间充质干细胞对脐血CD34^＋细胞扩增及其细胞特性变化的影响

本研究探讨脐带间充质干细胞（MSC）对CD34^＋细胞（HSPC）体外扩增的支持作用及对CD34^＋细胞表面标志、归巢黏附分子、集落形成能力等干细胞特征变化的影响。用免疫磁珠法从新鲜分离的脐血单个核细胞分离CD34^＋造血干祖细胞（HSPC）；用MSC饲养层（feeder）制备经^137Cs照射的间充质干细胞饲养细胞（MSC feeder cells）。将CD34^＋细胞接种在不同的培养体系中，实验分为3组：HSPC＋CK组为培养液中加入细胞因子组合（SCF、FL和TPO），HSPC＋MSC组为CD34^＋细胞接种在MSC feeder上，HSPC＋MSC＋CK组同时加入细胞因子组合及MSC饲养细胞。培养后4、7、10、14天计数有核细胞总数（MNC），计算细胞扩增情况；用流式细胞术检测不同处理组间CD34^＋细胞及亚群免疫表型、归巢黏附分子和集落形成能力。结果表明：在2周的培养时间里，3组MNC和CD34^＋细胞均明显增加，MNC扩增数依次HSPC＋MSC＋CK组〉HSPC＋CK组〉HSPC＋MSC组。体外扩增10天内HSPC＋MSC＋CK组MNC得到大量的扩增，同时CD34^＋细胞的扩增亦较高。培养4天3组细胞CD34^＋比例较0天有明显下降（P〈0．01）；扩增后CD34^＋细胞比例：HSPC＋MSC组〉HSPC＋MSC＋CK组〉HSPC＋CK组（P〈0．01）；各组CD34^＋细胞亚型细胞比例有所不同，HSPC＋CK组4天时CD34^＋CD38^-细胞有一过性升高（62．71％），之后迅速降低，7天时为0．05％；HSPC＋MSC组7天时CD34^＋CD38^-细胞比例为18．92％，与HSPC＋CK组比较差异有统计学意义（P〈0．05）。从集落形成分析结果看出：MSC、细胞因子混合组扩增后细胞集落形成能力在不同时间点均维持在较高水平。结论：脐血CD34^＋细胞在体外短期培养（〈7天）下，MSC和细胞因子联合应用能同时使CD34^＋细胞得到明显的扩增并维持造血干祖细胞的生物学特征。     

203例慢性淋巴细胞白血病患者预后相关因素分析

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.     

203例慢性淋巴细胞白血病患者预后相关因素分析

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.     

硼替佐米为主的联合化疗方案加或不加造血干细胞移植治疗多发性骨髓瘤疗效分析

目的 观察以硼替佐米为主的联合化疗方案加或不加造血干细胞移植(SCT)治疗多发性骨髓瘤(multiple myeloma,MM)患者的疗效及不良反应.方法 31例初治或复发(难治)MM患者接受硼替佐米为主治疗.之后有6例患者接受SCT治疗.按照EBMT标准评价疗效,WHO标准判断不良反应.结果 ①有5例患者由于急性肾功能衰竭、肿瘤溶解综合征等原因终止治疗,其中3例死亡.可以统计疗效的26例患者共完成了99个疗程的治疗,总有效率(ORR)为80.8%.15例初治患者的ORR为100.0%.11例复发(难治)患者的ORR为54.6%.②15例初治患者中有7例完成了8个疗程的治疗,动态观察发现随着疗程的延长疗效不断提高.③6例初治患者化疗达完全缓解(CR)或接近CR(mCR)后行SCT治疗,其中1例复发,5例随访至移植后6～11个月仍持续CR.未采取SCT巩固的9例初治患者中除1例持续CR外有6例在停药后1～3个月复发或进展,2例失访.④多数治疗相关不良反应为l～2级,有3例患者因为末梢神经炎、窦性心动过缓等原因降低硼替佐米的用量,5例因严重不良反应终止治疗.结论 硼替佐米治疗初治及复发(难治)MM疗效肯定,但可能需要进行巩固治疗(如SCT)以维持疗效.硼替佐米不良反应多数轻微且可以耐受,但也应注意少见的严重不良反应.     

外周T细胞淋巴瘤非特指型的预后及治疗的研究进展

外周T细胞淋巴瘤非特指型（peripheral T—cell lymphoma,not otherwise specified,PTCL—NOS）是外周T细胞淋巴瘤中最常见的1种类型,它包括了大部分淋巴结性的未能独立分型的PTCL,是1种异质性的疾病。尽管近几年随着免疫治疗和分子靶向治疗的进展,某些亚型的非霍奇金淋巴瘤（non—hodgkin＇s lymphoma,NHL）患者预后和生存情况已有较大改观,但PTCL—NOS属于侵袭性淋巴瘤,与B细胞性NHL相比,总体预后较差。下面就最近关于PTCL—NOS的预后判断和治疗的研究进展做一综述。     

203例慢性淋巴细胞白血病患者预后相关因素分析

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.     

不同培养体系对脐带血造血干细胞扩增的影响

目的探讨不同培养体系对造血干细胞的体外扩增及其表型的改变。方法新鲜分离人脐带血单个核细胞（MNC），免疫磁珠法分选CD34^＋造血干细胞（HSC），计数富集得到的CD34^＋细胞，平均分为3组，每组含CD34^＋细胞2．2×10^5：A组（HSC＋CK）CD34^＋细胞接种于Stemline^TMⅡ无血清培养基中．加入早期作用因子FST组合（SCF、FL和TPO，质量浓度50ng／ml的SCF、质量浓度100ng/ml的TPO和FL），并于接种0d添加质量浓度20ng／mlIL-3：B组（HSC＋MSC）CD34^＋细胞接种于含MSC feeder的培养瓶．加入Stemline^TMⅡ无血清培养基：C组（HSC＋MSC＋CK）CD34^＋细胞接种于含MSC feeder的培养瓶．加入Stemline^TMⅡ无血清培养基，加入早期作用因子FST组合首剂添加IL-3（剂量同A组）。在培养后4、7、10、14d计数有核细胞总数，流式细胞术检测扩增细胞免疫表型的改变。结果0～14d培养后MNC细胞扩增数C组（HSC＋MSC＋CK）〉A组（HSC＋CK）〉B组（HSC＋MSC），P〈0．01。3组间CD34^＋细胞比例B组（HSC＋MSC）〉C组（HSC＋MSC＋CK）〉A组（HSC＋CK），P〈0．01。CD34^＋细胞绝对数也出现了明显增加，其中C组（HSC＋MSC＋CK）增加最为明显．其次是A组（HSC＋CK）。其中A组（HSC＋CK）培养4d较0d（14．68％）CD34^＋CD38^-细胞有明显增加（62．71％，P〈0．05），C组（HSC＋MSC＋CK）CD34^＋CD38^-细胞也略有增加（23．99％）：培养7d时，A组（HSC＋CK）、C组（HSC＋MSC＋CK）CD34^＋CD38^-细胞数明显下降，分别为4．44％和1.38％，而B组（HSC＋MSC）CD34^＋CD38^-细胞上升为18．92％，与0d时比较P〈0．05，与A组（HSC＋CK）、C组（HSC＋MSC＋CK）比较P〈0．05。结论MSC和细胞因子的联合应用，一方面使得总MNC细胞得到大量扩增，同时还使扩增后细胞保持CD34^＋免疫表型，培养体系中加入MSC能更有效／特异地扩增CD34^＋造虹干细胞群.     

异基因造血干细胞移植后免疫性肺损伤的诊断及治疗研究进展

随着造血干细胞移植(HSCT)成功率的逐渐提高,移植后并发症正成为影响移植疗效和患者生存质量的主要因素,移植后各种肺部并发症的发生率高达55%,移植相关的死亡有一半是由肺部并发症引起[1,2].     

203例慢性淋巴细胞白血病患者预后相关因素分析

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.     

263例慢性淋巴细胞白血病临床与实验室检查分析

目的 探讨慢性淋巴细胞白血病(CLL)的临床和主要实验室检查特点.方法 回顾性分析263例CLL患者的临床及实验室检查资料.结果 患者中位发病年龄为60岁,男女比例为2.17:1.35.4%的患者因查体或其他疾病检查发现,多处于疾病早期.乏力倦怠和淋巴结肿大是患者就诊最常见的原因,后者也是最常见的体征(54.8%).CLL患者常合并感染、结缔组织病和继发肿瘤,但发生自身免疫性溶血性贫血(AIHA)的概率较小,为1.5%.初诊患者外周血白细胞多在(10～100)×109/L,97.1%的患者淋巴细胞比例在0.50以上.骨髓增生活跃,99.4%的患者骨髓淋巴细胞比例在0.300以上.骨髓病理检查以弥漫性浸润为主(72.2%).细胞免疫表型CD5阳性细胞率为85.1%,CD25阳性细胞率为78.9%.CLL患者常合并免疫球蛋白降低,以IgM降低最常见.常规染色体检查不易发现异常.结论CLL多发于老年人,男性多见,临床特征和免疫表型有一定特点.