目的 提高对继发性肺淋巴瘤的认识.方法 报道滨州医学院烟台附属医院1例继发性肺弥漫大B细胞淋巴瘤患者的诊治经过,并对该病的影像学表现、 发病率及治疗进行文献复习.结果 该患者初诊为弥漫大B细胞淋巴瘤,治疗半年后肺CT示右肺下叶及肺门区多发团块灶,肺穿刺活组织检查诊断为继发性肺弥漫大B细胞淋巴瘤,给予二线方案R-EDOCH治疗有效.结论 继发性肺淋巴瘤比较少见,临床医师应提高警惕,早期诊断、早期治疗.

Objective:To raise awareness of chronic myelomonocytic leukemia (CMML) with CSF3RT618I mutation. Methods: Analysis of a case of CMML with CSF3RT618I mutation, combined with literature review.Results: We first reported the CSF3RT618I mutation in CMML. The overall survival of patients with CSF3R mutations was low. The prognosis of the patients with tyrosine kinase inhibitors was not clear.Conclusion:The significance of CSF3RT618I mutation in CMML patients needs further clinical study.

目的提高对慢性淋巴细胞白血病/小B细胞淋巴瘤(CLL/SLL)继发髓系肿瘤的认识。方法报道1例CLL/SLL继发急性髓系白血病患者, 并对该病的发生率、危险因素及可能的机制进行文献复习。结果 CLL/SLL继发髓系肿瘤患者大多数伴有染色体异常, 对接受以氟达拉滨为基础联合化疗的患者出现造血不良特征或血细胞减少应加强评估。结论 CLL/SLL继发髓系肿瘤少见, 预后差, 临床医师对具有危险因素的患者应提高警惕, 争取早诊断、早干预。

OBJECTIVE:To investigate the correlation of four types of inhibitory receptors(CD158a,CD158b,NKB1 and CD94/NKG2A) on NK cells and T lymphocytes from grafts and recipients peripheral blood cells 1 month after allogeneic HSCT(allo-HSCT) with hematopoietic reconstitution and acute graft-versus-host disease(aGVHD).METHODS: Twenty-nine patients receiving allo-HSCT were studied.Four types of inhibitory receptors on NK cells and T lymphocytes were analyzed by flow cytometry.RESULTS: The percentage of CD158a,NKB1 and CD94/NKG2A expressing on NK cells in grafts of grade Ⅱ-Ⅳ aGVHD group were(4.36±4.54)%,(1.37±3.24)% and(9.56±8.98)%;the percentage of grade Ⅱ-Ⅳ aGVHD group were significantly higher than that of grade 0-Ⅰ aGVHD group((0.52±0.51)%,(0.56±0.97)%,(1.85±1.71)%),and all P values were 0.05.The percentage of CD94/NKG2A expressing on CD8-positive T cells in grafts was significantly higher in grade 0-Ⅰ aGVHD group than that of grade Ⅱ-Ⅳ aGVHD group,(25.67±14.66)% vs(11.80±8.09)%,and P0.05.CONCLUSIONS: The higher percentage of CD158a,NKB1 and CD94/NKG2A expressing on NK cells in grafts may increase grade Ⅱ-Ⅳ aGVHD.The higher percentage of CD94/NKG2A expressing on CD8-positive T cells may reduce grade Ⅱ-Ⅳ aGVHD.

Objective:To investigate the efficacy of combination of bortezomib and autologous stem-cell transplantation in the management of primary plasma cell leukemia(PPCL) .Method:Two patients achieved complete remission or very good partial remission with bortezomib-containing chemotherapy followed by autologous peripheral blood stem cell transplantation.Result:Bortezomib demonstrates high potency in the treatment of PCL and does not impair the mobilization of peripheral blood stem cells for the autologous stem cell transplantation.The combination of bortezomib and ASCT is an effective management stratety for PCL.Conclusion:Bortezomib containing chemotherapy and autologous stem-cell transplantation may improve the outcome of PCL.

近年来,王风芝等将头皮式双向采血针用于加压输液,经临床应用,效果满意.我们将其应用于2瓶以上免疫球蛋白的静脉滴注,经临床多次实践,同样收到满意效果.现报告如下.材料:头皮式双向采血针n-1个(n为免疫球蛋白的瓶数,n>1),安尔碘,免疫球蛋白瓶配套网套n个,棉签1包,6～7号头皮针1个.

心肌特异性肌钙蛋白T(cTnT)是心肌细胞损伤坏死时释放出来的一种收缩调节蛋白亚单位,对诊断心肌细胞损伤具有高度特异性和敏感性[1].多发性肌炎和皮肌炎是以侵犯骨骼肌为主的自身免疫性疾病,但可同时累及心脏,并成为导致本病死亡的最常见原因之一[2].笔者对37例多发性肌炎和皮肌炎患者血清cTnT进行测定,以了解其在本病中的变化并探讨其临床意义.