为探讨伏立诺他联合NVP-BEZ235诱导人外周血白血病T细胞(Jurkat细胞)凋亡及机制,培养Jurkat细胞,用伏立诺他或(和)NVP-BEZ235处理,采用流式细胞术检测Jurkat细胞的凋亡情况,Western blot检测FOXO3a磷酸化,免疫荧光检测FOXO3a的核转位核转位.采用si RNA干扰Bim1,观察对Jurkat细胞增殖的影响.结果表明,伏立诺他协同NVP-BEZ235能够促进Jurkat细胞凋亡,降低FOXO3a的磷酸化并诱导其发生核转位,且能诱导Bim1表达,沉默Bim1能逆转伏立诺他和NVP-BEZ235对Jurkat细胞生长的抑制效应.

多发性骨髓瘤(MM)是骨髓中浆细胞克隆性增殖的恶性疾病,其生物学异质特性较高,因患者个体之间具有明显差别,所以在治疗时,患者生存期存在明显差异,可为数月,也可为十多年.采用合理预后分层评估方法,对于多发性骨髓瘤治疗具有重要意义.细胞分子遗传学异常对多发性骨髓瘤预后具有重要影响,将分子遗传学作为基础,建立有效预后分层方法,可使得患者得到更为针对性的个体化治疗.

Objective:To analyze relationship between 13q14 deletion and prognosis in initial-treatment patients with multiple myeloma (MM).Methods:The follow-up data of 121 patients with newly diagnosed MM admitted to the First People's Hospital of Xiangtan City from January 2012 to December 2016 were collected and divided into deletion group ( n=39) and non deletion group ( n=82) according to the deletion of 13q14.The prognosis situations were compared among patients with different 13q14 deletion. Univariate analysis was performed for 3-year overall survival (OS) and progression free survival (PFS) in patients with MM. Results:As of the follow-up time, the 3-year OS rate, 3-year OS, 3-year PFS rate, 3-year PFS and median PFS were 71.90%(87/121), 5.8-36 months, 47.93%(58/121), 2.3-36 months and 34.8 months, respectively. The age, hypoproteinemia, high lactic dehydrogenase (LDH) and 13q14 deletion were independent influencing factors of OS ( P<0.05). The age, high LDH and 13q14 deletion were independent influencing factors of PFS ( P<0.05). The 3-year OS rate and 3-year PFS rate in 13q14 deletion group were 61.54%(24/39) and 25.64%(10/39), lower than those in non-deletion group ( P<0.05). Conclusions:The short-term prognosis is poor in initial-treatment MM patients with 13q14 deletion. Conducting risk stratified treatment for patients based on common influencing factors of OS and PFS is conducive to improving their prognosis.

目的:探讨加用头孢拉定封管对预防血液透析导管相关性感染的疗效.方法:行中心静脉留置血液透析双腔管的128例患者随机分为头孢拉定加肝素钠封管组(A组)66例和单纯肝素钠封管组(B组)62例.以患者出现导管相关性感染或导管栓塞为观察终点,未出现感染者以3个月为观察终点.分别记录2组患者导管相关性感染的发生率,并分析其病原菌谱,比较2组的导管栓塞率及不良反应的发生情况.结果:A组导管相关性感染的发生率比B组明显降低(11%比23%,P＜0.05),B组8例(67%)发生革兰阳性球菌感染,A组仅2例发生革兰阳性球菌感染.A、B组的导管栓塞发生率分别为10%和11%(P＞0.05),2组未见其他不良反应.结论:加用头孢拉定封管能有效预防血液透析导管相关性感染的发生,而且不会增加导管栓塞的发生率.

目的:探讨中老年缺铁性贫血(IDA)的病因及临床特点。方法:采用回顾性分析方法。结果:中老年组IDA患者以消化道恶性肿瘤为病因占26.9%,明显高于青年组2.7%(P<0.01)。中老年组重度贫血比例(48.72%)明显高于青年组(23.64%)(P<0.01)。结论:中老年IDA患者贫血程度较重,对中老年IDA患者应高度警惕消化道恶性肿瘤。

【目的】探讨CAG预激方案治疗老年骨髓增生异常综合征(MDS)难治性贫血伴原始细胞增多(RAEB)和难治性贫血伴原始细胞增多转变型(RAEB-T)的近期临床疗效。【方法】应用小剂量阿糖胞苷(Ara-C)、阿克拉霉素(Acla)、粒系集落刺激因子(G-CSF)组成的CAG预激方案治疗22例老年MDS-RAEB和MDS-RAEB-T,观察其疗效和不良反应。对照组予小剂量Ara-C治疗。【结果】22例患者中完全缓解10例,部分缓解6例,CR率45.5%,总有效率72.7%(16/22),明显高于对照组(27.8%,5/18)。毒副反应主要为骨髓抑制,但均不严重,非血液学不良反应少。【结论】CAG方案治疗老年MDS-RAEB和MDS-RAEB-T疗效肯定,不良反应少。

[Objective] To explore the efficacy and toxicity of recombinant human interleukin-11 in treating chronic refractory idiopathic thrombocytopenic purpura.[Method] 24 patients with chronic refractory idiopathic thrombocytopenic purpura were administered with 25 μg/(kg.d)rhIL-11 subcutaneously once daily for 14 days,Blood routine,urine routine,stool routine,the function of liver and kindney,electrocardiograph and coagulation function were monitored.[Result] The peak platelet count after treatment(115.2±62.8)×109/L was significantly greater than the mean platelet count before treatment [(21.0±16.8)×109/L,P ≤0.01].The evaluation of synthetic efficacy showed 52.4% of the apparent efficiency rate and 100% of the total efficiency rate.Few side effects occurred in four patients and they disappeared in the treating process or after withdrawal of rhIL-11.[Conclusion] rhIL-11 had satisfactory efficacy in the treatment of chronic refractory idiopathic thrombocytopenic purpura with few side effects.

患者女性,48岁,因头晕、乏力、发热十余天于2003年11月28日入院.查体:体温38.5℃,急性病容,贫血貌,全身皮肤未见出血点、瘀斑,浅表淋巴结无肿大,咽后壁充血,扁桃体无肿大,胸骨压痛,听诊心肺无异常,腹平软,无压痛,肝脾肋下未扪及.入院后查血常规:Hb 65 g/L,RBC 2.81×1012/L,WBC37.2×109/L,BPC178×109/L,白细胞分类:幼稚细胞0.87,淋巴细胞0.12,分叶核0.01.

目的:研究湘潭制槟榔与幽门螺旋杆菌感染相关关系.方法:首先随机对1 914例工矿、城市人口进行流行学调查,了解嚼槟榔与上消化道症状的分布情况.之后,从上述1914例中随机抽取105例无临床症状的人群分成食槟榔组55例,不食组50例,做血清抗H pylori-IgG检查;另外,在内镜室对1 814例有消化道症状的患者随机分成嚼湘潭制槟榔实验组956例和不嚼者的对照组858例.然后,通过胃镜对每位患者进行镜下胃窦部取2-3块标本做尿素酶检测,并进行实验室体外Hpylori抑菌试验.在临床上快速尿素酶、病理切片、涂片方法找Hpylori,其中上述三项中两项为阳性者为Hpylori阳性,共60例,分成治疗组及对照组各30例,治疗组用湘潭制槟榔每日8-50 g,对照组用传统三联(铋剂+氨苄青霉素+甲硝唑),治疗2 wk,停药后1 mo复查14C呼气试验.结果:流行学调查,1 914例中嚼槟榔1 236例,有上消化道症状的383例(占30.99%),且有上消化道症状的人中有嚼槟榔后缓解的153例(占39.34%),而不嚼槟榔者678例,有上消化道症状的215例(占31.7l%);血清学调查,嚼槟榔组55例中,抗Hpylori-IgG阴性者43例(占78.18%)、阳性12例(占21.82%),不嚼食50例抗Hpylori-IgG阴性者22例(占44%),阳性28例(占56%).另外,内镜调查,两组1 814例中,实验组Hpylori阳性率26.46%,对照组71.95%(P＜0.005).体外小剂量湘潭制槟榔对幽门螺旋杆菌有明显的杀灭作用.临床60例Hpylori感染患者中,治疗组30例,其中17例Hpylori阴性(占56.67%),对照组30例中Hpylori阴性21例(占70%),两组对此无明显差异(P＞0.05),证明体内试验湘潭制槟榔与传统三联疗效基本相近.结论:湘潭制槟榔对幽门螺旋杆菌有很强的抑菌作用.

患者,男,68岁.因头晕、乏力6个月于2000年6月8日入院.体检:T 36.5 C,重度贫血貌,皮肤巩膜无黄染、出血点及皮疹,浅表淋巴结无肿大,胸骨无压痛,腹平软,肝脾肋下未扪及.实验室检查:Hb49 g/L,RBC 1.55×1012/L,BPC 42×109/L,WBC 27.6×109/L,其中原粒0.01,早幼粒0.03,中幼粒0.11,晚幼粒0.13,杆状核0.20,分叶核0.37,嗜酸性粒细胞0.02,嗜碱性粒细胞0.02,淋巴细胞0.10,单核细胞0.01,可见晚幼红细胞.

缺铁性贫血(IDA)是一种常见的营养缺乏症,在我国发病率相当高.本病既往常用硫酸亚铁治疗,但因其消化道反应大而使一些病人不能坚持治疗.近几年来,作者使用右旋糖酐铁片口服治疗IDA,,获得满意疗效,且副作用少见,现报道如下.