同期同胞HLA全相合与亲缘间单倍体相合异基因造血干细胞移植治疗恶性血液病对比观察

目的 比较同胞HLA全相合与亲缘间单倍体相合异基因造血干细胞移植(allo-HSCT)在恶性血液病治疗中的造血重建情况、移植相关并发症及临床疗效.方法 18例恶性血液病患者中,HLA同胞全相合9例、亲缘间单倍体相合9例,回顾性分析两组造血重建情况、移植相关并发症及临床疗效情况.结果 两组在造血重建、预处理相关毒性、急慢性移植物抗宿主病(GVHD)及临床疗效经改良预处理方案后无明显差异,但在移植过程中及术后、血制品的输注量、CMV感染率及真菌感染率发生方面,单倍体相合移植组明显高于同胞全相合组.结论 经改良预处理方案后同胞HLA全相合与亲缘间单倍体相合allo-HSCT在恶性血液病治疗方而临床疗效相近,亲缘间单倍体相合移植为恶性血液病治疗开辟了又一新途径,从根本上解决了供者来源问题.     

血液肿瘤化疗后血清可溶性白细胞介素-11水平的变化及其意义

目的 观察血液肿瘤化疗后血清可溶性白细胞介素-11(sIL-11)水平与血小板数量改变的关系,探索能维持血小板安全水平的sIL-11临界值,以指导临床治疗.方法 收集血液肿瘤患者化疗前后的血标本,测定sIL-11和血小板水平,观察两者变化间关系并进行统计学分析.结果 99例患者完成研究.化疗后患者的sIL-11水平逐步升高,第6天达到峰值后逐渐下降;血小板数量随时间逐步降低,第10天达到最低值,然后逐渐上升;在血小板达到最低之前sIL-11已达峰值;患者化疗后sIL-11越高,血小板数量越有可能维持于较高水平.根据血小板水半最低值将病例分为两组比较,具较高血小板组有较高sIL-11峰值.其sIL-11平均增长速度快,血小板达到最低值的时间较晚,高sIL-11峰值的病例较多.多元回归显示化疗后血小板低于临界值的影响因素有:sIL-11达到最大值的日平均增长速度和化疗第4天sIL-11低于2000Pg/ml.结论 血液肿瘤患者化疗后sIL-11水平与血小板数量的变化存在相关关系,可以通过测量sIL-11的变化来预测血小板数量的变化趋势.化疗第4天sIL-11<2000 Pg/ml的患者发生严重血小板减少的可能性大,建议给予rhIL-11治疗或输注血小板治疗.     

调节性T细胞在血液系统恶性肿瘤中的研究进展

胸腺产生的CD^＋4CD^＋25调节性T细胞（Treg细胞）被认为在控制自身免疫、防止移植物排斥反应、抑制抗感染自身免疫以及抑制异基因免疫反应中发挥重要作用。最近有报道此类细胞有抑制机体抗肿瘤的作用。Foxp3是Treg细胞最具特异性的蛋白分子标志物。阐述了血液系统恶性肿瘤患者CD^＋4CD^＋25去Foxp3 Treg的表达以及其对免疫治疗的潜在作用。     

单纯性肥胖青少年脑血流变化及动脉硬化的研究

目的了解单纯性超重、肥胖对青少年脑血流的影响,为对动脉硬化性心脑血管疾病的早期干预提供依据。方法对40例单纯性肥胖青少年和15例正常青少年,分别进行脑血流图检查及血脂水平的测定。结果超重、肥胖组大脑左椎动脉(leftvertebralartery,LVA)、大脑后动脉(posteriorcerebralartery,PCA)及大脑中动脉的血管脉动指数(pulsatilityindex,PI)和阻力指数(resistentindex,RI)均显著高于正常青少年(P<0.05);超重、肥胖组青少年胆固醇(CHO)和三酰甘油(TG)水平均显著高于正常青少年(P<0.05),高密度脂蛋白(HDL)水平低于正常青少年(P<0.05)。基底动脉(bollomartery,BA)的PI和RI变化不明显。结论肥胖可以导致青少年脑血流变化异常和血脂水平增高,早期防治肥胖有助于预防动脉粥样硬化性心脑血管疾病。     

HL-60细胞淫羊藿甙诱导后信号传导因子表达变化与意义

目的检测急性早幼粒白血病细胞HL-60经过淫羊藿甙（ICA）诱导后信号传导与转录激活因子（STAT1、STAT3）和有丝分裂原激活蛋白激酶（p38MAPK、p42MAPK）表达变化在分化中的作用。方法建立ICA诱导分化模型，用瑞氏染色观察细胞形态，MTF实验测定细胞增殖的变化，NBT还原实验测定细胞分化状态，RT-PCR方法检测STATI、STAT3、p38MAPK、p42MAPK的mRNA的表达。结果HL-60细胞经ICA作用24h后，随着细胞增殖降低和分化的发生，p42MAPK的mRNA表达增加，STAT3的mRNA表达降低，STAT1和p38MAPK的mRNA未见明显的表达。结论p42MAPK和STAT3与ICA诱导HL-60细胞分化有关，而p38MAPK和STAT1则与ICA诱导HL-60细胞分化无关。     

沙利度胺对血液肿瘤患者内皮细胞功能的影响

目的探讨沙利度胺对血液肿瘤患者内皮细胞功能的影响。方法检测和比较32例血液肿瘤患者服用沙利度胺前后内皮细胞功能指标：血浆内皮素-1（ET-1）、血管内皮生长因子（VEGF）、组织因子（TF）、凝血酶调节蛋白（riM）、凝血因子V、血管性血友病因子（vWF）、抗凝血酶（AT）、组织型纤溶酶原激活物（tPA）及纤溶酶原激活物抑制物-1（PAI-1）的活性。结果服用沙利度胺后血液肿瘤患者体内的VEGF、TF、TM、vWF、AT活性明显降低（P〈0．05或P〈0．01），而血浆ET-1水平比治疗前显著升高（P〈0．05），其余指标无明显改变（P〉0．05）。结论沙利度胺可以影响内皮细胞功能，抑制新生血管的增生，从而在血液肿瘤治疗中发挥作用。     

经验性抗真菌治疗血液病侵袭性真菌感染14例疗效分析

目的评价卡泊芬净在经验性抗真菌治疗中的疗效。方法对14例侵袭性真菌感染(IFI)血液病患者给予卡泊芬净(首日70mg/d,以后50mg/d)经验性抗真菌治疗后,评价其临床疗效。IFI诊断符合欧洲癌症研究和治疗组织(EORTC)及侵袭性真菌感染协作组(IFICG)的标准。结果14例患者中治疗有效者11例,有效率为78.6%,治疗起效时间5～7d。不良反应发生率为28.6%(4/14),为轻度、可逆的不良反应,患者耐受性较好。结论卡泊芬净是一种高效、低毒、作用迅速的抗真菌药,是血液病患者抗真菌经验性治疗的理想药物。     

Immunohistochemistry in bone marrow pathology: a useful adjunct for morphologic diagnosis

Pathomorphological examination of trephine biopsies of the bone marrow (BM) represents a standard method for the diagnosis and staging of hematologic neoplasms and other disorders involving the BM. The increasing knowledge about the genetic basis and biology of hematologic neoplasms, as well as the recently proposed WHO classification system, provide the framework for an accurate diagnosis. Although conventional morphology remains the gold standard for paraffin-embedded BM trephines, immunohistochemical stainings have become an integral part of the diagnostic workup. Antibodies suitable for paraffin sections are generally applicable to BM trephines, but modifications of staining protocols may be necessary due to the alternative fixatives and decalcification procedures used for BM biopsies. The indications for immunostainings range from confirmation and classification of lymphoma involvement, subclassification of acute leukemias, and estimating blast counts in myelodysplastic and myeloproliferative syndromes to characterization of BM involvement in nonhematologic neoplasms. Although subtyping of NHL in the BM is more difficult from the point of morphology, classification of the entities that frequently involve the BM, especially the small B-cell lymphomas, can easily be achieved with the help of immunohistochemistry. In this review, we try to summarize the current state of the art in BM immunohistochemistry for the diagnosis of hematologic disorders. Moreover, diagnostic algorithms and useful antibody panels are proposed for a rational and cost-effective approach.     

Hand-assisted laparoscopic splenectomy in the setting of splenomegaly

Background Hand-assisted laparoscopic surgery (HALS) devices may be well suited to splenectomy in cases of splenomegaly.Methods All cases of HALS for splenectomy between 1997 and 2001 were reviewed. Patient characteristics, operative details, and morbidity and mortality were analyzed.Results HALS for splenectomy was performed in 54 patients. A total of 39 patients with massive splenomegaly (MS) (>600 g) were identified. The average weight of the MS group was 1285 ± 505 g. There was one (3%) conversion. Operative time was 159 ± 65 min, estimated blood loss was 257 ± 240 ml, and length of hospital stay was 5.4 ± 2.9 days. Morbidity was limited to 13 patients (24%), and there were two postoperative mortalities (5.1%).Conclusions HALS for splenectomy in the setting of splenomegaly is feasible and safe. For the surgeon considering a laparoscopic approach in the setting of splenomegaly, a hand-assisted technique is ideally suited for removal of the enlarged spleen.Paper presented at the annual meeting of the European Association for Endoscopic Surgery (EAES), 1st European Endoscopic Surgery Week, Glasgow, Scotland, June 2003     

肿瘤坏死因子基因多态性与血液系统恶性肿瘤

研究表明,包括血液系统恶性肿瘤在内的恶性肿瘤病人血清中肿瘤坏死因子（TNF）升高,过多的TNF产生与TNF基因多态性有关,此种多态性能通过影响TNF的转录调节来影响TNF的表达。本文旨在就TNF基因多态性与淋巴瘤、慢性淋巴细胞白血病、毛细胞性白血病、急性淋巴细胞白血病及多发性骨髓瘤等血液系统恶性肿瘤的相关性作一综述。