外周血NK细胞亚群检测在恶性血液病患者中的应用研究

目的探讨外周血自然杀伤细胞(NK)亚群检测在恶性血液病患者中的应用价值。方法选择2014年3月至2016年4月于该院接受治疗的100例恶性血液病患者作为观察组,其中急性期50例,平缓期50例,并在同一时段内选择100例体检健康者作为对照组,比较各组间外周血NK细胞数及亚群的变化。结果急性期白血病及淋巴瘤患者NK细胞绝对数及相对数均远低于对照组,而平缓期白血病及淋巴瘤NK细胞绝对数及相对数高于急性期,差异具有统计学意义(P0.05)。治疗后,白血病及淋巴瘤患者NK细胞绝对数及相对数均高于治疗前,差异具有统计学意义(P0.05)。治疗前,白血病及淋巴瘤患者CD56~(bright)及CD56~(dim)水平与对照组比较差异有统计学意义(P0.05);治疗后,两类患者CD56~(bright)及CD56~(dim)水平明显改善,治疗前比较差异有统计学意义(P0.05)。结论恶性血液病患者外周血NK细胞数量降低,细胞功能受损。NK细胞亚群检测在评价恶性血液病患者预后及疗效方面有一定的指导意义。     

Reactivation of overt and occult hepatitis B infection in various immunosuppressive settings

The aim of the study was to evaluate clinical and virological differences in HBV reactivation between patients with overt and occult HBV infection. Twenty-three consecutive patients with symptomatic HBV reactivation occurring during or after immunosuppressive therapy were enrolled in a retrospective study: 10 with reactivation of overt HBV infection (overt group) and 13 of occult HBV infection (occult group). Twenty-one patients were treated with nucleot(s)ide analogues after HBV reactivation. Regimens including rituximab or fludarabine were administered more frequently in the occult group (61% vs. 31%, respectively). HBV reactivation was severe frequently in the overt (40%) and occult groups (38.4%). Patients in the overt group showed higher HBV-DNA titers (1.1 × 10(8) ± 1.4 × 10(8) vs. 5.1 × 10(5) ± 6.8 × 10(5) IU; P < 0.005). Seven patients died during HBV reactivation, two in the overt and five in the occult group. Of these seven patients, two remained untreated and five had been treated with Lamivudine; of the 16 patients showing remission of HBV reactivation, four had been treated with Lamivudine, four with Entecavir, two with Telbivudine, and six with Lamivudine plus Adefovir. It is concluded that HBV reactivation is life-threatening in patients with diseases inhibiting the immune response and/or receiving immunosuppressive drugs. Supportive therapy without antiviral drugs or Lamivudine monotherapy may not be effective for treating patients with HBV reactivation.     

Genital pyoderma gangrenosum: Report of two cases and published work review of Japanese cases

Pyoderma gangrenosum is an ulcerative skin disorder showing characteristic non‐infectious ulcers and affects the lower extremities in approximately 70% of cases. Pyoderma gangrenosum is commonly associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis and hematological malignancies. Herein, we report two cases of Japanese patients diagnosed with genital pyoderma gangrenosum. Case 1 was a 74‐year‐old woman without associated systemic complications, whose skin lesion resembled a squamous cell carcinoma and was limited to the vulva. Case 2 is an 89‐year‐old man, who suffered from myelodysplastic syndrome and acute myeloid leukemia, and presented with penile and leg ulcers mimicking pressure sores. Both cases responded well to systemic steroids. We review 13 genital pyoderma gangrenosum cases (76.9% male; aged 30–89 years) from 1996 to 2012 in Japan, including 11 previously reported cases and the present study's two cases. Four of the 13 genital pyoderma gangrenosum cases had associated systemic diseases and their skin lesions spread to the extragenital areas. Eight of the remaining nine genitalia‐localized pyoderma gangrenosum cases had no associated systemic diseases. In conclusion, genital pyoderma gangrenosum is rare and may be misdiagnosed. It should therefore be considered in cases of refractory genital ulcers. In addition, genitalia‐localized pyoderma gangrenosum tends to be without systemic complications.     

Lenalidomide in the management of eosinophilic dermatosis of hematological malignancy

Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B‐cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy.     

A case of nodal marginal zone lymphoma with hypersensitivity to mosquito bites as initial symptom

Hypersensitivity to mosquito bites (HMB) refers to skin reactions such as bullae and necrosis, which occurs after being bitten by mosquitoes and can present with multiple systemic reactions such as fever, lymphadenopathy, hepatosplenomegaly simultaneously or subsequently. A 48‐year‐old male patient presented with recurrent erythema, nodules, papules, vesicles and bullae over upper body and bilateral limbs with itching over the sites of mosquito bite for more than 1 year with low‐grade fever and superficial lymph nodes enlargement. The patient's symptoms failed to improve from conventional anti allergic treatment although skin biopsy showed changes of HMB reaction. Subsequently, the lymph node was biopsied and was reported to be nodal marginal zone lymphoma (NMZL), and then the patient was eventually diagnosed with nodal marginal zone lymphoma with HMB. To date only one case of nodal marginal zone lymphoma with HMB has been reported from Korea, and this is the first case to be reported in China.     

血液系统恶性肿瘤多肽类疫苗的研究进展

近年来血液系统恶性肿瘤的治疗有了显著进展,但由于微小残留病灶(MRD)的存在,复发仍是亟待解决的主要问题.肿瘤多肽疫苗是有望克服MRD的免疫疗法之一.本文重点介绍血液系统恶性肿瘤中WT1、RHAMM、BCR-ABL、PR1多肽疫苗的最新临床试验结果,PRAME、Survivin等多肽的特异性免疫反应新进展,及不规则肽疫苗、新型免疫佐剂、结合肽疫苗、Ad-tWT1疫苗等增强疫苗免疫治疗效应的最新措施及其应用前景.     

NKG2D在NK细胞杀伤血液肿瘤细胞中的作用

本研究旨在探讨NKG2D在NK细胞杀伤血液肿瘤细胞时是否发挥作用。将多种血液肿瘤细胞株作为靶细胞,并在靶细胞中检测NKG2D相应配体的表达,而后进行杀伤实验。将靶细胞与羧基荧光素二醋酸盐琥珀酰亚胺酯(CFSE)共孵育,同时将NK细胞系NK92MI分别与NKG2D特异性封闭抗体或同型对照抗体共孵育。之后将NK92MI分别与多种血液肿瘤细胞共同培养,2 h后用流式细胞分析方法检测靶细胞的凋亡率。结果显示:加入NKG2D特异性封闭抗体后,NK细胞对于急性髓系白血病细胞Kasumi-1的杀伤作用减弱约30%,而在其他血液肿瘤细胞株中封闭NKG2D并未明显影响NK细胞对于靶细胞的杀伤。结论:在NK细胞作用于某些靶细胞时,NKG2D促进NK细胞的杀伤作用。     

Both aluminum and polyphenols in green tea decoction (<Emphasis Type="Italic">Camellia sinensis</Emphasis>) affect iron status and hematological parameters in rats

Background Green tea leaves naturally contain high levels of polyphenols and aluminum (Al). Polyphenols in green tea decoction are considered to be one of the major factors responsible of low iron status. However, the effects of Al from green tea decoction on iron status and hematological parameters remained unclear. Aim of the study The objective was to investigate the Al absorption from green tea decoction and studied its influence on iron status and hematological parameters in rats. Methods During the experiment period, rats were given the experimental diet + a simple dose of Al sulfate with or without graded doses of green tea decoction (25, 50 and 100 g/l). The Al absorption was evaluated in the serum; however, iron status was evaluated by the iron concentration in the liver, kidney, spleen and femur. In addition, the hemoglobin and hematocrit were evaluated. Results Our results showed that the serum Al significantly increased between 61.5 and 342%, as tea doses-dependant. The Al sulfate significantly decreased the reserve of iron in all studied organs between 21.7 and 17% (P < 0.05). In groups receiving green tea decoction alone or Al + graded doses of tea, the reserve of iron significantly decreased in all studied organs between 59.4 and 18.5% (P < 0.01). Al alone or associated with drinking doses of tea significantly decreased hemoglobin concentration between 23.6 and 9% (P < 0.05) and hematocrit between 12.7 and 7% (P < 0.01). Conclusion Our data showed that Al from green tea decoction was more absorbed in the serum than Al sulfate. Al absorption was associated with low iron status and reduction of hemoglobin and hematocrit. Considering that Al competes with iron in different stage of erythropoiesis including transferrin binding, so we could assume that the negative effect of tea on iron status arises not only from polyphenols iron complexes but also from Al released in tea decoction.