目的 观察不同原发性血小板增多症(ET)基因突变患者的临床特征及其实验室检查结果的变化.方法 选择北京市海淀医院血液内科2015年7月至2020年6月收治的56例初诊ET患者.根据基因突变结果将患者分为JAK2突变组(n=40)、CALR突变组(n=6)和基因阴性组(n=10).比较三组患者的临床特征(性别、年龄、临床症状、血栓及栓塞事件等)和实验室检查指标[血小板数(PLT)、白细胞数(WBC)、血红蛋白(Hb)、纤维蛋白原(FIB)、血栓弹力图(TEG)、基因突变、乳酸脱氢酶(LDH)、血钾、血糖(GLU)]的差异.结果 JAK2突变组患者的平均发病年龄明显高于CALR突变组和基因阴性组,差异均有统计学意义(P<0.05),而三组患者的性别、脾脏是否肿大、TEG是否异常、是否发生血栓及栓塞事件比较差异均无统计学意义(P>0.05);CALR突变组患者WBC数、Hb水平明显低于JAK2突变组、基因阴性组,LDH水平则明显高于JAK2突变组、基因阴性组,而基因阴性组患者的GLU水平明显高于JAK2突变组、CALR突变组,差异均有统计学意义(P<0.05);三组患者的Plt数、FIB水平比较差异均无统计学意义(P>0.05).结论 JAK2基因突变的ET患者发病率高,年龄大,而CALR突变及CALR阴性患者WBC和Hb水平较低,故ET患者多样化的基因突变类型具有不同的临床特征.

目的:分析影响终末期恶性肿瘤生存期的因素.方法:回顾性分析2015年8月-2018年12月肿瘤科死亡患者62例的临床资料,先用Kaplan-Meier法计算生存期,对临终前患者外周血白细胞总数、血红蛋白、血小板计数、白蛋白、中性粒细胞百分比、胆固醇、甘油三酯、乳酸脱氢酶、尿酸等指标进行单因素分析,找出对终末期恶性肿瘤患者生存期影响较大的指标.结果:62例患者,入院到死亡的中位生存时间为8 d;中性粒细胞百分比与生存期有明显相关性.结论:本研究分析了影响终末期恶性肿瘤患者生存期的相关血液指标,有利于临床更准确地预测患者生存期.

目的 探讨血栓弹力图(TEG)检测晚期结直肠癌初诊患者的价值和意义.方法 选取80例合并血栓的晚期结直肠癌患者为结直肠癌合并血栓组,选取80例未合并血栓的晚期结直肠癌患者为结直肠癌未合并血栓组,选取80例体检健康者为对照组,对3组研究对象行TEG、传统凝血功能检测,比较3组研究对象的TEG参数和传统凝血功能指标,并对3组中测量数值超出正常范围的研究对象的TEG参数进行比较.结果 结直肠癌合并血栓组、结直肠癌未合并血栓组和对照组的综合凝血指数(CI)值,以及凝血时间(K)值、凝固角(Angle角)值、最大振幅(MA)值和CI值异常比例比较,差异均有统计学意义(P<0.05);结直肠癌合并血栓组的CI值明显高于结直肠癌未合并血栓组和对照组,结直肠癌未合并血栓组的CI值明显高于对照组(P<0.05);结直肠癌合并血栓组、结直肠癌未合并血栓组和对照组的凝血酶原时间、活化部分凝血活酶时间、凝血酶时间和纤维蛋白原水平比较,差异均无统计学意义(P>0.05);TEG检出123例(76.9％)患者的凝血功能存在异常,而传统凝血检验指标检出92例(57.5％)患者的凝血功能存在异常,组间比较差异有统计学意义(χ2=13.622,P<0.05).结论 对晚期结直肠癌患者行TEG检测可以有效反映患者的凝血状态,进而有效预防血栓、栓塞等并发症,值得临床推广.

目的 探讨老年恶性肿瘤化疗患者网织红细胞参数的变化及其临床意义.方法 选取2016年1月至2019年10月在北京市海淀医院就诊的老年恶性肿瘤患者120例纳入研究组,另选取来我院体检的健康老年人60例纳入对照组.检测对照组受试者的白细胞(WBC)、血小板计数(PLT)、网织红细胞参数,以及研究组患者化疗前和化疗后3 d、1周、2周和3周的WBC、PLT、网织红细胞参数.结果 研究组患者化疗前的高荧光强度的网织红细胞百分率(HFR％)和网织红细胞百分率(RET％)分别为(2.63±0.81)％和(1.44±0.41)％,明显大于对照组的(1.13±0.23)％和(1.10±0.32)％,差异均有统计学意义(P<0.05);两组受试者的中荧光强度的网织红细胞百分率(MFR％)、WBC和PLT值比较差异均无统计学意义(P>0.05);化疗后3 d,研究组患者的网织红细胞绝对数(RET)、未成熟网织红细胞指数(IRF)值分别为(0.51±0.04)×1012/L和(7.18±2.62)％,明显小于化疗前,且差异均有统计学意义(P<0.05);化疗后1周,研究组患者的RET和IRF值最低,分别为(0.16±0.02)×1012/L和(4.13±1.25)％,化疗后2周RET、IRF值回升,分别为(0.83±0.11)×1012/L和(8.69±2.37)％,化疗后1周和2周与化疗前比较差异均具有统计学意义(P<0.05),但化疗后3周,RET、IRF值恢复至化疗前水平,差异均无统计学意义(P>0.05);化疗后2周,研究组患者的PLT、WBC值达到最低,分别为(125.06±32.14)×109/L和(3.99±0.86)×109/L,与化疗前比较差异具有统计学意义(P<0.05);化疗后3周有所回升,与化疗前比较差异均无统计学意义(P>0.05).结论 网织红细胞参数可用来监测恶性肿瘤老年患者化疗后的骨髓造血功能的抑制作用,其中网织红细胞参数中RET和IRF在化疗后检测骨髓造血功能抑制以及恢复方面的敏感度更高,因此,在恶性肿瘤临床化疗治疗过程中,RET和IRF对治疗方案的调整、用药时机的选择具有指导意义.

Objective To explore the value of color Doppler ultrasonography in Argon-Helium cryoablation treatment of tumors.Methods Twenty-seven patients (31 times) of tumors were treated with Argon-Helium cryoablation under the guidance of color Doppler ultrasound and punctuation-guide device.All patients received enhanced CT,and the melted volume was calculated.Results Of all 27 patients,24 received once cryoabation,the other three received at least 3 times because tumors were larger and scattered.The treatment programs were disposed on the basis of the size of the tumors.The ice ball presented a half circle shape being followed by phonic shadow; and became larger rapidly in the first 15 min,whereas in 15—20 min,the development of the ice ball was slow,and the ice ball covered smaller as the size of the tumor grew larger.Conclusion In the argon-helium cryoablation of tumors,color Doppler ultrasound is useful for real time observation,therefore is highly effective in clinic treatments.

目的分析晚期恶性肿瘤患者凝血、抗凝、纤溶系统的改变,探讨晚期肿瘤患者的凝血状况。方法采用酶联免疫吸附双抗体夹心法检测50例晚期恶性肿瘤患者和50例正常人的凝血、抗凝、纤溶系统和内源性抗凝活性相关的实验室指标,包括血浆纤维蛋白原(Fbg),血管性血友病因子抗原(vWF),组织型纤溶酶原激活剂(t-PA),尿激酶型纤溶酶原激活剂(u-PA),纤溶酶原活化抑制物-1活性(PAI-1),D-二聚体(D-dimer)。结果晚期恶性肿瘤患者的血浆D-二聚体、纤维蛋白原、组织型纤溶酶原激活剂、纤溶酶原活化抑制剂-1活性的水平较正常人显著升高。结论晚期恶性肿瘤患者存在凝血、抗凝、纤溶系统的激活,机体呈现高凝状态。

Objective To explore the clinical manifestation, treatment and prognosis of essential thrombocytemia (ET).Methods A retrospective analysis was conducted on 40 ET cases treated in this hospital during May,1994 to Dec,2007.Results 40 cases (28 males and 12 females with a median age of 57 years) were diagnosed, thrombosis occurred in 8 cases(20.0%), hemorrhage occurred in 3 cases(7.50%), and 6 cases(15.0%)seeking medical advice due to splenomegaly,16 cases(40.0%)confirmed by routine blood examination due to other causes, 7 cases(17.5%)exhibiting only such nonspecific symptoms as dizziness or fatigue. The median thrombocyte count at diagnosis was 985×109/L (range from 699×109/L to 1200×109/L ). Bone marrow biopsy was performed in all cases and local fibrosis was revealed in 3 cases; Ph chromosome and BCR/ABL were negative in all cases, 4 cases were positive for JAK2/V617F. Among 28 followed-up cases, one patient evolved into marrow fibrosis, and other patients are stable. The effective rates of 23 patients treated with hydroxyurea (Hu) and 17 patients treated with Hu combined with interferon (IFN) were 88% and 95% respectively.Conclusions The main clinical manifestations of essential thrombocythemia were thrombosis and hemorrhage. A good therapeutic effect can be achieved by treatment of hydroxyurea or hydroxyurea combined with interferon with favorable prognosis.

Objective To explore the clinical significance of platelet-associated antibody(PAIg)and T lymphocytes subsets in patients with idiopathic thrombocytopenic purpura (ITP) .Methods PAIgG and T lymphocyte subsets were detected by enzyme linked immunosorbent assay(ELISA)and flow cytometry (FCM).Results PAIg in ITP group was higher than that in normal group(P<0.01=. The percentage of CD3+, CD4+ and the value of CD4+/CD8+ was lower in ITP patients. The percentage of CD8+ and CD19+ was higher. There was significant difference between ITP group and normal group(P<0.01).Conclusion PAIg and the changes of T lymphocyte subset can reflect the pathogenesis of ITP.

血管生成与肿瘤的生长、侵袭和转移密切相关,目前抑制血管生成作为靶点治疗肿瘤成为抗肿瘤治疗新疗法之一.血管生成抑制素(angiostatin)是纤溶酶原在体内的天然水解产物,能够有效抑制血管内皮细胞的增殖、迁移和管状结构的形成而参与对血管生成过程(angiogenesis)的调节.本文主要介绍近年来关于血管生成抑制素的研究进展以及作为治疗药物的应用前景。

Objective To investigate the character,affecting factor and clinical significance of the detection value of T lymphocytes sub-group and natural killer (NK) cells in peripheral blood of patients with advanced malignant tumor.Methods T lymphocyte sub-group and NK cells in peripheral blood of 60 patients with advanced malignant tumor (patient group) and 30 normal individuals (control group) were detected by flow cytometry (FCM).Results In the patient group,the percentage of CD3+,CD4+ and NK16+56+ decreased and CD8+ increased,the value of CD4+/CD8+ decreased.There was significant difference between the two groups (P<0.05).The age and sexuality of patients,the region and category of tumor didn't influence the expression of T lymphocyte sub-group and NK (P<0.05).Conclusions The function of cellular immunity is abnormal in patients with advanced malignant tumor.It is of active significance for the choice of immune therapy.

Objective The character, influence and significance of value of T lymphocytes sub-group and NK cells in patients with gastric cancer. Methods T lymphocyte subset and natural killer in peripheral blood of 50 patients with gastric cancer and 50 healthy man were detected by flow cytometry(FCM). Results The percentage of CD3+, CD4+ and NK16+56+ decrease, the percentage of CD8+ increase, the value of CD4+/CD8+ decrease, there are significant difference between the cancer patient and the healthy control (P<0.05);the change is related to the TNM pathological stage, not to the histological types of the tumors.Conclusion The function of cell immune is low in patients with gastric cancer, and even worse in the lower grade of TNM stage. It is of active significance for the choice of immune therapy.

Objective To observe the curative effect and side effect of recombinent human tomor necrosis factor(rhTNF) injection on treating malignant ascites.Methods After all ascites was sucked from abdominal cavity,rhTNF was injected into abdominal cavity,three times a week until ascites didn't come out.Results Among 30 patients with malignent ascites,12 patients obtained complete response(CR),14 partial response(PR) and 4 no change(NC),the overall response rate was(86.6%).Conclusions The rhTNF is effective on malignent ascites without obvious side effect,and it can improve patients' life quality,especially suitable for patients who couldn't able to endure chemical therapy.