婴幼儿营养性贫血620例相关因素分析

目的探讨婴幼儿营养性缺铁性贫血发生的相关因素,寻求降低患病率的有效方法。方法对在五华县人民医院儿科定期保健的620名6个月、1岁、1岁半儿童进行母乳喂养、辅食添加等情况进行调查、统计和分析。结果6个月、1岁、1岁半儿童贫血患病率分别为27．10％、20．10％、13．02％,差异有统计学意义（P〈0．05）;纯母乳喂养儿和非纯母乳喂养儿6月龄时贫血患病率分别为23．49％和39．01％,差异有统计学意义（P〈0．05）;母乳质量丰富与单一在6月龄时贫血患病率分别为17．10％、41．02％,差异有统计学意义（P〈0．05）。结论母乳是婴儿理想的食物;6月龄时要及时合理地添加辅食;儿童系统保健在儿童生长发育过程中起重要的作用,要广泛开展并认真做好此项工作。     

缺铁性贫血并发脑血栓形成4例临床分析

目的 探讨脑血栓形成与缺铁性贫血之间的关系,临床表现及治疗.方法:回顾性分析4例缺铁性贫血并发脑梗死患者的临床资料.结果:4例患者均为中重度贫血,血小板增多,血压偏低,2例存在慢性感染病灶.所有患者均为颈内动脉系统脑梗死,其中2例为分水岭梗死,2例为基底节梗死.吸氧、纠正贫血、调整血压在适当水平以及其他常规治疗有效.结论:对于中重度缺铁性贫血患者,如伴有血小板增多和血压偏低等情况,易导致脑血栓形成.在常规治疗脑血栓形成的同时应注意寻找贫血原因并且纠正贫血.     

Membrane Plasma Exchange for the Treatment of Thrombotic Thrombocytopenic Purpura

The aim of our report is to present our 11‐year experience with therapeutic membrane plasma exchange therapy for the treatment of idiopathic thrombotic thrombocytopenic purpura syndrome (TTP). In 56 patients, membrane plasma exchange therapy was initiated immediately and performed once or twice daily until the platelet count normalized. During each plasma exchange procedure, 1–1.5 plasma volumes (3606 ± 991 mL) were replaced with fresh frozen plasma. In 37 females and 19 males (44 ± 21 years), 1066 plasma exchange procedures were performed. The average duration of treatment was 23 ± 17 days. The average number of plasma exchanges was 19 ± 17 per patient. Renal impairment was detected in 36% of patients. At the initiation of plasma exchange treatment, the average platelet count was 31 ± 30 × 10⁹/L and reached 199 ± 95 × 10⁹/L thereafter. Fifty‐two of 56 (93%) patients demonstrated an excellent response to plasma exchange therapy, of whom 48 patients (86%) attained complete remission with a platelet count of more than 100 × 10⁹/L. Four patients died soon after the initiation of plasma exchange therapy, when only 1–3 procedures had been performed. During the follow‐up period, six patients with complete remission had 1–5 subsequent relapses each year. One of them died of acute hemolytic reaction during the tapering of plasma exchange procedures. Three patients underwent additional splenectomy. Our experience with primary TTP supports the plasma exchange treatment with fresh frozen plasma as a mandatory, up‐to‐date therapy. Close monitoring during all 1066 procedures showed no serious side‐effects.     

Effect of iron deficiency anemia and its treatment on cell mediated immunity

Iron deficiency anemia (IDA) is one of the most prevalent micronutrient deficiencies particularly in the developing countries. While there is evidence of an altered immune profile in iron deficiency, the exact immunoregulatory role of iron is not known. Knowledge particularly in children, who are vulnerable to iron deficiency and infection, is lacking. We aimed to study the effects of IDA and its treatment with oral iron supplementation on cell-mediated immunity. The levels of T-lymphocytes, their CD4⁺, CD8⁺ and CD1a⁺ subsets, transferrin receptor (CD71) and serum ferritin were evaluated in 40 iron-deficient and 40 healthy children. The impact of oral iron supplementation for three months on the same parameters was also noted in children with IDA. The level of mature T-lymphocytes (CD4⁺ and CD8⁺) was significantly lower (P<0.001) while that of the immature T-cells (CD1a⁺) was significantly higher (p<0.001) in IDA children compared to the control. The mature T-cell count was significantly improved after iron therapy. In spite of significant reduction in the immature T-cells (CD1a⁺) level after iron supplementation, it was significantly higher than the control. The present study demonstrated that T-lymphocytes maturation was defective in IDA and improved partially after 3 months of iron supplementation. Therefore, longer time of iron therapy may be required to induce complete maturation of T-lymphocytes.     

VEGF、bFGF在再生障碍性贫血患者骨髓中的表达及意义

目的 探讨骨髓微环境-骨髓基质在再生障碍性贫血（AA）发病机制中的作用。方法采用免疫组化方法检测32例AA（AA组）治疗前后（缓解后）及10例正常人（对照组）骨髓组织中血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）的表达。结果AA组治疗前骨髓组织中VEGF、bFGF表达水平明显低于对照组,缓解后VEGF、bFGF表达水平较治疗前明显提高（P均〈0．001）。结论骨髓基质损伤是AA的发病机制之一,此为从治疗提供了新思路。     

再生障碍性贫血的骨髓和细胞病理

目的：研究再生障碍性贫血（AA）患者骨髓组织病理及有核细胞的超微结构变化。方法：光镜观察20例AA患者骨髓活检病理,透射电镜分析骨髓有核细胞超微结构。结果：光镜下所有患者骨髓脂肪组织增多,造血面积减小,大部分存在血浆渗出、出血和纤维细胞局灶性增生,血窦血管结构紊乱。电镜观察显示原始和早幼红细胞代偿性不典型增生,中晚幼红细胞核损伤。粒细胞呈活化和损伤状态;巨核细胞显著减少,胞浆灶性坏死;单核细胞异常增生、活化、吞噬和坏死。淋巴细胞大部分结构正常。结论：AA患者骨髓造血细胞减少和炎症反应同时存在,单核巨噬细胞活化和吞噬反应与造血细胞损伤相关。     

骨髓增生异常综合征RAEB、RAEB-T和老年急性髓系白血病的临床对照分析

目的：在WHO分类中,FAB分型中的骨髓增生异常综合征一难治性贫血伴原始细胞增多转化型（MDS—RAEBT）被划分为急性髓系白血病（AML）,本文探讨该划分的合理性。方法：采用病例对照研究比较58例老年AML患者、88例骨髓增生异常综合征-难治性贫血伴原始细胞增多（MDS-RAEB）10％～19％（骨髓原始细胞10％～19％）患者和37例MDS-RAEBT患者在临床和染色体核型及共同累及的染色体异常类型上的区别。结果：MDS-RAEBT和MDS-RAEB在病程、WBC、Hb、肝脾肿大比例、正常核型和复杂核型比例及共同累及的染色体异常类型上差异无统计学意义,而和老年AMI,患者比较差异有统计学意义。结论：MDS-RAEBT应该划分为MDS,该结论有待于前瞻性实验进一步验证。     

在校大学生贫血及诸多因素分析

目的：探讨河南省大学生贫血状况及原因,为开展健康教育提供科学依据。方法：在河南某高校随机抽取406名在校生,采用迈瑞全自动血细胞分析仪（BC-2800）进行血常规检查及问卷调查,并运用Excel,SAS9．13软件进行统计分析。结果：调查对象中,贫血发生率为20．7％,女生贫血发生率22．5％（58／258）高于男生17．6％（26／148）。结论：河南在校大学生贫血发病率高于全国平均水平。大学生的饮食结构不合理和女生月经,是发生贫血的主要原因。     

Effect of transfusion therapy on cerebral vasculopathy in children with sickle-cell anemia

This retrospective study assessed the long-term effect of transfusional exchange therapy on MRA/MRI abnormalities in 24 homozygous sickle-cell anemia (HbSS) children presenting with abnormal brain MRA. The median time elapsed from baseline to last available MRA was 29 months. Follow-up MRAs showed improvement, stabilization or worsening of cerebrovascular lesions in 11, 6 and 7 patients respectively. Complete normalization of MRA was observed in 6 patients within a mean time of 1.4 years, but stenosis recurred at the same location in the 4 patients in whom transfusion therapy was discontinued. Baseline severe stenosis/occlusion of large cerebral arteries and occurrence of moyamoya syndrome were significantly associated with an absence of improvement of the cerebral vasculopathy. These data emphasize the heterogeneity of the course of cerebrovasculopathy in SS children receiving chronic transfusion. Further studies are needed to determine whether different therapeutic approaches have to be considered according to these different evolutive patterns in SS children.