OBJECTIVE:To assess the prognostic significance of plasma fibrinogen（FIB） levels in patients of diffuse large B-cell lymphoma(DLBCL). METHODS:We retrospectively analyzed 203 newly diagnosed with DLBCL patients who met the study requirements from November 2016 to May 2024. Based on the receiver operating characteristic (ROC) curve analysis of plasma FIB levels during diagnosis, the critical value of FIB was determined, and patients were divided into high FIB and low FIB groups. The clinical characteristics and relevant laboratory indicators of two groups were compared. The impact of plasma FIB levels on overall survival (OS) were evaluated using Kaplan-Meier curves as well as univariate and multivariate Cox regression analysis. The differences in FIB and other laboratory indicators under different disease states were compared. RESULTS:According to the ROC curve, the optimal cut-off value of FIB was 3.49 g/L. Compared with the high FIB group (>3.49 g/L), the low FIB group (≤3.49 g/L) had a significant decrease in neutrophil count (ANC) (P =0.001) and platelet count (PLT) (P =0.027), and a significant increase in prealbumin (PA) (P =0.001). A high FIB level was associated with decreased OS (P =0.005). Univariate analysis results showed that FIB had an impact on survival of patients(HR＝2.031，95%CI : 1.221-3.375, P =0.006). Multivariate analysis showed that higher FIB level was an independent adverse prognostic factor affecting patients survival （HR＝2.684， 95%CI :1.478-4.875, P =0.001）. Compared with patients with newly diagnosed or recurrent DLBCL, patients with complete remission showed a significant decrease in FIB (P ND < 0.001, P R=0.001) and ANC (P ND < 0.001, P R=0.021), as well as an increase in albumin (ALB) (P ND < 0.001, P R=0.018) and PA (P ND < 0.001, P R < 0.001). CONCLUSION:Elevated FIB is a poor prognostic factor for DLBCL patients. The plasma FIB level is correlated with laboratory indicators such as ANC, PLT, PA, and disease status in DLBCL patients. Dynamic monitoring can assist in the early detection of changes in the condition.

通过总结恶性淋巴瘤(ML)不同时期的症结及变化规律,探讨ML最根本的中医病机,也就是中医治疗可能的"靶标".ML初始成因乃寒、痰搏结而后生瘀,其发生发展规律乃太阳中风,寒客于卫,邪盛卫虚,开阖失度,肺失宣肃,不司水道,津停液凝,结于经隧,与毒相合.病机要素涉及寒、痰、毒、瘀,且互有兼夹.临证紧扣卫气亏虚,不能御邪,气化失司,液凝生痰为主,治宜行卫气,通津液以求阴阳平衡,治愈顽疾.

急性白血病、淋巴瘤和多发性骨髓瘤是临床常见的恶性血液病,具有病因复杂、病位深疴、病情顽固、变化多端、难以根治等临床特征.中医药治疗该类疾患积累了丰富经验,显示出一定优势,但临床疗效仍有待提高.在长期临床实践基础上,根据中医风邪致病理论,将风药应用于恶性血液病的中医临床诊疗,形成了理论特色,可提高临床疗效.风邪入里滞留是恶性血液病发生和进展的重要原因,气滞、痰湿、瘀血、癌毒是恶性血液病过程中的关键病理产物.风药能通关达窍,兼开郁、化痰、涤饮、行水、胜湿、化瘀、解毒,契合恶性血液病复杂的病机特点.临证中常用麻黄、桂枝、柴胡、僵蚕、刺蒺藜、升麻、葛根、金银花、连翘、细辛、白芷、羌活、独活等,可以祛风散邪,对恶性血液病正虚、气滞、痰凝、血瘀、癌毒等病理因素均具有干预作用.

急性髓性白血病(AML)是一种主要发生在老年人的血液系统恶性肿瘤,诊断时的中位年龄为68 岁[1].目前AML的标准治疗包括强化诱导化疗、巩固化疗及造血干细胞移植.然而,由于高龄、合并症多、一般情况差等不利因素,导致部分AML患者不能耐受标准化疗,通常会接受低强度的化疗方案,包括低甲基药物(阿扎胞苷或地西他滨)单药或联合低剂量阿糖胞苷;部分合并脏器功能不全的患者因无法耐受化疗,仅接受最佳支持治疗.

慢性免疫性血小板减少症(CITP)常呈间歇性反复发作,目前西医尚缺乏根治该病的特效药物,中医药在辨证论治CITP方面具有一定优势.膏方是一种传统中药剂型,多用于慢性病的治疗.临证应用膏方治疗CITP当以辨证论治为原则,重视对脾肾的调治,做到穷本探源.同时根据CITP气阴亏虚、血瘀内阻这一本虚标实的病机特点,结合不同人群的生理特点、体质状态、感受邪气等情况,以"卫气营血""瘀热"及"调周"等理论为基础,采取灵活的调补治法,追求以和为贵.附验案1则以佐证.

目的 总结原发肝脏细胞淋巴瘤(PHDLBCL)的诊断及治疗方法.方法 回顾性分析1例PHDLBCL的临床资料.结果 患者因上腹部胀痛入院,PET-CT及腹部影像学检查提示肝脏多发占位,有典型的"血管漂浮征",肝脏穿刺活检病理及免疫组化检查提示符合弥漫大B细胞淋巴瘤,确诊为PHDLCL.经VP方案预处理及R-CHOP和GemOx方案诱导缓解巩固后,以来那度胺维持治疗,随访9个月,患者处于完全缓解状态.结论 PHDLBCL症状不典型,影像学的"血管漂浮征"常有提示作用,确诊需要病理学检查.VP方案预处理有利于快速降低瘤负荷,以利妥昔单抗联合多柔比星脂质体的R-CHOP的方案有良好的诱导缓解作用,来那度胺的维持治疗可能会带来生存获益.

Review question / Objective: The benefits of Chinese herb in patients with multiple myeloma remain unclear.Condition being studied: We intend to evaluate Chinese herb applied

髓外浆细胞瘤(extramedullary plasmacytoma,EMP)是一种原发于骨髓造血组织以外,单克隆浆细胞异常增生所致的软组织恶性肿瘤,占浆细胞肿瘤的3％～5％.EMP可发生于任何髓外组织器官,多见于头颈部或上呼吸道,其次为胃肠道,且以单发病灶为主,而原发于胆道的EMP临床罕见,尚未见报道,其临床症状及影像学检查结果与胆总管癌难以鉴别,易被误诊,诊断主要依靠病理检查.本文报告1例原发于胆总管的EMP,并结合文献,探讨此类疾病的治疗策略及转归.

目的:初步探讨成人原发免疫性血小板减少症(ITP)与中医体质的关系.方法:采用《中医体质量表》记录60例成人原发ITP患者的一般资料和体质类型,分析不同性别、不同病程患者中医体质类型的分布情况,并进行统计学分析.结果:60例成人原发ITP患者,统计体质频次98例次,气虚质所占的比例最大,为22例次(22.45％),其后分别为阴虚质＞痰湿质＞阳虚质/平和质＞血瘀质＞特禀质＞湿热质＞气郁质;不同性别体质类型的比较,无显著差异;平和质在不同病程中的构成比不同,差异具有统计学意义(P＜0.05).结论:从气虚、阴虚角度调理ITP具有一定优势.

Purpose: To identify the biological function of phosphoserine aminotransferase 1 (PSAT1) in regulating cell proliferation and apoptosis in multiple myeloma (MM).Methods: The mRNA and protein levels of PSAT1 were determined using quantitative real-time polymerase chain reaction (PCR) and western blotting, respectively. Cell proliferation was measured using CCK-8 assay.Results: PSAT1 mRNA and protein expression levels were significantly increased in MM cell lines when compared to control cells. Moreover, downregulation of PSAT1 inhibited MM cell proliferation and induced cell apoptosis, whereas overexpression of PSAT1 promoted MM cell proliferation and suppressed cell apoptosis. Further analysis demonstrated that the underlying mechanism was via regulation of PI3K/AKT pathway.Conclusion: The results identified a novel role for PSAT1 in the progression of MM, which may provide a therapeutic and a new anticancer target for the therapy of MM. Keywords: Multiple myeloma, PSAT1, Cell proliferation, PI3K/AKT pathway

目的:基于现代中医文献,挖掘成人慢性原发免疫性血小板减少症(cITP)的用药特点和组方规律.方法:检索中国知网、维普、万方数据库,筛选近20年中医药治疗成人cITP的临床研究型文献,提取处方建立数据库.采用频数分析、关联规则和聚类分析等法对处方中药进行数据挖掘.结果:共纳入文献95篇,涉及处方98首中药165味,其中中药性味归经以甘寒、入肝经居首,高频药物为黄芪、生地黄、当归、仙鹤草、牡丹皮等26味.关联规则得出药对13个,分别为"黄芪-鸡血藤""黄芪-党参""当归-党参"等组合.聚类分析确立基本方4组,即左归饮类方、二至丸类方、当归补血汤类方和犀角地黄汤类方.结论:研究表明cITP治疗原则为"益气养阴、和血柔肝",核心药物为黄芪、生地黄和当归,药对配伍遵循"治气、治火、治血"原则.

To describe the health-related quality of life (HRQoL) and fatigue burden among adult patients with immune thrombocytopenia (ITP) in China and determine whether they vary with disease phase. This is a cross-sectional, multi-centre observational study of adult ITP patients and the general population. Participants completed the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). We compared HRQoL and fatigue between ITP patients and the general population, overall and by disease phase (newly diagnosed, persistent, and chronic), using propensity score matching. 203 Patients and 269 members of the general population were recruited. Thirty-six ITP patients (17.7%) were newly diagnosed, 46 (22.7%) were persistent, and 121 (59.6%) were chronic. Compared with the general population, ITP patients had impaired HRQoL and greater fatigue burden. The persistent ITP group showed the largest number of SF-36 scales exceeding the minimally important difference: physical functioning [− 10.5; 95% confidence interval (CI) − 24.5 to 3.5; P < 0.001], role physical (− 16.7; 95% CI − 36.4 to 3.0; P < 0.001), social functioning (− 15.6; 95% CI − 34.5 to 3.3; P < 0.001), and role emotional (− 12.1; 95% CI − 26.0 to 1.8; P < 0.001). Chronic ITP patients had the worst FACIT-F scores (36.89 ± 5.21). Higher fatigue severity was associated with lower physical and mental HRQoL. The HRQoL and fatigue burden of Chinese adult patients with ITP vary by disease phase. Persistent ITP patients were the most vulnerable subgroup in terms of HRQoL, while chronic ITP patients bear the heaviest fatigue burden.

目的:评价中文版慢性病治疗功能评估-疲劳量表(FACIT-F量表)在原发免疫性血小板减少症(ITP)患者中的信效度,并分析患者疲劳程度的影响因素.方法:首先向量表授权机构提出申请,获取中文版FACIT-F量表.纳入206例成人ITP患者.采用中文版FACIT-F量表、健康调查简表(SF-36)进行患者自评,记录相关临床资料.计算中文版FACIT-F量表的Cronbach'a系数、重测信度和效标关联系数,运用多因素线性回归分析筛选患者疲劳程度的影响因素.结果:206例患者中男84例,女122例,中位年龄50(18～76)岁.中文版FACIT-F量表的Cronbach'a系数为0.934,重测信度为0.971,与SF-36量表中“活力”维度的效标关联系数为0.591(P＜0.01).多因素线性回归分析显示,女性(P=0.022)及血小板计数偏低(P=0.007)是ITP患者疲劳的独立危险因素.结论:中文版FACIT-F量表信效度良好,可作为国内ITP患者疲劳的评价工具.女性ITP患者可能更易受到疲劳困扰;提升血小板计数有助于改善疲劳状态.

"不仁"又为"麻木",历代多有论述,而张仲景以"营卫阴阳立论",最具临证指导价值,清代医家林珮琴《类证治裁》设立专篇.多发性骨髓瘤治疗相关性周围神经病变,西医尚无确切有效治疗药物和方法,我们认为与药物戕伤,阳气受损,营卫不和,浊邪阻络有关,治重益营卫以使气血充盈,温阳气以使浊邪消散,化痰瘀以使气血畅通,柔肝阴以使筋脉和利.故治拟益气温阳,调和营卫,柔肝舒筋,活血通络.方以黄芪桂枝五物汤、吴茱萸汤、肾气丸、止痉散等加减,可获良效.

卡波济肉瘤(Kaposi's sarcoma)又名多发性良性色素性特发性出血性肉瘤,属于内皮细胞肿瘤.该病在我国较为罕见,主要发生于新疆地区.由于获得性免疫缺陷综合征(AIDS)的蔓延,发病率明显上升[1],其发生与感染人类第8型疱疹病毒(HHV-8)相关.本文报告本院最近确诊的1例经典型卡波济肉瘤,报道如下.

Chronic immune thrombocytopenic purpura is still a difficult problem in the western medicine field because of its long course of illness (>12 months) and easy to relapse.Professor ZHANG Yacheng thougth that CITP pathogenesis is deficiency of both qi and yin, according to the age of its unique physiological characteristics and clinical manifestations, on the treatment of supplementing qi and nourishing yin, each age respectively, to highlight spleen, nourishing the liver and blood, and in order to guide the clinical medication, the effects are significant.

圆运动理论为现代中医学重要的理论补充,如太极、八卦、子午流注等.基于育龄期女性特有的月经周期现象,提出了遵循圆运动生物钟节律的“调周法”.基于圆运动理论从人体血小板的产生及衰亡、月经周期的阴阳消长转变及气机的升降出入对育龄期女性免疫性血小板减少症的辨治进行探讨,旨在为临床治疗拓展思路.

多发性骨髓瘤,其病因病机为肾精亏虚,邪毒内蕴,瘀血阻络,痰湿内停,治疗上以补肾填精、凉血解毒、活血通络、化痰祛湿为基础辨证施治,从而达到提高机体免疫,促进骨髓造血,抗肿瘤,镇痛,抗菌抗炎,抗凝溶栓等效果.西医多采用化疗治疗,但常致周围神经病变的产生.结合中医治疗,既可促使化疗药到达骨髓病变部位,增加化疗敏感性,又可有效提高病人生活质量.

目的 观察养血平障汤治疗慢性再生障碍性贫血的临床疗效.方法 21例慢性再生障碍性贫血患者给予养血平障汤治疗,每日1剂,同时常规给予对症支持治疗.3个月为1个疗程,共治疗2个疗程后判定临床疗效、中医证候疗效,观察外周血象[包括血红蛋白(Hb)、白细胞(WBC)、血小板(PLT)]及不良反应. 结果 临床疗效:基本治愈3例(14.29％),缓解3例(14.29％),明显进步5例(23.81％),无效10例(47.61％),总有效率为52.39％.中医证候疗效:临床痊愈4例(19.05％),显效6例(28.57％),有效5例(23.81％),无效6例(28.57％),总有效率71.43％.治疗后21例患者的WBC、Hb及PLT水平较治疗前均有明显升高(P＜0.01). 结论 养血平障汤治疗慢性再生障碍性贫血临床疗效肯定,可提高外周血WBC、Hb、PLT水平.

Objective To investigate the clinical characteristics and outcome of T-cell acute lymphoblastic leukemia (T-ALL) with SIL-TAL1 rearrangement.Methods 62 newly diagnosed T-ALL patients including 15 patients with SIL-TAL1 rearrangement were systemically reviewed.Results Compared with SIL-TAL1-T-ALL patients,SIL-TAL1 + T-ALL patients was characterized by higher white blood cell count (P =0.029) at diagnosis,predominant cortical T-ALL immunophenotype (P =0.028) of the leukemic blasts,a higher prevalence of acute tumor lysis syndrome (P ＜ 0.001) and disseminated intravascular coagulation (P ＜ 0.001),which led to a higher early mortality (26.7 ％ (4/15) vs 4.3 ％ (2/47),P =0.011).Compared with SIL-TAL1-patients,SIL-TAL1+ patients had shorter relapse free survival (2 months vs 12 months,P =0.007) and overall survival (4 months vs 25 months,P =0.002).Conclusion SIL-TAL1 rearrangement identifies a distinct subtype with inferior outcome which could allow for individual therapeutic stratification for T-ALL patients.