张某,男,67岁,主因"肠套叠手术后4天,发热伴意识障碍1天"于2022年5月9日收入某院重症医学科.入院前患者因"肠套叠"于当地县医院行"肠套叠复位术",术后第3天查血常规示:白细胞(WBC)16.31×109/L,中性粒细胞(N)14.03×109/L,淋巴细胞(L)1.14×109/L,红细胞(RBC)4.00×1012/L,血红蛋白(Hb)131.00g/L,血小板(PLT)20×109/L,血肌酐(SCr)225μmol/L,尿素氮(BUN)20.64mmol/L,白蛋白(Alb)29g/L;第4天复查血常规示:PLT12×109/L,SCr235μmol/L,BUN24.65mmol/L,Alb20g/L,患者出现嗜睡、言语混乱、发热、少尿等临床表现,测体温最高为39℃,每日尿量约400ml,遂转院至兰州.

驻马店市位于河南省中南部,是国家重要的商品粮生产基地和粮食生产核心区,素有"中原粮仓"的美誉.全市耕地面积1384万亩,农作物常年种植面积2600万亩,粮食产量160亿斤以上,占河南省的1/8;油料产量31亿斤,占河南省的1/4.全市在市场监管部门注册的农民合作社23694家,其中国家级示范社56家、省级示范社87家、市级示范社464家,这些合作社积极响应政府号召,在"三夏"生产中大展身手,为国家粮食安全作出了积极贡献.

探讨血府逐瘀汤对急性胰腺炎(AP)大鼠血清淀粉酶(AMY)、谷丙转氨酶(ALT)、内皮素(endothelin,ET)、血管内皮生长因子(VEGF)和血清炎症因子hs-CRP、TNF-α、IL-1β、IL-6水平的影响及作用机制.取SD大鼠60只,随机分为假手术组(SHAM)、AP模型组、甲磺酸加贝酯组(0.01 g/kg)、血府逐瘀汤低剂量组[8 g/(kg·d)]、血府逐瘀汤中剂量组[16 g/(kg·d)]、血府逐瘀汤高剂量组[32 g/(kg·d)].除血府逐瘀汤组给予相应剂量药物灌胃外,其余各组分别灌胃等体积的蒸馏水,连续给药7 d.第7天灌胃结束,除SHAM组外,各组分别采用胰腺被膜下注射5％牛磺胆酸钠诱导大鼠AP模型;于造模前12 h和造模后1 h,除甲磺酸加贝酯组大鼠尾静脉注射甲磺酸加贝酯外,其余各组分别大鼠尾静脉注射等体积的生理盐水.造模12 h后采血,检测AMY、ALT、ET、VEGF及血清炎症因子hs-CRP、TNF-α、IL-1β、IL-6水平,采用H.E染色观察胰腺组织病理变化.结果显示,与SHAM组比较,AP模型组大鼠AMY、ALT、ET、VEGF与血清炎症因子hs-CRP、TNF-α、IL-1β、IL-6水平均显著升高(P＜0.05);相比于AP模型组,甲磺酸加贝酯与血府逐瘀汤各剂量组大鼠AMY、ALT、ET、VEGF与血清炎症因子hs-CRP、TNF-α、IL-1β、IL-6水平均显著降低(P＜0.05).与SHAM组比较,AP模型组大鼠胰腺组织表现出不同程度受损;相比于AP模型组大鼠,甲磺酸加贝酯与血府逐瘀汤各剂量组大鼠胰腺组织均得到改善.结果提示,血府逐瘀汤对AP模型大鼠具有较好的治疗和预防作用,其作用机制可能是通过调节AMY、ALT、ET、VEGF及血清炎症因子hs-CRP、TNF-α、IL-1β、IL-6的表达水平,从而改善胰腺微循环障碍.

目的:观察扶正祛邪中药联合化疗治疗急性髓系细胞白血病的临床疗效,及对患者血清乳酸脱氢酶(Lactate Dehydrogenase,LDH)、β2-微球蛋白(β2-Microglobulin,β2-MG)及C反应蛋白(C-reactive Protein,CRP)水平的影响.方法:选择40例急性髓系白血病患者,随机分为对照组20例和试验组20例.对照组采用标准柔红霉素注射液联合+阿糖胞苷注射液(DA)方案化疗;试验组在化疗基础给予扶正祛邪中药辅助治疗,每日1剂,分2次口服.比较两组骨髓缓解率、不良反应发生率、中医证候积分等.检测两组患者血清 LDH、β2-MG和CRP水平.结果:治疗结果显示,试验组骨髓缓解率显著高于对照组(P＜0.05);试验组临床不良反应发生率、中医症状发生率较对照组均有降低;通过治疗前、治疗后LDH、β2-MG和CRP水平的检测,试验组数值较对照组显著降低,差异有统计学意义(P＜0.01).结论:中药联合化疗方案治疗急性髓系白血病的疗效显著,不良反应小,安全性高,可降低患者血清中LDH、β2-MG和CRP水平.

目的:观察中西医结合治疗真性红细胞增多症的临床疗效,及对患者血细胞、血凝及血液流变学指标的影响.方法:选择40例真性红细胞增多症患者,随机分为对照组20例和试验组20例.对照组采用标准西医治疗;试验组在对照组治疗的基础上给予辨证分型中医药治疗,总疗程为2个月,比较两组缓解效率、中医证候积分,检测两组患者血细胞、血凝和血液流变学水平.结果:试验组的总有效率高于对照组(P<0.05);治疗后两组的中医证候积分均降低(P<0.05),且试验组显著低于对照组(P<0.05);与治疗前相比,两组患者治疗后的红细胞(Red Blood Cells,RBC)、血红蛋白(Hemoglobin,HGB)、D-二聚体(D-Dimer,D-D)水平明显降低(P<0.05),且试验组患者治疗后的RBC、HGB、D-D水平比对照组低(P<0.05);治疗后两组患者血液流变学指标的下降程度显著(P<0.05);两组治疗后血液粘度水平均降低,组间差异有统计学意义(P<0.05).结论:西医治疗基础上联合中医药治疗真性红细胞增多症有助于降低血液粘度,预防血栓形成,改善临床症状.

OBJECTIVE To observe the expression of plasma microRNA (miR)-146a and miR-223 in children with acute lymphoblastic leukemia (ALL), so as to analyze the relationship between the two factors and the prognosis of children with ALL. METHODS 100 children with ALL treated in the hospital from January 2015 to December 2017 were selected, according to the standard of Chinese Children's Leukemia Group (CCLG)-ALL-2008 program, the children were performed standardized treatment in our hospital according to different risk degree, the follow-up results were obtained, the follow-up time was ≥36 months, and the follow-up time was till to March 2021, the recurrence and mortality of the children were used as prognostic indicators; the baseline data of the children at admission were inquired and recorded, the plasma miR-146a and miR-223 levels were analyzed at admission, and their correlation with the prognosis of children with ALL was analyzed. RESULTS During the follow-up period, 4 cases of children died while 18 cases recurred, which means 22(22.00%) children showed the poor prognosis; the plasma miR-146a level of the children in poor prognosis group at admission was higher than those in good prognosis group, while the plasma miR-223 level was lower than those in good prognosis group, the differences showed statistically significantly (P<0.05); the results of regression analysis showed that the over expression of plasma miR-146a and low expression of plasma miR-223 at admission might be associated with poor prognosis in ALL children, and might be a risk factor for poor prognosis in children (P<0.05); the ROC curve showed that the AUC of plasma miR-146a and miR-223 at admission alone or in combination showed the predictive value for the risk of poor prognosis in children with ALL(AUC >0.80); the results of correlation test showed that there was a negative correlation of plasma miR-146a with miR-223 levels at admission (r=-0.239, P=0.016). CONCLUSION Plasma miR-146a is overexpressed and miR-223 is low-expressed in children with ALL, the abnormal expression of the two factors is related to the prognosis of children with ALL.

探讨中医序贯疗法联合减低剂量的DA方案诱导化疗治疗初治老年急性髓细胞白血病(AML)的疗效及安全性.将90例初治老年AML患者按随机信封法分为2组,对照组45例仅进行减低剂量的DA方案诱导化疗,观察组45例在其基础上联合中医序贯疗法治疗(诱导化疗期在对照组基础上口服参芪杀白汤,骨髓抑制期则口服参芪仙补汤),2组均以4周为1个治疗周期,治疗2个周期后评估疗效.比较2组临床疗效、血常规变化情况、生活质量评分、化疗不良反应和长期疗效.结果显示:治疗后观察组CR率和总缓解率均高于对照组(P<0.05).治疗前2组血常规指标(WBC、Hb、PLT)差异无统计学意义(P>0.05),治疗后2组WBC、Hb、PLT均较治疗前下降(P<0.05),观察组各指标水平均高于对照组(P<0.05).治疗前2组生活质量评定量表(QOL-BREF)各维度评分无明显差异(P>0.05),治疗后2组症状、精神心理状态和生存质量评分均较治疗前下降(P<0.05),观察组症状、社会功能和生存质量评分均低于同期对照组(P<0.05).2组均有胃肠道反应、电解质紊乱、肝肾损害、感染等不良反应,观察组发生率低于对照组(P<0.05).2组一年生存率差异无统计学意义(P>0.05).中医序贯疗法联合减低剂量的DA方案诱导化疗治疗初治老年AML能提高近期疗效,改善患者骨髓抑制和生活质量,减少化疗不良反应,是老年AML患者可耐受且疗效较理想的治疗方案.

Introduction: Targeted therapy with microRNAs (miRNAs) has been a significant challenge in recent years. Studying the role and mechanism through which miRNAs regulate various cancer processes is very critical in cancer treatment, including acute lymphoblastic leukemia (ALL). Areas covered: This review summarizes the diverse roles of miRNAs in ALL and provides new perspectives in miRNA-based therapeutic strategies. Expert opinion: MiRNAs belong to a kind of endogenous non-coding small RNA with the length of 19 similar to 25 nucleotides. They inhibit the expression of target genes and participate in almost all essential physiological processes such as cell proliferation, apoptosis, differentiation, and inflammatory responses. Many miRNAs are abnormally expressed in tumor cells, suggesting that they might be related to the occurrence and development of tumor. ALL is a common hematological malignancy in children. Its clinical manifestation, morphology, immunophenotype, and genetic characteristics are highly heterogeneous. A number of miRNAs have been found to be abnormally expressed in ALL and related to the biological characteristics, clinical features, diagnosis, and treatment in ALL patients. The understanding of miRNAs could help reveal ALL pathogenesis and identify accurate molecular markers for ALL diagnosis, prognosis, and therapeutic targets.

为进一步推动水下湿法焊条电弧焊的应用,设计并研制一套能实现水下电弧摆动功能的湿法焊条电弧自动焊接试验系统.利用该系统进行水下摆动电弧焊条电弧焊焊接试验.试验结果表明:该系统能实现稳定的水下焊接过程,焊缝熔宽均匀.随着摆动幅度和摆动频率的提高,焊缝熔宽均有增大的趋势,焊缝铺展性的确得到改善,但同时电弧稳定性均呈不同程度的下降趋势.此外在短弧焊接条件下,水下湿法焊接易产生短路过渡,焊接电流和焊接电压波形波动较大,但该现象在摆动频率为2Hz时有所改善.

目的:探索髓白1号方联合化疗对AML患者骨髓液中Th17细胞的调控作用,为提高AML患者治疗效果与长期生存提供指导.方法:选取2017年4月-2019年8月在武威市人民医院血液科住院的AML患者70例,并以25名健康志愿者纳入对照组;然后AML患者根据治疗方案分为联合治疗组(髓白1号方联合化疗)和非联合治疗组(单纯化疗).采用流式细胞术检测骨髓液中CD3+CD161+IL-17+IFN-γ+T细胞的比例,采用ELISA法检测骨髓液中血管内皮生长因子(VEGF)、白介素17 (IL-17)的浓度.用SPSS 22.0统计软件对数据进行统计学分析.结果:初诊及复发的AML患者CD3+CD161+IL-17+IFN-γ+T细胞的比例、VEGF和IL-17浓度显著高于正常对照组(P＜0.001);而CR及DFS期AML患者的CD3+CD161+IL-17+IFN-γ+T细胞的比例、VEGF和IL-17浓度显著低于初诊及复发的AML患者(P＜0.001),且DFS期AML患者的CD3+CD161+IL-1TIFN-γ+T细胞的比例、VEGF和IL-17浓度与对照组无明显差异(P＞0.05).单纯化疗组AML患者CR期CD3+CD161+IL-1TIFN-γ+T细胞的比例、VEGF和IL-17浓度明显高于对照组(P＜0.05),而用髓白1号方联合化疗组AML患者的上述指标则与对照组无差异;单纯化疗组AML患者CR期CD3+CD161+IL-17+IFN-γ+T细胞的比例、VEGF和IL-17浓度高于联合治疗组AML患者(P＜0.05).联合治疗组的AML患者首次诱导化疗CR率明显高于单纯化疗组患者(P＜0.05),且复发率明显低于单纯化疗组患者(P＜0.05).结论:初诊及复发的AML患者骨髓中Th17细胞的表达水平明显升高,治疗后显著减低.髓白1号方联合化疗治疗AML可明显提高CR率,降低复发率.

OBJECTIVE To explore the regulation effect of myeloid leukemia No.1 Chinese herb medicine prescription combined with chemotherapy on Th17 cells in bone marrow fluid of AML patients, so as to provide guidance for improving AML treatment effect and patients' long-term survival. METHODS Seventy patients with AML who were hospitalized in Department of Hematology, Wuwei People's Hospital from April 2017 to August 2019 were selected and enrolled in AML group, 25 healthy volunteers were selected and enrolled in control group; then according to therapeutic regimen, AML patients were divided into 2 groups: combined therapy group (myeloid leukemia NO.1 Chinese herb medicine prescription combined with chemotherapy) and non-combined therapy group (chemotherapy alone). Flow cytometry was used to detect the ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells in bone marrow fluid, and ELISA was used to detect the vascular endothelial growth factor (VEGF) and interleukin-17 (IL-17) concentrations in bone marrow fluid. Statistical analysis was performed on the data with SPSS 22.0. RESULTS The ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, VEGF and IL-17 concentration in newly diagnosed and relapsed AML patients were significantly higher than those in the normal control group (P<0.001); while those in CR and DFS stage patients were significantly lower than those in newly diagnosed and relapsed patients (P<0.001), and the ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, VEGF and IL-17 concentration in DFS patients with AML were not significantly different from those in the control group (P>0.05). The ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, VEGF and IL-17 concentration in CR stage of AML patients treated with chemotherapy alone were significantly higher than those in the control group (P<0.05), but there was no difference between combined therapy group and the control group; the ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, the concentration of VEGF and IL-17 in CR stage of AML patients treated with chemotherapy alone were higher than those of patients treated with combined therapy regimen (P<0.05). AML patients treated with combined therapy regimen had a significantly higher complete remission rate compared with patients received chemotherapy alone (P<0.05), but the recurrence rate was significantly lower (P<0.05). CONCLUSION Th17 cells expression in bone marrow of newly diagnoses and relapsed AML patients significantly increase, and decrease significantly after treatment. Myeloid leukemia No.1 Chinese herb prescription combined with chemotherapy can significantly increase the CR rate and reduce the RL rate for AML.

目的:观察重组人血小板生成素(rhTPO)、环孢素A(CsA)及达那唑治疗原免疫性血小板减少症(ITP)的疗效和安全性.方法:选择2019年6月至2020年12月我院50例激素治疗无效或复发的ITP患者,随机分为对照组25例和观察组25例.对照组给予rhTPO注射液,皮下注射,1/日,持续14天.观察组在对照组治疗基础上给予CsA软胶囊4mg/(kg·d),达那唑胶囊0.2g/次,3/日,比较两组近期(两周内)、远期(六个月)的血小板恢复情况和不良反应发生率.结果:对照组和观察组治疗前及第3、7、14天的血小板计数无统计学差异(P>0.05);第1、2、3、6月的血小板计数观察组较对照组明显升高(P<0.05);观察组的肝脏毒性、肾脏毒性均显著低于对照组(P<0.05),两组的感染症状、消化道症状发生率比较无统计学差异(P>0.05).结论:rhTPO单药治疗ITP近期疗效显著,联合CsA、达那唑治疗,可显著提升远期疗效.

目的:观察髓白1号方联合地西他滨治疗老年急性髓系白血病(Acute Myeloid Leukemia,AML)的临床疗效,及对血清血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)和尿酪氨酸(Urinary Tyrosine,UT)水平的影响.方法:选择32例老年AML患者,随机分为对照组16例和实验组16例.对照组采用地西他滨方案治疗;实验组在地西他滨基础给予髓白l号方辅助治疗.比较两组骨髓缓解率,血细胞水平、中医证候积分、中医临床效果及不良反应等.检测两组患者的血清VEGF和UT水平.结果:实验组骨髓缓解率显著高于对照组(P＜0.05),血细胞水平明显优于对照组,治疗有效率明显高于对照组(P＜0.05),临床不良反应发生率、症状发生率较对照组均有降低.实验组治疗后VEGF、UT水平显著低于对照组,差异有统计学意义(P＜ 0.01).结论:髓白1号方联合地西他滨方案治疗老年AML的疗效显著,不良反应小,安全性高,可降低VEGF和UT水平.

OBJECTIVE To detect the level of vascular endothelial growth factor (VEGF) in bone marrow of patients with non-M3 acute leukemia (AL), and estimate its relationship with prognosis. METHODS From January 2016 to December 2019, 114 patients with AL in department of Hematology, Wuwei People's Hospital were selected as study group, and 25 healthy volunteers were enrolled as control group. The concentration of VEGF in bone marrow was detected by ELISA. The patients were divided into high and low concentration group according to the level of VEGF. The overall survival (OS) and event-free survival (EFS) were compared among different groups. RESULTS The level of VEGF in patients with AL was significantly higher than that in the control group. The median OS and EFS in the low concentration group was 34.5 and 32 months, respectively, while, in the high concentration group was 30 and 26 months, respectively. The differences between the two groups were statistically significant (P=0.010). There were significant differences in OS rate (P=0.035) and EFS rate (P=0.026) between low and high concentration group. Multivariate analysis showed that high VEGF concentration was an independent risk factor affecting OS (HR=2.619, 95%CI 1.070-6.406, P=0.035) and EFS (HR=2.221, 95%CI 1.074-4.552, P=0.031) in AL patients. CONCLUSION VEGF highly expresses in the bone marrow of patients with AL at initial diagnosis and relapse, and shows adverse effects on the prognosis.

目的 探讨自体骨植骨联合浓缩骨髓移植在全膝关节置换术(total knee arthroplasty,TKA)术中修复胫骨侧骨缺损的临床疗效.方法 自2014年1月至2018年1月甘肃武威市人民医院对合并骨缺损的重度膝关节骨关节炎患者行TKA术时采用自体骨植骨联合浓缩骨髓移植修复骨缺损,共12例19膝,其中男3例4膝,女9例15膝;年龄55～78岁,平均(68.0±5.5)岁;包容性骨缺损3膝,非包容性骨缺损16膝.记录术前及术后1周、1个月、3个月、半年、1年、末次随访时的美国膝关节协会评分(knee society score,KSS)和影像学检查,观察植骨后骨块愈合情况及假体有无松动下沉等.结果 所有患者术后获得门诊或信息平台随访,随访时间12～48个月,平均(23.0±6.5)个月.术后3个月植骨后区域均一期愈合.末次随访时,摄X线片未提示有骨吸收、假体松动下沉等发生.末次随访时,KSS功能评分由术前(23.9±5.3)分提高至(87.2±5.3)分;临床评分由术前(25.7±6.2)分提高至(85.4±7.2)分,差异有统计学意义(P＜0.05);优2膝,良16膝,可1膝,优良率达94.6％.结论 采用自体骨植骨联合浓缩骨髓移植在TKA术中修复骨缺损,可以促进植骨区域愈合,既能最大限度地保留骨量,又能很好地重建膝关节的稳定性.

目的:研究白刺果(Nitraria L.)对白血病NB4细胞的抑制作用.方法:采用MTT法研究白刺果对NB4细胞抑制作用,通过流式细胞仪进一步确定白刺果对NB4细胞的抑制周期,采用免疫印迹法探讨白刺果对相关蛋白的表达.结果:白刺果对白血病NB4细胞有明显的抑制作用,呈时间和浓度梯度依赖性,阻止细胞周期G2,且对半胱氨酸天冬氨酸蛋白酶3(Pro-caspase3)具有上调作用,下调抗凋亡蛋白B细胞淋巴瘤(B cell lymphoma/leukemia-2,Bcl-2)和细胞色素C(cytochrome C,C-myc)水平.结论:白刺果对白血病NB4细胞具有一定的抑制作用,该抑制作用通过激活线粒体途径Pro-caspase3及Bcl-2和C-myc起作用,其他途径有待于我们进一步研究.

目的:观察炙甘草汤加减治疗消化道肿瘤癌因性疲乏(cancer-related fatigue,CRF)的疗效,探讨CRF与血清皮质醇的关系.方法:选取就诊于武威市人民医院、处于康复期的胃癌或结直肠癌患者58例,将符合CRF诊断标准、中医辨证为气血两虚证的32例患者组成治疗组,将无CRF的患者26例组成对照组.对照组不予治疗.治疗组给予炙甘草汤(炙甘草、桂枝、党参、生地黄、阿胶、生姜、麦冬、麻仁、大枣).伴失眠者,加酸枣仁30 g、夜交藤15 g;有癌痛者,加酸枣仁30 g、延胡索15 g;脱发者,加鹿角胶10 g、何首乌10 g;呕吐,加半夏10 g、紫苏叶10 g;便秘者,加大黄6～10 g、白芍15 g.1 d 1剂,水煎,取汁约400 mL,分早晚2次温服.4周为1个疗程,治疗1个疗程.治疗结束,进行两组的组间及组内的疲乏状况、血清皮质醇水平对比.采用多维疲乏症状量表-简化版(MFSI-SF)和疲劳症状量表(FSI)检测疲乏状况,采用化学发光免疫分析法测定血清皮质醇水平.结果:与治疗前对比,治疗组治疗后MFSI-SF评分、FSI评分均降低,血清皮质醇水平升高,差异有统计学意义(P<0.05).治疗组治疗前的MFSI-SF评分、FSI评分较对照组高,血清皮质醇水平较对照组低,差异有统计学意义(P<0.05);治疗后,与对照组对比,差异无统计学意义(P<0.05).结论:炙甘草汤能有效改善消化道肿瘤CRF患者的疲乏状况,提高血清皮质醇水平;消化道肿瘤患者的CRF状况与血清皮质醇水平相关,即疲乏者较无疲乏者血清皮质醇水平低.

目的:观察血小板生成素(rhTPO)、白介素-11(rhIL-11)治疗HBV相关ITP的临床疗效.方法:回顾分析2017年1月至2019年3月我院血液科、肝病科就诊HBsAg(+)、HBV-DNA(+)需抗病毒治疗的ITP患者51例.根据用药情况分为观察组与对照组,观察组rhTPO联合泼尼松,对照组rhIL-11联合泼尼松.观察治疗第9天、第15天两组的完全反应(CR)、有效(R)、无效(NR)、总有效率.结果:治疗后第9天观察组CR率、R率及总有效率均明显高于对照组,NR率明显低于对照组,差异均有统计学意义(P<0.05).治疗第15天,两组CR率、R率、总有效率、NR率差异均无统计学意义(P>0.05).结论:rhTPO联合泼尼松治疗HBV相关ITP较rhIL-11联合泼尼松治疗HBV相关ITP提升血小板速度更快,较长时间维持血小板于安全水平,更早完成聚乙二醇干扰素抗病毒.

目的:提高对急性髓系白血病（AML）伴末梢闭塞性脉管炎皮肤溃烂的认识。方法:报道1例AML伴末梢闭塞性脉管炎皮肤溃烂病例的临床诊断思路、治疗过程及预后，并进行文献复习。结果:患者为35岁男性，2019年7月11日入住甘肃省武威市人民医院，诊断为AML（M 2b型），入院后行第1个疗程DA方案（柔红霉素+阿糖胞苷）化疗，10 d后患者左上肢皮下触及一个2.0 cm×0.5 cm的小结节，于2019年8月5日行第2个疗程IDA（盐酸伊达比星+阿糖胞苷）方案化疗。化疗过程中患者左上肢红肿明显，张力高，出现黄色透明分泌物，并有溃烂坏死现象，疼痛难忍，局部出现感觉障碍。经病理分析符合慢性脉管炎及脉管周围炎。经2周综合治疗，左上肢前臂溃烂坏死创面全部愈合。 结论:AML化疗中发生末梢（浅表）血栓闭塞性脉管炎致皮肤溃烂罕见，局部组织病理检查是诊断的关键。

1 病例资料患儿王某,男,9岁2月,2020年02月08日因“间断发热3天,咽痛、血小板减少2天”入院.入院前5天无明显诱因出现发热,Tmax38.0℃,自服退热药物,疗效欠佳,仍间断发热,就诊凉州区医院,查血常规:WBC 4.09×109/L,ANC 0.86×109/L, HGB 106g/L, PLT 48×109/L;CRP:21.9mg/L;骨髓穿刺示:增生明显活跃,粒系占47％,红系占30.0％,血小板少见;考虑脾功能亢进、免疫性血小板减少症.给予“利巴韦林、头孢曲松钠(罗氏芬)”等药物治疗,期间患者发热1次,Tmax38.5℃,之后未再出现发热,偶有鼻腔渗血.入院前1天血常规:WBC 1.27×109/L,ANC 0.86×109/L,HGB 106g/L,PLT 21×109/L.既往体健.入院查体:T 36.3℃,P 96次/分,R 22次/分,BP 91/58mmHg,体重24kg.神志清楚,精神稍差,睑结膜略苍白,咽部充血,扁桃体无肿大;浅表淋巴结未触及肿大.