老年原发性肝癌患者介入治疗前后微循环的变化

目的 研究20例老年肝癌患者经导管化疗栓塞（TACE）治疗前后微循环的变化。方法 将导管经股动脉插入肿瘤区供血动脉进行药物灌注。结果 介入治疗后管襻模糊增，红细胞聚集、微血栓增多（P＜0．05），血浆粘度增加。结论 化疗药物冲击治疗对肝细胞功能、对微血管内皮细胞和血细胞的损害是介入治疗后微循环改变主要原因之一，所以介入治疗后改善肝癌患者微循环、增加血流量、加快血流速度、降低血液粘度，不同程度延缓并控制肿癌转移，延长患者生命有一定意义。     

化疗对恶性肿瘤患者甲襞微循环影响的临床观察

目的:观察化疗对恶性肿瘤患者甲襞微循环的影响。方法:采用自身对照方法,检测43例恶性肿瘤患者化疗前后甲襞微循环指标的动态变化,并设30例健康者作为对照组。结果:恶性肿瘤患者化疗前甲襞微循环形态积分、流态积分、管周状态积分和总积分值较健康对照组显著增高(P<0.05或P<0.01)。经过4个疗程化疗后,患者甲襞微循环的流态积分和总积分值明显增加,与化疗前相比,其差异有统计学意义(P<0.01)。结论:恶性肿瘤患者术后存在甲襞微循环障碍,化疗后可使患者这种微循环障碍加重。甲襞微循环检查可以作为肿瘤血瘀证诊断和疗效观察的客观指标之一。     

肌钙蛋白T阳性的甲襞微循环特征

目的 :通过观察肌钙蛋白T阳性患者的甲襞微循环变化 ,分析心肌微循环障碍与外周微循环的关系。方法 :选取肌钙蛋白T阳性的患者 ,检测其甲襞微循环并根据田牛微循环评分标准进行观察比较。结果 :观察组的外周形态、流态及袢周形态积分值与正常对照组比均有明显增加 (P均 <0 .0 1)。结论 :心肌微循环障碍与外周微循环障碍呈平行关系 ,这为临床早期预防疾病、诊断病情 ,提供了一项客观依据。     

老年结核性胸膜炎患者微循环障碍观察

老年结核性胸膜炎病人存在不同程度的微循环障碍［１］。通过对老年结核性胸膜炎患者和健康者的甲襞微循环及血液流变学的临床对照 ,了解老年结核性渗出性胸膜炎及合并肺结核患者在治疗前后的微循环变化。对象与方法１对象老年结核性胸膜炎患者３９例 ,平均年龄 (６２±６)岁。男２１例 ,女１８例。双侧胸腔积液９例 ,右侧胸腔积液１６例 ,左侧胸腔积液１４例。大量胸水 (胸水量超过第二前肋间 )为２１例 ,中等量积水 (胸水量在第二至四前肋 )１８例。合并肺结核者１１例。２方法采用２ＨＲＺ -４ＨＲＥ化疗方案加激素及胸穿排液术治疗 ,于…     

高血压病外周微循环功能状态

目的比较高血压患者与健康人外周微循环状态。方法用 ＷＺＤ 多部位微循环显微镜观察 １００例高血压患者和 ６０例健康人的甲襞微循环及球结膜微循环状态、结果高血压病人的甲襞微循环及球结膜微循环的积分值比健康人高（Ｐ＜０．０５Ｐ＜０．０５），甲襞微循环的形态积分值及流态积分值山比健康人高（Ｐ＜０．０５，Ｐ＜０．０５）。其变化与中医肝气郁结、瘀血阻络的病理改变相似。结论高血压患者多有不同程度的外周微循环功能障碍，可以用疏肝解郁。活血通络的方法治疗高血压。     

老年前期和老年期高血压病患者甲襞微循环的变化和意义

目的:探讨中老年高血压病患者甲襞微循环变化的特征及临床意义。方法:检测109例老年前期和老年期轻中度高血压病患者的甲襞微循环,并与58例健康中老年人作对照;比较老年前期和老年期高血压病患者甲襞微循环变化。结果:老年前期和老年期高血压病患者存在甲襞微循环障碍,甲襞微循环形态积分、流态积分、管周状态积分和总积分值均增高,与对照组比较有显著性差异。而老年期组甲襞微循环的管周状态、流态及总积分比老年前期组高。结论:中老年高血压病患者存在不同程度的微循环障碍,在治疗过程中辨证运用活血化瘀法以改善微循环有积极意义。     

泰必利、优布芬对头痛患者甲襞微循环的影响——附580例临床分析

观察580例头痛患者应用泰必利、优布芬治疗前甲襞微循环16项指标的异常率,有14项明显高于正常人(P<0.01),治疗后有13项指标明显低于治疗前(P<0.01)。讨论了患者外周微循环障碍与血管机能不稳定有关。认为外周微循环改变是本病病理改变的一部分;微循环障碍程度与病情轻重相关;微循环检查可作为本病判断疗效及估计预后的检测方法。     

核素89SrCl2治疗骨转移瘤患者的临床观察

目的探讨核素89SrCl2对骨转移瘤患者的治疗效果。方法 75例肿瘤患者经全身骨扫描显像证实存在多发性骨转移瘤,使用核素89SrCl2治疗后,通过统计分析比较治疗前后骨痛的缓解程度、外周血象的改变及骨转移灶变化情况。结果核素89SrCl2治疗骨转移瘤疗效明确,75例患者中60例疼痛出现不同程度的缓解,缓解率达80%（P〈0.01）,其中19例患者疼痛完全消失;而治疗前后外周血象无明显改变;患者骨转移灶缓解率达89%（P〈0.01）。结论核素89SrCl2对骨转移瘤患者的止痛效果好,毒副反应小,且骨转移灶缓解率高,是一种有效的治疗手段。     

老年恶性肿瘤、常见病患者及健康老年人的甲襞微循环观察

通过对141例恶性肿瘤患者与98例健康老年人及98例老年常见病患者的甲襞微循环观察分析,表明恶性肿瘤患者普遍存在着明显的甲襞微循环障碍,这种障碍较之增龄及老年常见病所致的甲襞微循环改变更为突出,提示恶性肿瘤的发生、发展过程与微循环功能状态存在着内在的联系。     

“抗帕颗粒”对脑梗死患者血液流变性及甲襞微循环的影响

目的：探讨“抗帕颗粒”对脑梗死患者血液流变性及甲襞微循环的影响。方法：80例脑梗死患者随机分为对照组及“抗帕颗粒”治疗组，并于治疗前后进行甲襞微循环及血液流变性的检测。结果：用药后血液流变学各项指标显著下降，甲襞微循环加权积分明显下降，肝肾功能及血象无明显变化。结论：“抗帕颗粒”能明显改善血液流变性及甲襞微循环，且无肝肾损害及抑制血细胞等副作用。     

急性淋巴细胞白血病患者CD4+CD25+调节性T细胞水平变化

目的 观察急性淋巴细胞白血病(ALL)患者外周血中CD4+ CD25+调节性T细胞(Treg)的变化,探讨其临床意义.方法 收集47例ALL初诊患者组、13例经化疗完全缓解组、9例未缓解组及20例健康对照组抗凝血,采用流式细胞仪检测CD4+ CD25+ Treg的水平.结果 CD4+ CD25+ Treg比例在ALL初...     

恶性葡萄胎患者化疗前后血清IL-2、SIL-2R和外周血B细胞和T淋巴细胞亚群检测的临床意义

目的:探讨了恶性葡萄胎患者化疗前后血清IL-2、SIL-2R和外周血B细胞及T淋巴细胞亚群水平及临床意义.方法:分别应用放射免疫分析、ELISA法和单克隆抗体法对32例恶性葡萄胎患者进行了血清IL-2、SIL-2R和外周血B细胞及T淋巴细胞亚群进行了检测,并与35名正常健康人作比较.结果:恶性葡萄胎患者在化疗前血清SIL-2R和B细胞数均非常显著地高于正常人(P＜0.01),而IL-2、CD3、CD4、CD4/CD8比值则显著地低于正常人组(P＜0.01),经化疗后6个月,与正常人比较仍有显著性差异(P＜0.05).结论:恶性葡萄胎患者是一种自身调节免疫异常的疾病.     

The Effect of Anti-Ia Antibody on Immunoglobulin-secreting Cells from Healthy Individuals and Myeloma Patients

Immunoglobulin-secreting cells (ISC) in the peripheral blood of healthy individuals and in the bone marrow, peripheral blood, or plasmacytomas of patients with multiple myeloma were enumerated by a protein-A plaque-forming cell assay after treatment with anti-Ia antibody and complement. Rabbit anti-human B-cell antisera and monoclonal anti-Ia antibody (OKIal) were used. By this treatment, the number of ISC in the peripheral blood of healthy individuals decreased to half, and that of M-protein-secreting cells from some patients with multiple myeloma also decreased markedly. In one patient, the number of M-protein-secreting cells in the bone marrow were markedly reduced by this treatment, but this was not the case after 6 months of chemotherapy, suggesting that the chemotherapy reduced chiefly the Ia-positive myeloma cells rather than Ia-negative myeloma cells.     

Assessment of chemotherapy-induced DNA damage in peripheral blood leukocytes of cancer patients using the alkaline comet assay.

The alkaline comet assay was employed to assess the pre- and post-treatment levels of in vivo DNA damage in peripheral blood leukocytes of cancer patients. During the study all patients were given antineoplastic drugs, mainly as polychemotherapy. To quantify the DNA damage, two different comet parameters were evaluated: the tail length and the tail moment. Our results indicate marked interindividual variations between baseline DNA damage in peripheral blood leukocytes recorded among cancer patients prior to the chemotherapy. After intravenous administration of various antineoplastic drugs, a significantly increased level of DNA damage in all cancer patients compared to their pre-treatment values was recorded The highest level of DNA damage was seen following administration of 5-fluorouracil, adriamycin, and cisplatin (FAP protocol). The results indicate that administration of antineoplastic drugs in standard protocols is accompanied by significant DNA damage in peripheral blood leukocytes. In order to diminish the potential risks of developing second neoplasms, a continuous biomonitoring of cancer patients after the ending of chemotherapy becomes important. Despite their limitations, present results confirm the usefulness of the alkaline comet assay as a sensitive biomarker of exposure that enables rapid and simple detection of primary DNA damage in peripheral blood leukocytes of cancer patients. Together with standard cytogenetic endpoints, the comet assay provides a powerful technique for the routine detection of critical DNA lesions produced after administration of antineoplastic drugs in the clinical settings.     

流式细胞术检测调节性T细胞方法的建立

目的建立流式细胞术（FCM）检测外周血CD4＋CD25＋调节性T细胞（Tregs）的方法，并观察紫杉醇联合卡铂治疗对晚期肺癌和乳腺癌患者外周血CD4＋CD25＋Tregs数量的影响。 方法19例晚期肺癌和10例乳腺癌患者均给予紫杉醇联合卡铂方案化疗，于化疗前1d和化疗后第7天采集患者外周血，分别加入鼠抗人CD4-FITC（异硫氰酸荧光素）/CD8-PE（藻红蛋白）/CD3-PerCP（多甲藻叶绿素蛋白）、CD25-FITC/CD127-PE/CD4-PerCP、CD3-FITC/CD（16＋56）-PE/CD45-PerCP单抗，并以分别加入同型鼠抗人IgG1-FITC、IgG1-PE、IgG1-PerCP抗体作为阴性对照。采用流式细胞术（FCM）检测化疗前后外周血CD3＋、CD4＋、CD8＋T细胞和CD4＋CD25＋Tregs、NK细胞所占比例并进行数据分析。实验重复3次。 结果与化疗前比较，晚期肺癌和乳腺癌患者化疗后外周血CD4＋CD25＋Tregs的比例均明显降低（6.82%±3.11%vs.5.48%±2.13%，P=0.045；6.38%±1.84%vs.3.88%±1.69%，P=0.007）；晚期肺癌患者化疗后外周血CD4＋T细胞的比例升高（48.84%±16.44%vs.56.35%±14.50%，P=0.006），CD8＋T细胞的比例降低（51.18%±16.44%vs.43.65%±14.50%，P=0.006），CD4＋/CD8＋T细胞比值升高（1.12±0.60vs.1.57±0.88，P=0.008），而CD3＋T细胞和NK细胞的比例均无明显变化；乳腺癌患者化疗后外周血CD3＋、CD4＋、CD8＋T细胞、NK细胞的比例和CD4＋/CD8＋T细胞比值均无明显变化。 结论成功建立了FCM检测CD4＋CD25＋Tregs的方法，联合应用CD4、CD25、CD127检测CD4＋CD25＋Tregs简便可行、重复性好，检测结果可靠、准确，比较适用于临床检验。紫杉醇联合卡铂能够降低晚期肺癌和乳腺癌患者外周血CD4＋CD25＋Tregs的数量。     

血循环肿瘤细胞检测在中晚期乳腺癌疗效评价及转移监测中的应用

目的 探讨血循环肿瘤细胞(CTCs)检测对中晚期乳腺癌疗效评价及转移监测的应用价值.方法 纳入中晚期乳腺癌患者100例,于第1、2、3周期化疗前3天内分别取外周血,采用免疫磁珠阴性富集联合免疫荧光染色法进行CTCs检测;于第3周期化疗前进行影像学疗效评价,比较化疗2周期后不同转归患者的CTCs情况;所有患者于第3周期化疗开始每个月随访,直至出现新增转移灶时终止;于全部化疗结束后3个月、6个月、9个月再次分别进行CTCs检测及影像学检查.结果 第1、2、3周期化疗前,中晚期乳腺癌患者的CTCs数目分别为(15.34±4.12)、(7.82±1.56)、(3.71±1.04),阳性率分别为73.00%、56.00%、29.00%,化疗1、2周期后的CTCs数目及阳性率均较初次化疗前显著降低(P<0.05);化疗2周期后,CTCs阴性患者及CTCs数目减少患者的总有效率(RR)(73.24%、66.20%)分别高于CTCs阳性患者及CTCs数目增加的患者,差异均有统计学意义(P<0.05);全部化疗结束后3个月、6个月及9个月,CTCs阴性患者的转移复发率(5.41%、10.91%、25.00%)均明显低于CTCs阳性患者.结论 外周血CTCs检测可用于中晚期乳腺癌的化疗疗效评价和转移监测,对乳腺癌具有一定的预后预测价值.     

High dose chemotherapy and peripheral blood stem cell transplantation for high risk primary breast cancer: a single center experience in Thailand

Twenty patients with high risk primary breast cancer underwent a high dose chemotherapy program at Ramathibodi Hospital, Bangkok. Eligible patients included 21 women who had a histological diagnosis of breast cancer with more than 10 axillary lymph nodes involved. The patients first underwent modified radical mastectomy, followed by conventional doxorubicin containing adjuvant chemotherapy, before entering the treatment program. Peripheral blood stem cells were mobilized with cyclophosphamide and G-CSF and were harvested by leukapheresis. High dose chemotherapy consisted of cyclophosphamide 5,625 mg/m2, cisplatinum 165 mg/m2 and carmustine (BCNU) 600 mg/m2 were subsequently given, followed by infusion of the harvested peripheral blood stem cells. The median duration of cytopenia after transplantation was 8 days (range 7-12). The median expense for the transplantation, in addition to the cost of mastectomy and conventional chemotherapy, was 224,396 Baht (approximately US $5,350). Three out of the first four patients developed interstitial pneumonitis within three months after transplantation. There was one fatal case which was the only regimen related mortality. BCNU was then reduced to 450 mg/m2 and lung complications were markedly reduced afterwards. The median follow up time was 37 months with a median disease free survival of 38 months and overall survival of four years at 84%.     

CD4+CD25+Treg在急性淋巴细胞白血病患者外周血中的表达及其体外实验研究

目的初步探讨CD4 CD25 调节性T细胞(CD4 CD25 regulatory T cells,CD4 CD25 Treg)在急性淋巴细胞白血病(acute lymphocytic leukemia,ALL)患者化疗前及化疗缓解后外周血中的表达水平,并研究患者血清能否诱导外周血CD4 CD25-T细胞转化为CD4 CD25 Treg。方法①采用流式细胞术分别检测ALL初诊组、化疗完全缓解或部分缓解组及正常对照组外周血中CD4 CD25 T细胞所占比例,然后通过荧光定量RT-PCR检测各组外周血中转录因子Foxp3mRNA的表达水平,并逐层分析比较。②采集正常人外周血单个核细胞后,对照组用正常人血清,实验组用患者血清并分别设浓度梯度进行培养,72h后采用流式细胞术、荧光定量RT-PCR分别检测CD4 CD25 T细胞和Foxp3mRNA表达。结果ALL化疗缓解组CD4 CD25 T细胞及Foxp3mRNA表达水平均明显高于ALL初诊组和正常对照组(P<0.05),后两者之间CD4 CD25 T细胞水平无统计学差异(P>0.05),但ALL初诊组Foxp3mRNA含量较正常对照组明显升高(P<0.01),差异具有统计学意义;并且血清培养对照组CD4 CD25 T细胞水平及Foxp3mRNA含量均明显低于实验组(P<0.05),且其表达并不随血清浓度的增加而升高。结论CD4 CD25 Foxp3 Treg在ALL初诊组及化疗缓解组患者外周血中比例明显升高,且初步表明患者血清中的可溶性物质可诱导外周血CD4 CD25 T细胞转化为CD4 CD25 Treg,提示CD4 CD25 Treg可能是ALL免疫抑制的一个重要原因。     

Long-term outcome after prophylactic lamivudine treatment on hepatitis B virus reactivation in non-Hodgkin's lymphoma

Hepatitis B virus (HBV) reactivation is the frequent complication after cytotoxic chemotherapy in HBsAg-positive non-Hodgkin's lymphoma (NHL) patients. Pre-chemotherapy viral load may be a risk factor and HBeAg-positive status is associated with increased viral load. The aim of this study was to investigate the long-term treatment outcome of lamivudine in preventing HBV reactivation and its associated morbidity according to HBeAg status. Twenty-four adult HBsAg-positive NHL patients were taken 100 mg of lamivudine daily before the initiation of chemotherapy. The median duration of lamivudine therapy was 11.5 months (range: 1-54 months) and the median number of chemotherapy cycles was 6 (range: 1-16 cycles). The steroid containing chemotherapy regimens were used in 18 patients (75%), and the anti-CD20 monoclonal antibody containing chemotherapy regimen was used in 6 patients (25%). Four patients received autologous peripheral blood stem cell transplantation without resultant HBV reactivation. Hepatitis related to HBV reactivation was developed in 1 patient among 14 HBeAg-positive patients and no one among 10 HBeAg-negative. One patient developed HBV reactivation after lamivudine withdrawal, and 4 patients developed the YMDD (tyrosine-methionine-aspartate-aspartate) mutation during lamivudine therapy. There were no statistical differences in HBV reactivation rate during chemotherapy according to the HBeAg status. Our results demonstrate that lamivudine should be considered preemptively before the chemotherapy for all HBsAg-positive NHL patients to prevent HBV reactivation, regardless of pre-chemotherapy HBeAg status. Finally, compared with the chronic hepatitis B patients, similar rate of HBV reactivation after lamivudine withdrawal and development of YMDD mutation was observed in NHL patients.