OBJECTIVE:To investigate the predictive value of serum soluble interleukin-2 receptor(sIL-2R), tumor necrosis factor alpha(TNF-α), IgG and IgA for the recurrence in patients with multiple myeloma(MM). METHODS:A total of 108 MM patients who were initially diagnosed and treated in our hospital from January 2017 to March 2019, and 72 patients who met the diagnostic criteria and had complete follow-up data were selected as the study subjects. MM recurrence was the endpoint event, and follow-up was conducted until the occurrence of the endpoint event or the deadline of this study. MM patients were divided into recurrent group(RG) and non-recurrent group(NRG) based on whether they have relapsed or not. Venous blood was collected from patients at the first diagnosis and follow-up (at the occurrence of endpoint events or termination of the study), and enzyme-linked immunosorbent assay(ELISA) was used to detect sIL-2R and TNF-α levels in the patient's serum. An automatic immune analyzer was used to detect the levels of IgG and IgA in the patient's serum. The differences in expression levels of the factors between two groups were compared and the correlations between sIL-2R and TNF-α, IgG and IgA at the first diagnosis and follow-up were analyzed. At the same time, venous blood was collected from patients during complete remission, and their serum sIL- 2R levels were measured to compare the differences in sIL-2R expression levels at the first diagnosis, complete remission and recurrence. Receiver operating characteristic(ROC) curves was used to determine the optimal cutoff values for serum sIL-2R, TNF-α, IgG and IgA, and the predictive value of sIL-2R, TNF-α, IgG and IgA in the recurrence of MM patients were analyzed based on the area under the curve(AUC). RESULTS:The serum sIL-2R levels of MM patients at the first diagnosis and recurrence were significantly higher than at complete remission (P < 0.05). At the first diagnosis, the hemoglobin content of RG was lower than that of NRG, while the β2-microglobulin content was higher than that of NRG (P < 0.001). There was no significant difference in other clinical parameters between the two groups (P >0.05). The levels of sIL-2R, TNF-α, IgG and IgA at the first diagnosis and follow-up of RG were higher than those of NRG (P < 0.05). There was a significant correlation between sIL-2R and TNF-α, IgG and IgA at the first diagnosis and follow-up (P < 0.001). The ROC curve showed that, at the first diagnosis, sIL-2R, TNF-α, IgG and IgA predicted the AUC of MM patients were 0.919, 0.850, 0.766 and 0.795, respectively, after follow-up, they predicted AUC of MM were 0.890, 0.815, 0.760 and 0.794, respectively (P < 0.001). CONCLUSION:The serum sIL-2R has the highest predictive value for MM patient's recurrence, and it is possible to detect the TNF-α, IgG and IgA levels at specific times to infer changes in sIL-2R levels and evaluate the patient's prognosis.

OBJECTIVE:To investigate the expression and clinical significance of soluble interleukin-2 receptor(sIL-2R) in patients with multiple myeloma(MM). METHODS:54 newly diagnosed MM patients in the Second Affiliated Hospital of Fujian Medical University from February 2020 to December 2021 were selected as the observation group, and 60 healthy people in our hospital in the same period were selected as the control group. The expression levels of sIL-2R in the serum of the two groups were detected by enzyme-linked immunosorbent assay. The differences of sIL-2R expression level among different clinical parameter groups in MM patients were compared. The clinical parameters include:gender, age, ISS stage, hemoglobin, albumin, serum creatinine, lactate dehydrogenase and β2-microglobulin, blood calcium, bone marrow plasma cell ratio and treatment response. The relationship between sIL-2R expression level and progression-free survival(PFS) and overall survival(OS) in MM patients were analyzed. RESULTS:The expression of serum SIL-2R in MM patients was significantly higher than that in healthy control group (P<0.05). The expression of sIL-2R in MM patients who did not achieve complete remission(CR) was significantly higher than those of CR patients (P=0.037). There was no significant difference in the expression of serum sIL-2R between the groups of different sex, age, ISS stage, hemoglobin concentration, albumin content, serum creatinine level, lactate dehydrogenase level, the content of β2-microglobulin, the concentration of blood calcium, and the proportion of bone marrow plasma cells(P>0.05). The PFS of sIL-2R high expression group(15 months) was shorter than that of sIL-2R low expression group (22 months), which was significant difference (P=0.041). But there was no significant difference in OS between sIL-2R high expression group and sIL-2R low expression group (P=0.124). Univariate analysis results showed that the high expression of serum sIL-2R was associated with poor PFS in MM patients. Multivariate analysis results showed that the high expression of serum sIL-2R was still an independent adverse prognostic factor for PFS in MM patients, However, the expression of serum sIL-2R was not statistically significant in evaluating OS in MM patients by univariate and multivariate analysis. CONCLUSION:The expression of serum sIL-2R in MM patients was significantly higher than that in healthy people. Serum sIL-2R is an independent prognostic factor of PFS in MM patients.

目的 探讨伴异常染色体核型的初诊急性髓系白血病(acute myeloid leukemia,AML)患者的临床、实验室特征.方法 收集我院收治的伴异常染色体核型的初诊AML患者资料,分析其临床及实验室资料.结果 除M2b外14例患者骨髓合并病态造血,FAB分型中M2a13例、M51例,染色体核型中复杂核型10例、单体核型2例、染色体易位2例.71例异常染色体核型表现为染色体易位42例(其中M2b6例,M321例,M4EO4例)、单体核型14例、复杂核型15例.结论 伴异常染色体核型的初诊AML以染色体易位为主,但除M2b、M3、M4EO外,3种染色体核型异常(染色体易位、单体核型、复杂核型)无明显差异.合并病态造血的AML多见于复杂核型且以M2a为主.

Objective To investigate the types and laboratory characteristics of non-Hodgkin lymphoma(NHL) with bone marrow invasion as the first manifestation. Methods 81 non-Hodgkin lymphoma patients with bone marrow invasion as the first manifestation treated in our hospital from January 2010 to July 2019 were selected. The clinical features, blood routine, lactate dehydrogenase (LDH), EB virus results, bone marrow features, immunophenotyping, gene and genetic characteristics of all patients were analyzed retrospectivel. Results Among 81 patients, 73 cases(90%) were B-cell lymphoma, 5 cases(6%) were T-cell lymphoma and 3 cases(4%) were NK/T-cell lymphoma, while the mantle cell lymphoma and diffuse large B-cell lymphoma were the highest, which accounted for 21%(17 cases) and 19.7%(16 cases), and lymphoma accounted for 8.6%(7 cases). There were 44 cases(54.3%) showed B symptoms, 65 cases (80.2%) showed abnormal blood routine. The MYD88 gene was detected in 5 of 17 cases. 25 cases of patients underwent chromosome examination, the result showed that 5 cases were t(8; 14) (q24; q32), 3 cases were complex karyotype and 17 cases were normal karyotype. 23 cases(23.4%) were EB virus positive, 42 cases(51.9%) were LDH increased. The proportion of bone marrow lymphoma cells was 1%-92%. Among them, 32 cases were diagnosed as lymphoma leukemia, and 6 cases of bone marrow lymphoma cells showed mass distribution similar to extramedullary tumor cells with bone marrow metastasis. Conclusion B-cell lymphoma is the predominant NHL with bone marrow invasion as the first manifestation, while mantle cell lymphoma and diffuse large B-cell lymphoma are the most common pathological types with blood routine abnormalities. Bone marrow lymphoma cells can also present clusters of bone marrow metastasis, different types of lymphoma cells can make directional diagnosis.

OBJECTIVE To investigate the clinical characteristics and risk factors of nosocomial infection in patients with non-Hodgkin lymphoma (NHL), in order to guide better clinical prevention and treatment of nosocomial infection. METHODS The incidence of nosocomial infection, infection site, characteristics of pathogenic bacteria, drug sensitivity test results and infection risk factors of 472 non-Hodgkin lymphoma patients admitted to the Second Affiliated Hospital of Fujian Medical University from January 2015 to September 2020 were retrospectively analyzed. RESULTS Among the 472 patients, 97 (20.6%) had nosocomial infection, mainly in the lower respiratory tract (41.2%), followed by oral cavity, upper respiratory tract, urogenital tract, and blood. A total of 71 strains of pathogenic bacteria were isolated, including Gram-negative (G-) bacteria (52.1%), Gram-positive (G+) bacteria (28.2%), and fungi (19.7%). The detection rate of extended-spectrum β-lactamase (ESBLs) in Klebsiella pneumoniae and Escherichia coli was 36.4% and 22.2%, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenems (imipenem) in G- bacteria was 33.3%, while the sensitivity rate of other G- bacteria was 100%. Among the 7 strains of Staphylococcus aureus, 1 strain was found to be methicillin-resistant Staphylococcus aureus (MRSA), and the sensitivity of G+ bacteria to linezolid, tigecyclinetegacycline and vancomycin was 100%. Candida albicans was the main source of fungal infection. Univariate analysis showed that nosocomial infection was associated with hospital day, bone marrow involvement, clinical stage, chemotherapy, neutrophil count in peripheral blood, and lymphoma type. Multivariable Logistic regression model showed that hospital days ≤7 was the protective factor of nosocomial infection, while clinical stage (Ⅲ, Ⅳ period), tumor involving bone marrow, and peripheral blood neutrophil count <0.5×109/L were major risk factors. CONCLUSION NHL patients show high nosocomial infection rate and lower respiratory tract infection is common. Hospital day, clinical stage, presence of bone marrow invasion, and neutrophil count in peripheral blood are independent risk factors.

OBJECTIVE:To improve the understanding of the transformation of essential thrombocythemia (ET) into acute myeloid leukemia (AML), and to explore the relationship between JAK2 V617F gene mutation and disease transformation.METHODS:The detection of bone marrow morphology,cytogenetics, JAK2 V617F gene were performed before and after transformation, as well as the immunological tests after transformation was performed in 3 patients with ET into AML. The characteristics, clinical features, diagnosis and treatment of the patients before and after transformation were compared.RESULTS:Case 1 transformed into AML-M2a 5 years after diagnosis of ET. The patient abandoned treatment and was discharged from hospital. Case 2 transformed into AML 6 years after diagnosis of ET. After one course of chemotherapy, bone marrow was partially relieved, and platelets continued to rise up to 702×109/L, presenting as ET bone marrow image. One year later, AML relapsed and no remission was observed after chemotherapy. Case 3 transformed into AML-M6a 7 years after diagnosis of ET. The patient abandoned treatment and was discharged from hospital. The morphological heteromorphism of 3 cases of AML transformed from ET was more obvious than that of patients with newly diagnosed acute leukemia. The AML could not be classified accurately based on morphology simply, but could be classified accurately based on immunological detection. JAK2 V617F gene was positive before and after transformation in case 1 and case 2 of ET, the case 3 showed that JAK2 V617F gene was positive at ET stage and negative after AML transformation. Complex chromosome karyotypes were detected by routine karyotype analysis after ET transformation into AML in case 1, while normal karyotypes were found in case 2 and case 3.CONCLUSION:The morphological abnormality of AML transformed from ET is more significant than that of newly diagnosed acute leukemia, and it needs immunological detection to classify it accurately. The transformation of ET into AML may not involve JAK2 V617F gene mutation, but may be related with the occurrence of abnormal chromosome karyotypes. The condition of AML transformed from ET is dangerous and the effect of chemotherapy is poor.

OBJECTIVE:To investigate the infection rate of Toxoplasma gondii in patients with hematological diseases.METHODS:The Toxoplasma gondii IgM antibody in 200 patients with hematological diseases were tested, at the same time, IgM antibody in the persons received physical examination and other patients with common clinical diseases also were test, and their detection results were compared.RESULTS:The positive rate of Toxoplasma gondii IgM antibody in patients with hematological diseases was 7.50%, the positive rate in persons received physical examination was 0.67%, and the positive rate in patients with other common clinical diseases was 1.20%. The positive rate of IgM antibody in patients with hematological diseases was statistically significantly higher than that in the latter two kinds of persons(P<0.05). Among the patients with hematological diseases, the positive rate of Toxoplasma gondii IgM antibody in patients with bone marrow neoplastic diseases was 10.32%, which was statistically significantly higher than that in patients with bone marrow non-neoplastic diseases (2.70%).CONCLUSION:Patients with hematological diseases are susceptible to Toxoplasma gondii, and to whom enough attention should be paid.

OBJECTIVE:To investigate the diagnostic value of cytomorphology (including cytochemical staining) in newly diagnosed acute leukemia, so as to improve the importance of cytomorphology.METHODS:The clinical data of 119 cases of acute leukemia diagnosed in our hospital from April 2016 to June 2018 were analyzed retrospectively. According to morphologic and immunological typing, accordance rate to final diagnosis was compared.RESULTS:The diagnostic accordance rate of simple morphological typing was 76.5%, and the diagnostic accordance rate of simple immunological typing was 79.8%, the difference of diagnostic coincidence rate was not significant between the two groups of acute leukemia.CONCLUSION:Cytomorphology is the cornerstone of the diagnosis of acute leukemia, it has similar value to immunological classification in the diagnosis of leukemia and should pay enough attention. MICM comprehensive diagnosis can improve the final diagnosis rate, showing a guidance significance for the treatment and prognosis of patients with acute leukemia.

Objective To investigate the changes and clinical significance of plasma Hcy (homocysteine), hs-CRP (hypersensitive C-reactive protein), Cys-C (cystatin C) and D-dimer in patients with atherosclerotic cerebral infarction.Methods Plasma Hcy, hs-CRP, Cys-C, D-dimer concentrations and neurological function scores were measured in 85 patients with atherosclerotic cerebral infarction (divided into plaque-free group and plaque-containing group, the latter divided into stable plaque group and unstable plaque group) and 80 healthy subjects.Results The concentration levels of Hcy, hs-CRP, Cys-C and D-dimer in atherosclerotic cerebral infarction group were higher than those in the control group, with plaque group higher than without plaque group, unstable plaque group higher than stable plaque group, the differences were statistically significant (P<0.05).The four concentration levels were positively correlated with the severity of cerebral infarction.The positive rate of four combined tests was much higher than that of single test.Conclusion Plasma Hcy, hs-CRP, Cys-C and D-dimer levels are related to the development and diagnosis of atherosclerotic cerebral infarction.The combined determination of four items has high clinical value for the diagnosis of atherosclerotic cerebral infarction.