目的 分析维吾尔族骨髓增生异常综合征(MDS)患者淋巴细胞免疫表型特点及其在诊断、分型和预后中的临床意义.方法 选择新疆喀什第一人民医院2013年3月到2016年3月41例MDS患者(MDS组)和30例非MDS患者(non-MDS组)为研究对象.运用多参数流式细胞术(CD45/SSC设门法)识别淋巴细胞群及进行免疫分型检测骨髓淋巴细胞群比例,观察不同分化抗原的表达水平.结果 (1)淋巴细胞群比例在MDS组较non-MDS组显著升高[(23.47±10.12)％vs(15.15±10.08)％,P＜0.01];在MDS各亚型[难治性血细胞减少伴多系发育异常(RCMD)、难治性贫血伴原始细胞增多(RAEB)-Ⅰ、RAEB-Ⅱ]间差异无统计学意义(P＞0.05).(2)淋巴细胞群不同分化抗原表达,MDS组的CD25+ CD8+、CD7及CD8表达水平均较non-MDS组显著升高(P均＜0.01);CD5、CD19表达水平显著降低(P ＜0.05,P＜0.01);CD25+ CD4+、CD4、CD25及CD56表达水平两组差异无统计学意义(P均＞0.05);CD5的表达水平在RCMD与RAEB-Ⅱ显著高于RAEB-Ⅰ (P ＜0.01);CD25的表达水平在RC-MD高于RAEB-Ⅰ和RAEB-Ⅱ(P＜0.05);其他MDS抗原的各亚型间差异无统计学意义(P均＞0.05).结论 多参数FCM能检测到维吾尔族MDS患者淋巴细胞异常免疫表型特征,可给MDS患者的临床诊断、分型及预后评价提供更多有价值的客观信息.

Objective To explore the clinical application of multiprobe fluorescence in situ hybridization (FISH) combined with conventional cytogenetic G-banding(CCG) analysis in the diagnosis of acute myeloid leukemia (AML) in Uyghur adult patients in Kashgar region.Methods The multiprobe AML panel comprising 8 different FISH probes for PML/RAR transfusion gene,AML1/ETO transfusion gene,CBF/MYH11 transfusion gene,MLL gene,Del(20q),-7/ Del(7q),Del(5q),and P53 deletion was performed in 30 Uyghur adult patients newly diagnosed with AML in Kashgar region.The multiprobe FISH results were compared with those of CCG.Results With the multiprobe FISH panel,cytogcnetic aberrations were detected in 22 cases (22/30,66.7％),which have involved PML/RAR transfusion gene,AML1/ETO transfusion gene,CBF/MYH11 transfusion gene,MLL gene,trisomy 8,-7/Del (7q),Del (5q),P53 deletion.CCG was only idcntificd in 9 cases with the corresponding cytogenetic abnormalities and 2 cases with other cytogenetic abnormalities.The positive rate of multiprobe FISH was significantly higher than the CCG (P ＜ 0.05),and the detection rate by the combination of FISH and CCG increased to 73.3％.Conclusion Comparing with CCG,multiprobe FISH panel is more accurate,effective and rapid in the diagnosis of AML with cytogenetic aberrations.Multiprobe FISH combined with CCG can improve the detection rate of cytogenetic aberrations in AML and can provide more objective and reliable evidences for the diagnosis of Uyghur newly diagnosed adult AML in Kashgar region.

Objective To research the characteristics of immunophenotype of granulocytes and monocytes in 41 Uyghur patients with Myelodysplastic syndrome(MDS) and its clinic significance .Methods The expressions of antigens of granulocyte and mono-cyte population in 41 patients with MDS were detected by multiparametric flow cytometry .Results Comparing with the non-MDS group ,the percentage of granulocyte was significantly decreased (P= 0 .021) ,the proportion of monocyte population was signifi-cantly higher in the MDS group (P=0 .000) .The proportion of nucleated erythrocyte population was no significant differences in RCMD ,RAEB-I and RAEB-II (P>0 .05) .The expressions of CD10 ,CD11b ,CD15 ,CD16 and CD66d on granulocytes were much higher than non-MDS group(P=0 .012 ,P=0 .027 ,P= 0 .016 ,P= 0 .005 ,P= 0 .024 ,respectively);there were no significantly differences of the expressions of CD33 ,CD13 ,HLA-DR ,CD56 and CD117(P=0 .058 ,P=0 .337 ,P=0 .649 ,P=0 .096 ,P=0 .081 , respectively );the expression of CD10 in RAEB-II was decreased significantly than RAEB-I(P=0 .001);the expressions of CD13 and HLA-DR in RCMD were significantly decreased than RAEB-I and RAEB-II(P=0 .013 ,P=0 .005 and P=0 .018 ,P=0 .003 , respectively) .Other expressions of antigens were no significantly differences among the subtypes of MDS (P>0 .05) .The expres-sions of CD15 ,CD33 and CD64 on monocytes were significantly higher than non-MDS group(P=0 .001 ,P=0 .007 ,P=0 .000 ,re-spectively) ,however ,there were no significantly differences of the expressions of CD7 ,HLA-DR ,CD14 ,CD13 ,CD61 and CD56 on monocytes(P=0 .075 ,P=0 .066 ,P=0 .408 ,P=0 .153 ,P=0 .137 ,P=0 .322 ,respectively ) .Expressions of all antigens were no significantlydifferencesamongthesubtypesofMDS(P>0.05).Conclusion Multiparametricflowcytometry (FCM)canrevealthe characteristics of immunophenotypic abnormalities of granulocytes and monocytes in Uyghur patients with MDS and provide more valuable ,objective information for the diagnosis and prognosis .

目的：探讨血浆置换术联合激素疗法在血栓性血小板减少性紫癜治疗中的临床应用价值及疗效观察。方法收集2012年3月~2015年3月在喀什地区第一人民医院血液科采用血浆置换术联合大剂量激素疗法治疗TTP患者22例患者的临床资料，并对患者在血浆置换前后血小板、血红蛋白、血尿素氮、肌酐及间接胆红素的变化情况进行回顾性分析。结果22例血栓性血小板减少性紫癜患者中，完全缓解15例(68.18%)，近期复发3例(13.64%)，因脏器功能衰竭死亡4例(18.18%)，总有效率为81.82%。在治疗过程中未见明显不良反应发生。结论 TTP患者需要积极进行血浆置换，血浆置换联合激素治疗TTP，安全性高，见效快，副作用少，治愈率高，能真正帮助患者减轻病痛，值得临床推广。

骨髓增生异常综合征(myelodysplastic syndome,MDS)是一组异质性克隆性造血干/祖细胞疾病,其生物学特点是髓系细胞(粒系、红系、巨核系)一系或多系发育异常(或称病态造血),可伴有原始细胞增多,高风险进展成急性髓系白血病[1].目前MDS诊断主要依赖于综合临床症状、血象、外周血、骨髓涂片和活检形态学以及细胞遗传学等的结果.MDS形态学变化细微和主观,且仅约40％～50％检出细胞遗传学异常,故有时难以诊断MDS.

Objective:To research the characteristics of immunophenotype of nucleated erythrocytes in 41 Uyghur patients with Myelodysplastic syndrome (MDS) and analyze their clinic significance. Methods: The expressions of antigens of nucleated erythro-cyte population in 41 patients with MDS were detected by multiparametric flow cytometry. Results: Comparing with the non- MDS group, the proportion of nucleated erythrocyte population was significantly higher in the MDS group ( =0.029) . The proportion of nucleated erythrocyte population was no significant differences in RCMD, RAEB- I and RAEB- II ( ﹥0.05) . The expressions of GPA+CD71+, CD71, CD105 and GPA on nucleated erythrocytes were significantly increased than non- MDS group ( =0.026, =0.020, =0.033, and =0.024, respectively) , while the expressions of GPA+CD105+ and CD71+CD105+ were no significantly ( =0.050, =0.938, respectively) . Expressions of all other antigens were no significantly differences among the subtypes of MDS ( ﹥0.05) . Conclusion: Multiparametric flow cytometry ( FCM) can reveal the characteristics of immunophenotypic abnormalities of nucleated erythrocytes in Uyghur patients with MDS and provide more objective information for the diagnosis and prognosis.

目的 探讨核因子-κB(NF-κB)在慢性髓细胞白血病(CML)急变期前后的表达及意义.方法 选择2011年2月～2013年2月于新疆喀什人民医院血液科住院治疗的25例慢性髓细胞白血病慢性期(CML-CP)(CML-CP组)、16例慢性髓细胞白血病急变期(CML-BC)患者(CML-BC组)、30例缺铁性贫血或巨幼细胞性贫血患者(对照组)为研究对象.采用凝胶迁移或电泳迁移率实验检测三组入骨髓细胞中NF-κB的表达.结果 对照组患者的NF-κB活性测定均为阴性,CML-CP组也仅4例患者检测到NF-κB活性增强,CML-BC组14例患者的NF-κB活性增强.CML-BC组患者NF-κB活化率明显高于CML-CP组及对照组,差异均有统计学意义(P＜ 0.05或P＜ 0.01);CML-CP组活化率高于对照组,差异有高度统计学意义(P＜0.01).CML-BC组患者NF-κB mRNA表达水平(22.91±0.15)明显高于对照组(0)及CML-CP组(11.19±0.03),差异有统计学意义(P＜0.05).结论 与慢性髓细胞白血病慢性期比较,急变期NF-κB活性增强,表达增加,可作为慢性髓细胞白血病急性病变的重要标志物.

目的 探讨维吾尔族急性早幼粒细胞白血病(APL)患者的免疫表型特征.方法 39例维吾尔族APL患者,按FAB和我国标准诊断为M3a者35例,M3b者4例. 起病时外周血WBC≤10 ×109/L者22例(中低危组), WBC>10 ×10 9/L者17例(高危组). 抽取患者骨髓置于EDTA抗凝管,采用四色流式细胞术检测胞膜/胞质抗原,分析免疫表型.结果 39例维吾尔族APL患者细胞均表达髓系特异性抗原CD13CD33、CD38,CD34和HLA-DR阳性表达率分别为7.7%和15.4%,CD56、CD15、CD2 阳性表达率分别为7.7%、30.8%、0. 按CD34和HLA-DR的表达强度,将39例APL患者分成CD3+4或HLA-DR+(6/39,15.4%)、CD34 -和HLA-DR-(33/39,84.6%)两组,两组间CD56阳性率为分别为50%、0(P<0.05). 中低危组、高危组CD15阳性率分别为50%、5.9%(P<0.005). 结论 维吾尔族APL患者的免疫表型特征为CD34、HLA-DR多阴性,CD13 CD33高表达,而CD56、CD2 低表达,CD15表达偏高.

目的探讨老年急性白血病患者化疗后医院感染的临床特点并对其发生危险因素进行分析，为其临床预防及治疗提供依据。方法收集2012年3月~2015年3月在喀什地区第一人民医院住院并接受常规化疗的288例老年急性白血病患者的临床资料，并对医院感染情况进行回顾性分析。结果288例老年急性白血病进行常规化疗的患者中，共出现医院感染的患者171例，化疗后医院感染的发生率为59.38%；多因素Logistic回归分析提示院年龄、住院时间、糖尿病史、肛周疾患、肺部疾患及预防性使用抗生素是老年急性白血病患者化疗后医院感染的的相关危险因素(﹤0.05)。结论年龄、住院时间、糖尿病史、肛周疾患、肺部疾患及预防性使用抗生素是老年急性白血病患者化疗后医院感染的的独立危险因素(﹤0.05)，故适当缩短住院时间、化疗期间控制血糖、按照抗生素治疗指南使用，避免滥用抗生素，加强个人卫生，加强营养，加强对症支持治疗等，临床上应加强这些危险因素的控制。

目的 探讨特发性血小板减少性紫癜(ITP)合并幽门螺杆菌感染患者的免疫学变化.方法 ITP合并幽门螺杆菌感染患者52例和健康查体者35例,对二者分别采用放射免疫法测定抗血小板抗体(PAIgG),WL-快速免疫消浊比浊法测定IgA、IgG、IgM,APAAP法测定T淋巴细胞亚群,ELASA法测定血清IL-2、sIL-2R和IL-6;比较两种人群以上各检测指标的差异.结果 与健康查体者比较,ITP合并幽门螺杆菌感染患者CD;细胞明显减少、CD;细胞明显增多(P均＜0.01),IgA、IgM、IL-2、sIL-2R及IL-6表达均明显升高(P均＜0.01).结论 在ITP合并幽门螺杆菌感染患者致病机制中细胞免疫及体液免疫异常共同参与.

目的 探讨慢性阻塞性肺疾病(COPD)患者检测血尿酸和一氧化氮的意义.方法 选取COPD患者共120例,其中Ⅰ级组30例,Ⅱ级组30例,Ⅲ级组32例,Ⅳ级组28例,以及100例健康人群,通过酶法检测血尿酸(UA)、胆固醇(TC)、三酰甘油(TG)和血糖(S),测定血清NO代谢产物Nox(硝酸盐和亚硝酸盐).结果 对照组和COPD各分级组间血尿酸和血清Nox水平均有显著性差异(F=10.418,]2.672,均P＜0.01).随着COPD分级严重程度加剧血尿酸水平有升高的趋势,而血清Nox水平有下降的趋势.COPD各分级组间血尿酸和血清Nox水平也均有显著性差异(P＜0.05).血尿酸和血清Nox水平存在显著的负相关(r=-0.892).结论 联合检测血尿酸和血清Nox可作为诊断COPD严重程度的靶分子.