之一。     

抗T淋巴细胞单克隆抗体治疗再生障碍性贫血的临床研究

用抗人Ｔ巴细胞单克隆抗体ＳＭＵ３（抗ＣＤ３）ＳＭＵ８（抗ＣＤ８）治疗３２例再生障碍性贫血，基本治愈６例，缓解７例，明显进步１１例，无效８例，有效率７５％（２４／３２）。治疗前Ｔ淋巴细胞亚群ＣＤ４／ＣＤ８比例倒置，淋巴细胞表面ＨＬＡ－ＤＲ抗原表达增高，治疗后ＣＤ４／ＣＤ８比例恢复正常，ＨＬＡ－ＤＲ表达降低，无血清病及血细胞减少等严重毒副作用。