目的:探讨OSCE考核模式结合翻转课堂在血液科本科教学中的应用效果.方法:选择本学院2018年1月至2020年12月接受血液科学习的80名学生,将80名学生随机分为观察组与对照组,每组40名,对照组采用常规教学方式,观察组采用OSCE考核模式结合翻转课堂教学方式,对比两组学生的基础理论知识笔试成绩及OSCE考核成绩,对比两组教学模式的满意度.结果:观察组学生的基础理论知识笔试成绩及OSCE考核成绩明显较对照组高,P<0.05.观察组患者的血液新进展了解、提高参与度与积极性、临床思维习惯培养、对今后临床工作的帮助、医患沟通能力、临床分析问题能力评分明显较对照组高,P<0.05.结论:OSCE考核模式结合翻转课堂可提高本科血液教学的效果以及学生满意度.

目的 探讨急性白血病(AL)患者骨髓液中的血管紧张素-Ⅱ(Ang-Ⅱ)的表达及意义.方法 选取60例AL患者作为观察组,包括30例急性髓细胞白血病(AML)初发未治患者和30例急性淋巴细胞白血病(ALL)初发未治患者;另选取60例缺铁性贫血患者作为对照组.采用酶联免疫吸附试验(ELISA)测定两组患者骨髓液中Ang-Ⅱ含量并进行比较.结果 AML初发未治患者骨髓中Ang-Ⅱ含量(24.70±5.02)ng/ml明显高于ALL初发未治患者的(15.34±3.26)ng/ml及缺铁性贫血患者的(6.54±3.54)ng/ml,差异有统计学意义(P<0.01);ALL初发未治患者骨髓液中Ang-Ⅱ含量(15.34±3.26)ng/ml明显高于缺铁性贫血患者的(6.54±3.54)ng/ml,差异有统计学意义(P<0.01).AL患者化疗后缓解患者44例,化疗后未缓解患者10例,早期因感染、出血等原因死亡患者6例.化疗后缓解患者骨髓液中Ang-Ⅱ含量(11.70±5.02)ng/ml低于化疗后未缓解患者的(28.30±3.12)ng/ml,差异有统计学意义(P<0.01).结论 Ang-Ⅱ与AL的发生、发展密切相关,Ang-Ⅱ可能成为AL诊断、病情及治疗效果的新观察指标.

Objective:To explore the expression of heparanase (HPA) protein in leukemia cells.Method:The study group included 53 patients with leukemia and the control group included 20 patients with iron deficiency anemia.The expression of HPA protein in mononuclear cells of bone marrow was detected by Western blotting to compare the difference of HPA protein between the leukemia group and the control group,between the acute myeloid leukemia and the acute lymphocytic leukemia,between the primary acute leukemia and the chronic leukemia respectively.Result:The expression of HPA protein in leukemia group was higher than that in the control group (P＜0.05).The expression of HPA protein in patients with acute myeloid leukemia was higher than that in patients with acute lymphocytic leukemia (P＜0.05).The expression of HPA protein in patients with newly diagnosed acute leukemia was higher than that in patients with chronic leukemia (P＜0.05).Conclusion:The expression of HPA protein is high in the leukemia cells.It is different in various types of leukemia,and the expression in acute leukemia,particularly in acute myeloid leukemia,is more obvious.

目的 探讨血液肿瘤患者粒细胞减少期实施伊曲康唑治疗对并发真菌感染的预防疗效.方法 收集2015年12月—2016年12月本院收治的68例血液肿瘤粒细胞减少期患者作为研究对象.将其分为基础组(n=34,不干预)和干预组(n=34,伊曲康唑预防),统计分析两组患者真菌感染状况.结果 治疗后,干预组患者真菌感染发生率与基础组相比明显降低,差异具有统计学意义(P<0.05).干预组患者用药不良反应发生率与基础组相比,差异无统计学意义(P>0.05).结论 血液肿瘤患者粒细胞减少期实施伊曲康唑治疗可有效预防真菌感染的发生.

目的 探讨在临床工作中以出血为首发症状的原发性血小板增多症(ET)的临床表现及诊治体会.方法 对我院2014年6月～2016年6月收治的10例主要以出血为首发症状的原发性血小板增多症患者的临床资料进行分析、总结,针对不同表现给予的不同治疗.结果 10例ET患者治疗后血小板均较入院时明显下降,波动范围(290～899)×l09/L,2例消化道出血患者血红蛋白恢复正常,急性出血症状均得到控制.随访6个月时10例患者血小板先后恢复正常.结论 原发性血小板增多症容易合并血栓已被人们普遍认识且发病率较高,而出血虽也是此病的临床表现之一,但发病率低且报道较少,尤其对于短期急性出血所致失血性休克的报道更为罕见,所以快速明确病因积极的救治对疾病的预后尤为重要.

在各种血液肿瘤疾病中由于DNA的过度甲基化影响一些基因,从而调控细胞的生长、分化和凋亡.一些抑癌基因如P15、P16、P53的过度甲基化可能成为骨髓增生异常综合征(MDS)发病的重要原因,而其中DNA甲基化转移酶则具有关键作用.地西他滨作为一种新型的甲基化抑制剂,为MDS的治疗提供了新的思路,其作用靶点在于可以通过抑制DNA甲基化转移酶的活性而起到去甲基化的作用.本例患者为老年MDS转化为急性髓系白血病(AML)的病例,应用地西他滨化疗后取得良好效果,不良反应可控,有效延长生存期,改善生活质量.临床规范合理地应用地西他滨给MDS、AML患者带来新生的希望.

目的 研究分析伊马替尼与干扰素联合羟基脲治疗慢性粒细胞白血病的疗效.方法 选取我院收治的慢性粒细胞白血病患者68例作为研究对象.将患者随机分为观察组与对照组.观察组患者给予伊马替尼治疗,对照组患者给予干扰素联合羟基脲治疗.观察并比较两组患者的应用效果情况.结果 治疗后,两组患者的血液学疗效比较,差异无统计学意义(P>0.05).观察组患者细胞遗传学疗效优于对照组患者,差异具有统计学意义(P<0.05).结论 伊马替尼与干扰素联合羟基脲治疗慢性粒细胞白血病的临床疗效均较为确切,但伊马替尼在细胞遗传学方面疗效更加确切.

目的 探究去甲氧柔红霉素治疗急性白血病的临床疗效.方法 本次研究选取于2013年10月-2016年11月来我院就医的急性白血病患者(80例),通过患者自身经济能力进行分组,即经济能力较好的患者为观察组,经济能力较差的患者为对照组,分别给予去甲氧柔红霉素、柔红霉素治疗,探究两组患者近期疗效以及不良反应发生率的差异性.结果 观察组患者的近期疗效(完全缓解:50.00％)与对照组患者比较,差异有统计学意义,P＜ 0.05,而在不良反应发生率的比较中,观察组为77.50％(31/40),对照组为70.00％(28/40),P＞0.05,差异不具有统计学意义.同时,观察组患者的毒副作用与对照组患者的结果相对比,差异有统计学意义(P＜0.05).结论 去甲氧柔红霉素治疗急性白血病具有一定效果,可提高近期疗效.

MicroRNAs (miRNAs) play an important role in many human diseases including cancer. The aim of this study was to investigate the plasma expression level of miR-638 and explore its prognostic significance in acute myeloid leukemia (AML). Quantitative reverse transcription-polymerase chain reaction was used to examine plasma miR-638 expression level in the participants. Then the association between plasma miR-638 and clinical features of AML was analyzed. Our results demonstrated that plasma miR-638 was significantly reduced in AML patients compared to the healthy controls, and its level was increased in patients with complete remission. In addition, plasma miR-638 has a high accurate discrimination of the blood samples from AML patients and healthy volunteers. Plasma miR-638 expression level was significantly associated with various clinicopathological parameters including blast percentage and cytogenetics. Moreover, AML patients in the low plasma miR-638 expression group suffered statistically significant worse overall survival. Taken together, plasma miR-638 might be a promising biomarker useful to improve the clinical outcome of AML.

通过分析总结我院血液科在临床教学工作中的改革体会及效果,突出临床教学工作的目的及重要性,强调培养医学生的临床思维能力及综合素质,肯定教学模式的改革,促进教学质量的提高.

Clinical practice in the department of hematology always has the difficulties among the departments of internal medicine.To investigate the teaching method of clinical practice,we start from the following aspects:improving the attention of Medical intern on the importance of haematology,application of PBL teaching method and implementation the core idea of evidence-based medicine,in addation,strengthen the clinical skills training,in order to improve the clinical effect of practice.

Objective To explore whether the expression of heparanase (HPA) and other coagulation proteins on blast membrane could determine the hemostatic balance on the surface of leukemia cells.Methods 40 patients with leukemia (study group) and 20 patients with iron deficiency anemia (control group) were analyzed,the levels of TF,uPAR,HPA mRNA were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR).Results The levels of TF,uPAR,HPA mRNA in study group were higher than those in the control group (P ＜ 0.05).The levels of TF,uPAR,HPA mRNA in acute myeloid leukemia (AML) group (23 cases) were significantly higher than those in the acute lymphoblastic leukemia (ALL) (5 cases),chronic myelocytic leukemia (CML) (4 cases),chronic lymphocytic leukemia (CLL) groups (3 cases) (in control,AML,CML,ALL,CLL groups,TF levels were 0.66±0.03,2.56±0.37,1.33±0.06,1.93± 0.08,1.23±0.07,uPAR were 0.53±0.02,1.89±0.26,0.92±0.15,1.44±0.01,1.19±0.16,HPA were 2.37±0.24,1.42±0.13,1.68±0.09,1.54±0.12,respectively,all P ＜ 0.05).Conclusions The TF,uPAR and HPA predominate in leukemia cells.The expression of coagulation proteins on blast membrane may determine the hemostatic balance on the surface of leukemia cells,and the hemostatic balance on the blast surface may contribute to thombohemorrhagic syndrome manifestations in leukemic patients.

血管紧张素Ⅱ(angiotensin Ⅱ,ANG Ⅱ)是肾素-血管紧张素系统(renin angiotensin system,RAS)的一个主要生物活性激素,在调控血管内环境稳定中起重要作用.1996年Haznedaroglu等提出局部RAS的表达可影响生理和病理性血细胞产生的假设,经长时间研究[1],证实ANG Ⅱ受体1型(ANG Ⅱ type-1 receptor,AT1 R)在大鼠的造血系统和骨髓基质的CD 34+ (hematopoieticstem cell,HSC)中表达.ANG Ⅱ可以通过激活CD 34+细胞上的AT1 R来调节造血干细胞至红系和髓系祖细胞的增殖和分化过程.RAS参与了骨髓生理病理造血.

目的观察膜联蛋白Ⅱ（Annexin Ⅱ）在不同类型白血病细胞中的表达。方法研究组白血病40例,对照组20例。流式细胞仪检测白血病细胞表面膜联蛋白Ⅱ（Annexin Ⅱ）的表达。采用半定量逆转录聚合酶链反应（semi-quantitative reverse transcription polymerase chain reaction,RT-PCR）方法测定白血病患者骨髓单个核细胞中Annexin ⅡmRNA的含量。结果与对照组相比,白血病患者骨髓中白血病细胞表面Annexin Ⅱ的表达显著升高（P＜0.05）。白血病患者骨髓中单个核细胞Annexin ⅡmRNA的表达与对照组相比显著升高（P均＜0.05）。初发白血病中AML组细胞表面Annexin Ⅱ的表达及骨髓中单个核细胞Annexin ⅡmRNA的含量高于CML、CLL、ALL组（P均＜0.05）。结论白血病细胞中Annexin Ⅱ表达增高;不同类型白血病表达水平不同,急性白血病,尤其是AML表达更加明显。

目的探讨生长抑素与脑垂体叶素治疗肝硬化食管胃底静脉曲张破裂大出血的临床疗效。方法将75例食管胃底静脉曲张破裂出血患者随机分成两组,治疗组37例给予国产生长抑素治疗,对照组38例给予垂体后叶素治疗,观察两组治疗效果及不良反应。结果治疗组治疗效果优于对照组(P<0.05),且不良反应少。结论生长抑素治疗肝硬化食管胃底静脉曲张破裂出血效果显著。

<正>炎症反应与血栓性疾病的发生、发展密切相关。现在认为,氧化应激可能是血管内皮功能失调和损伤的核心环节,许多炎性介质可促进氧化应激反应,诱导组织因子(tissue factor,TF)释放。TF一方面是炎性反应的后果;另一方面,TF本身可起到前炎性反应的作用,加重炎性反应进程。组织因子途径抑制物(tissue factor pathway inhibitor,TFPI)是TF的生理抑制剂,对冠心病等起保护作用。推测TF与TFPI在血栓性疾病发病中起重要作用。

Objective On a retrospective analysis of clinical cases,understanding of thrombotic thrombocytopenic purpura(TTP) of the clinical features and treatment,to deepen understanding of the disease,improve diagnosis and treatment of TTP. Methods The hospital in May 2003~2010 September 8 cases of TTP diagnosis of clinical manifestations,treatment and prognosis were analyzed retrospectively. Results 8 cases of TTP patients,1 case of male,7 females,including 1 case of pregnancy,7 cases of clinical symptoms relieve,peripheral red blood cells break away,hemoglobin(HG),platelets(PLT),lactate dehydrogenase enzyme(LDH),serum creatinine(Scr),reticulocyte(Ret) has returned to normal;1 patient died because of delay plasma exchange treatment time. Conclusion Early plasma exchange therapy and then combined with glucocorticoids and immunosuppressive agents are effective treatment for TTP.

目的 本文主要探讨超声诊断脾肿大,鉴别来自于肝硬化还是血液系统疾病所致脾肿大的超声鉴别要点及临床意义.方法 应用超声诊断仪,3.5 MHz频率的探头,对包头医学院第一附属医院192例脾肿大患者进行检查,并与临床诊断结果相对照.结果 192例脾肿大患者,其中2例是血液系统肿瘤,临床诊断慢性粒细胞白血病,超声误诊为肝病所致脾肿大.结论 目前诊断脾肿大临床普遍首选超声,因为超声检查方便无创,能够给临床提供较为准确的诊断依据.但是必须结合临床,仔细观察图像,千万不要把血液系统疾病所致脾肿大,误诊为肝硬化造成脾肿大.

目的:探讨甲强龙联合丙种球蛋白治疗特发性血小板减少性紫癜(ITP)的疗效。方法:89例均为2002年1月~2010年1月在我科住院的成人患者,静脉应用甲强龙及丙种球蛋白冲击3~5 d,甲强龙1.0 g/d,丙种球蛋白20 g/d。之后均改为强的松片60 mg/d口服。结果:89例均接受甲强龙及丙种球蛋白冲击治疗,其中显效55例,占62%,有效24例,占27%,进步8例,占9%,无效2例,占2%。结论:甲强龙联合丙种球蛋白治疗方案安全有效,不良反应少,值得推广。

Objective To explore whether the expression level of heparanase (HPA) and its coagulation proteins on leukemic blast membrane could determine the hemostatic balance on the surface of leukemia cells.Methods Forty patients of leukemia were studied,and 20 patients with iron dificient anemia as the control group.Expression of tissue factor (TF),heparanase (HPA),tissue factor pathway inhibitor (TFPI),and urokinase plasminogen activator receptor (UPAR) on leukemic blast surfaces were analyzed by flowcytometry.Results The expression of TF,UPAR,and HPA in AML,ALL,CML,CLL and CRAL groups were significantly higher compared with the control group (t =.3.289,3.507,2.701,P ＜0.05; t =2.498,0.802,3.090,P ＜0.05; t =2.642,3.308,2.696,P ＜0.05; t =3.417,3.434,2.382,P ＜0.05; t =2.193,2.272,2.263,P ＜0.05).There were no significantly differences between the leukemic cell expression of TFPI and the control group (P ＞0.05).Expression of TF,UPAR,HPA in AML patients were significantly higher than ALL,CML and CLL groups (t =2.463,2.179,2.276,P ＜0.05; t =2.637,2.402,2.095,P ＜0.05; t =2.548,2.425,2.412,P ＜0.05).The levels of TF,UPAR and HPA in M3,M4 and M5 patients were higher than that of M1,M2 groups (P ＜0.05).There were no significantly differences among M3,M4 and M5 (P ＞0.05).Conclusions These results suggest that TF,UPAR and HPA are predominately expressed on leukemic blast surface,particularly in M3and M4,5 subtypes.The expression of coagulation proteins on blast membrane might determine the hemostatic balance on the surface of leukemia cells.