Objective To explore the curative effect of the combined regimen of low-dose thalidomide (THD) on the elderly with Crohn's disease (CD) and its safety.Methods A retrospective analysis was made to the clinical data of 37 CD elderly treated with low-dose THD;they were divided into 2 groups:observation group (n=32) and control group (THD group) (n=5),the combined regimen of low-dose THD was applied to cases in observation group while THD was signally administrated to cases in control group;the observation group was further divided into 3 subgroups:THD+ hormone group (n=13),THD+ infliximab (IFX) group (n=12) and THD+ azathioprine (AZA) group (n=7);the induction remission rate,mucosa healing rate,occurrence of side effects and the severity of side effect in each group were evaluated and a comparative study was performed.Results The clinical remission rate in THD group,THD+hormone group,THD+ IFX group and THD+AZA group was 40.0％,53.8％,66.7％ and 71.4％ respectively;the mucosa healing rate in the 4 groups was 20.0％,23.1％,16.7 ％ and 28.6％ respectively;the occurrence of side effects in the 4 groups was 60.0％,92.3 ％,83.3 ％ and 71.4 ％ respectively.Conclusions In the application of combined regimen of low-dose THD,THD + IFX is of best curative effect without increasing the side effects of THD obviously;hormone and AZA can promote the curative effect of THD but will cause more side effects.

目的 探讨云南白药联合小剂量沙利度胺(THD)组合方案治疗克罗恩病(CD)的疗效、安全性和优势,为中西医结合防治CD提供依据.方法 回顾性分析CD患者的临床资料,根据THD的组合方案和单用分为观察组和对照组.观察组接受云南白药联合小剂量THD组合方案治疗,对照组只接受THD单独治疗.比较两组的CD活动度、粘膜愈合率、不良反应发生率及其严重程度等,评价THD的组合方案和单用的临床疗效和安全性.结果 与治疗前比较,两组治疗后CDAI均显著下降(P＜0.05),观察组CDAI明显低于对照组(P＜0.05),观察组治疗前后的CDAI降幅明显大于对照组(P＜0.01),治疗后观察组的病情和临床应答率明显得到改善,提示云南白药联合THD组合方案治疗CD的疗效显著优于单用THD治疗CD.治疗后观察组黏膜愈合率明显高于对照组(47.2％ vs 20.0％,P＜0.05).两组不良反应最常见的是外周神经炎,其次是嗜睡、皮炎、便秘、肝功能损害、烦躁和焦虑等.治疗后观察组的不良反应发生率比对照组虽下降,但差异无统计学意义(P＞0.05).与治疗前比较,两组治疗后CRP值和ESR值均显著下降(P＜0.01),观察组CRP值和ESR值明显低于对照组(P＜0.01).结论 云南白药联合THD组合方案治疗CD的消炎作用明显强于单用THD治疗CD.云南白药联合小剂量THD组合方案治疗CD,效果较好,可协同提高THD的疗效,为临床上采取中西医结合治疗CD提供依据.

白介素27是具有独特免疫调节功能的细胞因子,可促进抗肿瘤Th1/Tc1免疫应答,去除Treg细胞亚群,同时它也能去除Th17细胞亚群和上调IL-10以抑制自身免疫发展.本文综述IL-27对T细胞免疫调节的特性,分析其在肿瘤免疫治疗中的潜在价值.

OBJECTIVETo investigate the efficacy of Yunnan Baiyao (YNBY)as an adjuvant treatment of active ulcerative colitis.METHODSA total of 221 patients with active ulcerative colitis were randomized into YNBY group (78 cases) and control group (143 cases). The patients were followed up for 26 weeks and time of remission and serological data (WBC, HGB, PLT, and CRP) were recorded.RESULTSThe patients receiving YNBY as an adjuvant therapy had a median remission time of 9 weeks (95% CI: 8.293-9.707), significantly shorter than that of 13 weeks (95% CI: 11.855-14.145) in the control patients (P<0.001). According to the extent of the lesion, both YNBY group and control group were classified into E1, E2 and E3 subgroups, and the median remission time was 7 versus 11 weeks in E1 subgroups (P=0.09), 10 versus 13 weeks in E2 subgroups (P=0.04), and 9 versus 14 weeks in E3 subgroups (P<0.001). According to the disease severity, the patients in YNBY group and control group had a median remission time of 9 versus 10 weeks in mild cases (P=0.568), 9 versus 14 weeks in moderate cases (P<0.001), and 11 versus 20 weeks in severe cases (P=0.001). According to the standard treatment received, the median remission time in YNBY group and control group was 9 versus 12 weeks in those receiving mesalazine (P<0.001), 9 versus 13 weeks in those receiving corticosteroid (P=0.001), and 7 versus 14 weeks in those receiving infliximab (P=0.04). Cox proportional hazards regression analysis showed that YNBY was a protective factor for disease remission. The remission time was shortened by 2.283 times (95% CI: 1.69-3.070, P<0.001) in patients having YNBY as an adjuvant treatment compared to the control group.CONCLUSIONPatients with active ulcerative colitis can benefit from YNBY as an adjuvant treatment, which shortens the time of disease remission, relieves the symptoms and improves the quality of life of the patients.

<正>放射后肉瘤是恶性肿瘤患者外部放射治疗后发生的一种罕见并发症,发病率约为0.03～0.8%[1]。其预后很差,更具侵袭性。我们现报道1例精原细胞瘤患者放疗后8年腰骶部(L4-S1)发生纤维肉瘤的病例。