Objective To study the fractional cultivation method and the immunomodulatory functions of human amniotic mesenchymal stromal cells(hAMSCs) in vitro.Methods Amniotic mesenchymal stromal cells from human were cultured with tissue piece method,passaged by trypsin digestion and identified with immunocytochemistry and fluorescence-activated cell sorter(FACS).HAMSCs treated by mitomycin according to different effective/target ratios(hAMSCs/peripheral blood monouclear cells) were added in the mixed lymphocyte reaction(MLR) system.To determine the growth rate of lymphocyte with 3H-TdR and observe the effect of hAMSCs on lymphocyte multiplication.Results HAMSCs migrated from explants and primary culture were established;they could multiply and expand steadily in a short time,and they could be passaged by trypsin digestion.The surface marker of hAMSCs was the same as that of bone marrow mesenchymal stem cells,hAMSCs could inhibit lymphocyte proliferation in MLR system and the influence on proliferation of lymphocyte related to the ratio of hAMSCs and lymphocyte.Conclusion HAMSCs can inhibit lymphocyte proliferation in MLR system and have down regulation effect in alloimmunity-reaction.

目的分析多发性骨髓瘤(MM)细胞遗传学变化以及它与MM的分型、分期及其他预后指标的关系,探讨其临床意义。方法采用骨髓细胞24 h短期培养法及R显带技术,对20例MM患者骨髓细胞进行染色体核型分析,并与MM的分型、分期及预后因素进行相应的分析。结果20例MM患者中,发现染色体核型异常者8例(40%),其中5例数目异常,表现为亚二倍体、超二倍体、四倍体;8例均有结构异常,包括易位、增加和丢失等;发生于MMⅢ期7例(35%),MMⅠ期1例(5%);IgG型6例(30%),IgA型1例,轻链型1例。有异常核型的MM患者表现为血沉加快、高钙血症、低血小板、高β2微球蛋白(β2-MG)、高C反应蛋白(CRP)、低血红蛋白(Hb)、原浆细胞比例增高、高乳酸脱氢酶(LDH),其中Hb、β2-MG、CRP、LDH、原浆细胞比例与无核型改变的MM比较,差异均有统计学意义(均P<0.05)。结论存在染色体异常的MM患者多发生于Ⅲ期,与分型无关,而与临床分期及病情的进展有关,且预后差。

Aplastic anemia (AA) is a potentially life-threatening failure of hemopoiesis defined as pancytopenia and an empty bone marrow. It is a more common disease in Asia than in the west with the annual incidence in china of 7.4 per million in contrasts to 2.34 per million in Europe and Israel (1 2). Clonal hematopoiesis has been related to AA, including paroxysmal nocturnal hemoglobinuria (PNH), myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) (3). The true incidence of acute leukemia after AA in China is not known but appears to be rare. Here, we report a case of aplastic anemia evolving into acute myeloid leukemia (AML) after 16 years.

Objective To evaluate the efficacy and safety of intravenous caspofungin followed by voriconazole tablet and itraconazole with complete period treatment for antifungal therapy of malignant hemopathic patients. Methods A retrospective analysis was employed from January 2005 to April 2008 in Wuxi People's Hospital.Fifty-two patients with malignant hematologic disease infected by invasive fungal were divided into 2 groups according to the different anti-invasive-fungal therapy.Patients in Group A(22 cases)were administered with intravenous caspofungi followed by voriconazole tablet sequential therapy,patients of Group B(30 cases) were administered with itraconazole with complete period treatment.Adverse events and the efficacy were investigated. Results The overall efficacy of A group was 81.8%(18/22),the incidence of ADR(adverse reactions rate) related to the drug was 9.1%(2/22).The total effective rate of Group B was 63.3%(19/30),the ADR was 16.7%(5/30).Both these two groups had high overall effective rates,but the adverse reactions occurrence of Group A was lower than that of Group B(P0.05). Conclusions Both the two regimens are effective for treating patients with malignant hematologic disease infected by invasive fungal.Caspofungin and voriconazole sequential therapy has more predominance in efficiency and safety than with itraconazole complete period treatment,the former has lower adverse reactions rates.

Objective:To observe the efficacy and side effect of the continue low-dose Dexamethasone and thalidomide for the treatment of refractory multiple myeloma.Method:Twenty-one patients were treated with continue low-dose Dexamethasone and thalidomide.Treatment protocol was as following:Thalidomide was administered at the dose of 100mg to 200mg at bedtime and associated with dexamethasone administered orally at the dose of 1.5 mg twice a day for three months.Dexamethasone can been reduced to 1.5 mg/d after one and half months.Three months is a cycle.some patients need chemotherapy between two cycles.Result:A fall in paraprotein levels of greater than 50% was observed in six of the 21 patients and greater than 20% was observed in nine of the 21 patients.the remaining six showed disease static or progression.Treatment effective rate was 71.4%.Conclusion:We conclude that the continue low-dose Dexamethasone and thalidomide is a feasible and active regimen in the treatment of refractory multiple myeloma without intolerable side effects.

例1,女,38岁,因"右侧腰痛、发热2周"入院.查体:T 38.5℃,神清,浅表淋巴结未扪及,心肺未及异常,肝、脾肋下未及.血常规:WBC 4.2×109/L,N 70%,Hb 110 g/L, BPC 131×109/L,ESR 50 mm/h.肝肾功能、结核抗体、血培养、尿常规均正常.腹部B超及CT检查提示:双侧肾上腺巨大肿瘤(直径约15 cm)伴淋巴结转移.行剖腹探查术,术中大出血死亡.病理检查提示:非霍奇金氏淋巴瘤(大B细胞型).

老年白血病,由于常规化疗相关的毒性和死亡率较高,因此近年来有应用阿克拉霉素、小剂量阿糖胞苷联合粒细胞集落刺激因子(G-CSF),即CAG方案治疗急性髓系白血病(AML)的报道,疗效较好,且不良反应较少.我们应用CAG方案治疗了25例老年性AML患者,也取得较好疗效.现报告如下[1].

Objective:To observe the near future curative effect and quality of life of patients with diffuse large B cell lymphoma(DLBCL) treated with alternate half-body irradiation combined with R-CHOP. Methods:The near future curative effect, quality of life and adverse reaction of three patients with DLBCL treated with alternate half-body irradiation combined with R-CHOP were evaluated. Results:The near future curative effect of patient has upgrade tendency and there was no obviously adverse reaction. Conclusion:The project of alternate half-body irradiation combined with R-CHOP to treat DLBCL has effect on apparente synergia and attenuation and could improve the patient's quality of life.alternate half-body irradiation; non-Hodgkin lymphoma; Mabthera [Acta Univ Med Nanjing, 2007, 27(04): 364-366]SUN Hong-li,SHEN Yun-feng,MAO Yu-wen,ZHOU Xin,ZHU Hua-chun (Department of Blood Disease, Wuxi Frist Hospital Afliliated to NJMU, Wuxi 214001, China) Abstract Objective:To observe the near future curative effect and quality of life of patients with diffuse large B cell lymphoma(DLBCL) treated with alternate half-body irradiation combined with R-CHOP. Methods:The near future curative effect, quality of life and adverse reaction of three patients with DLBCL treated with alternate half-body irradiation combined with R-CHOP were evaluated. Results:The near future curative effect of patient has upgrade tendency and there was no obviously adverse reaction. Conclusion:The project of alternate half-body irradiation combined with R-CHOP to treat DLBCL has effect on apparente synergia and attenuation and could improve the patient's quality of life.

非何杰金氏淋巴瘤(NHL)是一组起源于淋巴结或其它淋巴组织的恶性肿瘤.其中弥漫性大B细胞淋巴瘤(DLBL)是我国最常见的淋巴增值性疾病,大多数DLBL表达CD20表面标志.我们总结了近三年我院完成的3例交替半身照射联合利妥昔单抗(美罗华)治疗DLBL的临床分析.

目的观察亚标准剂量静脉丙种球蛋白(Sub-HD-IVIG)采用两种用法治疗急性特发性血小板减少性紫癜(AITP)临床疗效。方法62例AITP患者采取历史对照分组,采用Sub-HD-IVIG的两种用法(0.2g/(kg.d)×5d和1.0g/(kg.d)×1d)治疗,观察临床出血症状、血小板计数变化。结果两组患者的近期疗效相仿,血小板计数峰值、出血症状控制时间相近,差异无显著性(P>0.05),但血小板计数开始上升、升至≥50×109/L及达峰值的时间有显著性差异(P<0.05)。两组患者的治疗费用及住院天数亦有显著性差异(P<0.05)。结论两种用法均能取得良好效果,1天用法组起效更快,更经济,值得推广。

Objective To study the clinical biological features and prognosis of acute mixed leukemia(MAL).Methods All 8 patients were evaluated to prove the diagnosis and classification by morphologic,cytochemical and immunologic cytogenetic(MIC)examinations,and these patients were treated with projects suitable for acute lymphoblastic leukemia(ALL)or acute myeloid leukemia,or both.Results FAB classification showed 4 cases were ALL-L1,3 cases were ALL-L2,1 case was AML-M1.Immunologically,coexpression of myeloid and lymphoid lineage associated antigens was detected and CD34,CD38 were hyperexpressed in all cases.3 of them had T,B and myeloid lineage coexpression.Cytogenetically,there was no special disorder in these patients.Though abnormal karyotypes were observed in 4 cases.Both the treatment response and prognosis of MAL patients were poor.Conclusion MAL patients have unique clinical,biological features and poor prognosis.<

慢性粒细胞性白血病(CML)是一种具有ph染色体阳性和融合基因BCR-ABL的获得性干细胞克隆性疾病,现唯一的治愈方法为异基因骨髓移植,但在我国因供体及经费的限制,大部分患者只能进行药物治疗,并不能改变其自然病程,最终进入急变期.

对25例骨髓转移癌患者的血象及骨髓象特点进行观察和分析。发现:贫血23例(占92%),血小板减少17例(占68%),白细胞增多13例(占52%),血涂片出现幼稚粒细胞19例(占76%),出现幼稚红细胞17例(占68%),同时出现幼粒细胞及幼红细胞15例(占60%),血沉增快22例(占88%),血清碱性磷酸酶增高25例(占100%)。骨髓涂片尾部及边缘处均见到数量不等的散在或成簇分布的转移癌细胞。认为骨髓检查能为疾病的诊断提供细胞学证据。

现对作者收治的60例多发性骨髓瘤(MM)患者医院感染情况进行回顾性统计分析,探讨其危险因素.

目的观察VMTP方案治疗难治性或复发性多发性骨髓瘤患者的临床疗效.方法对13例难治性或复发性多发性骨髓瘤患者分别或先后采用MP方案及VMCP方案进行化疗,每隔4周施行一次,观察疗效及药物毒副作用.结果2例获得部分缓解,6例出现进步,5例无效,总有效率为61.5%;有显著性统计学意义(P＜0.001).结论THP为主的VMTP化疗方案治疗难治性或复发性多发性骨髓瘤安全有效,值得临床进一步推广应用.

OBJECTIVE To observe the etiology of disease and the clinical significance of nucleated red-cells in blood smear. METHODS Fresh blood smear stained by Wright Giemsa method and observed under microscope. RESULTS The nuclealed red-cells were found in blood smear in 100 cases distributed in 12 different kinds of diseases. CONCLUSION To observe morphological differences of nuclealed red-cells in blood smear has important significance in the diagnosis of some diseases.

目的:观察美罗华联合化疗治疗B细胞非霍奇金淋巴瘤的临床疗效、使用方法和安全性。方法:所有的病例均为病理检查证实CD20阳性的B细胞非霍奇金淋巴瘤患者。美罗华剂量375 mg/m2,静脉滴注,1次/周,共4周为一疗程并评价疗效。结果:9例患者中经治疗后完全缓解6例,部分缓解3例,均未见明显的毒副反应,无骨髓抑制。结论:美罗华是对CD20阳性的B细胞非霍奇金淋巴瘤有效的治疗药物,多数患者耐受良好,有条件的患者应推荐使用。

[目的]观察奈西雅的不同用法防治白血病化疗所致恶心、呕吐的疗效.[方法]对65例白血病化疗患者随机分成奈西雅1天用药组(32例)和3天用药组(33例).1天用药组在化疗前15分钟静注奈西雅0.3mg 1次,3天用药组在化疗当日及其后2天每天静注奈西雅0.3mg1次.[结果]恶心的控制率为86.2%,1天用药组及3天用药组对恶心的控制率分别为84.4%和87.9%,两组之间无统计学差异(P＞0.05).止呕率为89.2%,1天用药组和3天用药组的止呕率分别为87.5%,90.9%,两者无显著差异(P＞0.05).[结论]奈西雅1天用药和3天用药疗效无差异,说明其药理作用持续时间及半衰期均较长且不良反应轻微,值得临床推广应用.

目的:观察奈西雅的不同用法防治白血病化疗所致恶心、呕吐的疗效.方法:对65例白血病化疗患者随机分成奈西雅1天用药组(32例)和3天用药组(33例).1天用药组在化疗前15分钟静注奈西雅0.3mg1次,3天用药组在化疗当日及其后2天每天静注奈西雅0.3mg1次.结果:两组的恶心的控制率为86.2%,一天用药组及三天用药组对恶心的控制率分别为84.4%和87.9%,两组之间无统计学差异(P>0.05).两组的止呕率为89.2%,1天用药组和3天用药组的止呕率分别为87.5%～90.9%,两者无明显差异(P>0.05).结论:奈西雅药理作用持续时间及半衰期均较长,不良反应轻微,是临床最佳的止吐药物之一.

近十年来急性淋巴细胞性白血病(ALL)的初始安全缓解率显著提高,国内外报道在55%～85%[1],但成人急淋复发率高、生存期短,已成为目前治疗急淋的难点,如何提高难治性及复发性急淋的完全缓解率以延长患者的存活期仍为目前研究的重点.