【摘要】 目的 對原發性腸道非霍奇金淋巴瘤穿孔患者的臨床及病理特征、診治、預后進行探討。 方法 回顧性分析1999年1月-2008年12月診治的17例原發性腸道非霍奇金淋巴瘤穿孔患者的臨床資料。 結果 B細胞型9例，T細胞型8例。17例原發腸道非霍奇金淋巴瘤穿孔患者的穿孔部位:大腸7例，小腸7例，回盲部3例。所有患者均行手術治療。除2例穿孔前行化療的患者以外，其余患者術前均未明確診斷。有14例獲得隨訪結果，6例術后3個月內死亡，術后接受化療者7例，1、2、3年生存率分別為41.2%、 23.6%、11.7%，僅1例生存期超過5年。 結論 原發性腸道非霍奇金淋巴瘤穿孔術前診斷困難，預后極差。【Abstract】 Objective To analyze the clinical features, diagnosis, therapy and prognosis of primary intestinal non-hodgkin′s lymphoma perforation. Methods The clinical data of 17 patients with the primary intestinal non-Hodgkin′s lymphoma perforation from January 1999 to December 2008 were retrospectively analyzed. Results Nine patients had intestinal B-cell lymphoma, and eight had intestinal T-cell lymphoma. The sites of perforation were as follows: colon and rectum in 7 (41.2%), ileum and jejunum in 7 (41.2%), and ileocecal junction in 3 (17.6%). All patients had undergone the operations. The disease was not diagnosed before the operation in all of the patients except for the Two patients had a history of systemic chemotherapy before perforation. A total of 14 patients were followed up, in whom six died within three months after the operation; the survival rate 1, 2, and 3 years after the operation was 41.2%, 23.6%, and 11.7%, respectively in seven patients who had undergone the systemic chemotherapy before the operation; one patients lived more than 5 years. Conclusion The diagnosis of primary colonic malignant lymphoma perforation is difficult; the prognosis is miserable.
目的 提高對成人系統性Epstein-Barr（EB）病毒陽性T細胞淋巴組織增殖性疾病（ASEBV+T-LPD）腸道病變的認識。 方法 報道2012年3月－10月我院收治的2例以腸道病變為首發表現的ASEBV+T-LPD，并結合3例文獻報道進行分析討論。 結果 2例成人患者以腹瀉為主要表現，伴有發熱、淋巴結長大，初期分別誤診為結核及腸道感染，淋巴結病檢提示多克隆EBER+的T淋巴細胞浸潤，確診ASEBV+T-LPD。例1經3 周期GLIDE方案（吉西他濱+門冬酰胺酶+異環磷酰胺+地塞米松+依托泊苷）化學療法（化療）后疾病進展，死于肺部感染。例2經干擾素聯合抗病毒藥物治療，病情穩定。復習文獻目前僅3例以腸道病變為首發表現的ASEBV+T-LPD被報道，早期均被誤診為炎性腸病或感染，3例均出現腸道穿孔或大出血等并發癥，其中2例死亡。 結論 成人系統性EB病毒陽性T細胞淋巴組織增殖性疾病的腸道病變較為罕見，容易誤診為結核及炎性腸病。部分患者病情進展迅速，可出現腸道穿孔及消化道大出血等致死性并發癥，死亡率高，預后差。確診本病需密切結合臨床和病理學檢查。常規化療及抗病毒治療僅部分有效，不能維持長期緩解。
【摘要】 目的 分析異基因造血干細胞移植術（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相關的危險因素，動態監測受者尿BK病毒（BK virus，BKV），分析其與HC發病的關系。 方法 回顧性分析2003年3月-2008年1月期間接受allo-HSCT的121例患者的資料，選擇8個臨床參數[年齡、性別、疾病類型、移植時疾病狀態、供者類型、預處理方案、急性移植物抗宿主病（acute graft-versus-host disease，aGVHD）、aGVHD的預防方案]作COX回歸分析。采用SYBR Green染料實時熒光定量聚合酶鏈反應法對2006年9月-2008年1月42例allo-HSCT患者尿BKV載量進行動態監測，分析被檢查者尿液BKV基因載量與HC發生以及嚴重程度的關系。 結果 121例患者中有24例發生HC，發病時間為術后0~63 d，中位時間40 d；持續時間7~150 d，中位時間22 d。Ⅱ~Ⅳ度aGVHD為HC的獨立危險因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV檢出率為100%（42/42）。與正常人及未發生HC的allo-HSCT受者相比，HC患者尿中BKV基因載量具有更高平均峰值。 結論 Ⅱ~Ⅳ度aGVHD，尿中BKV DNA高載量與HC的發生有相關性。【Abstract】 Objective To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC. Methods The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC. Results Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load. Conclusions Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.
【摘要】 目的 分析異基因造血干細胞移植術（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后并發毛細血管滲漏綜合征（capillary leak syndrome，CLS）的發生率、危險因素和結局，并探討其防治措施。 方法 回顧性分析2005年6月-2011年2月住院的allo-HSCT術后14例并發CLS的臨床資料。 結果 CLS發生率為9.2%（14/152）。年齡、性別、診斷、HLA配型、預處理、CD34+細胞量、粒細胞集落刺激因子（granulocyte colony-stimulating factor，G-CSF）用量、植入時間均不能認定為造血干細胞移植后CLS誘發因素。 結論 HSCT術后CLS誘因尚不清楚，采用限水、減量G-CSF、使用糖皮質激素和羥乙基淀粉等措施及時治療，有助于控制CLS。【Abstract】 Objective To study the occurrence rate, risk factors and outcomes of capillary leak syndrome (CLS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and discuss its prevention and treatment. Methods We retrospectively analyzed the clinical records of 14 allo-HSCT recipients complicated with CLS from June 2005 to February 2011. Results Fourteen out of 152 patients developed CLS with a cumulative incidence of 9.2 %. None of the 8 clinical parameters including age, gender, underlying disease, donor type, conditioning regimen, CD34+ cell dose, granulocyte colony-stimulating factor (G-CSF) dosage, and days to neutrophil engraftment could be identified as risk factors for the occurrence of CLS. Conclusions Risk factors for CLS after allo-HSCT have not been fully established. Restriction of water intake, administration of corticosteroids and hydroxyethyl starch can be beneficial for patients with CLS.
【摘要】 目的 探討自體造血干細胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）治療侵襲性NK/T細胞淋巴瘤的療效。 方法 對我科2005年1月16日收治的1例侵襲性NK/T細胞淋巴瘤患者的造血干細胞移植和隨訪資料進行回顧性分析，并復習國內外相關文獻。 結果 患者為37歲女性，診斷結外鼻型NK/T細胞淋巴瘤，系統性，經CHOAP和ICE方案化學療法、手術、局部放射治療控制病情良好后，采集自體骨髓造血干細胞，行auto-HSCT，預處理方案為全身放射治療+ECy；移植+29 d造血功能即順利重建；移植后密切隨訪，患者一直處于完全緩解，至今已存活67個月。 結論 auto-HSCT治療侵襲性NK/T細胞淋巴瘤療效肯定、可靠。【Abstract】 Objective To explore the therapeutic effect of autologous hematopoietic stem cell transplantation (auto-HSCT) on aggressive NK/T lymphoma. Methods The clinical data of one patient with aggressive NK/T lymphoma diagnosed in January 2005 were retrospectively analyzed, and the relevant domestic literatures were analyzed. Results This thirty-seven-year-old female patient had good disease control after undergoing chemotherapy with CHOAP and ICE regimens, surgery, and locoregional radiotherapy. After that, she had been collected enough bone marrow-derived hematopoietic stem cells, then underwent auto-HSCT with these cells. The conditioning regimen was TBI plus ECy. On the +29th day after transplantation,the hematopoietic reconstruction was successful. During the follow-up period, the patient was in complete remission status all along and her disease-free survival (DFS) was 67 months. Conclusion Auto-HSCT is effective on aggressive NK/T lymphoma.
目的 探討骨髓增生異常綜合征（MDS）患者的臨床特點。 方法 選取我院2008年3月－2012年10月確診為MDS的231例患者臨床資料進行回顧性分析。患者年齡21～87歲，中位年齡59歲。 結果 231例患者中，難治性血細胞減少伴多系發育異常（RCMD）最多見，占45.0%（104/231）；以貧血乏力癥狀就診多見占66.7%（154/231）；血常規中以全血細胞均減少多見占61%（141例/231例）；網織紅細胞以正常或增高為主占61%（141/231）；低熒光值增高多見62%（144/231）。乳酸脫氫酶和鐵蛋白在各診斷亞型及各國際預后積分系統（IPSS）評分間存在差異，其中乳酸脫氫酶在難治性貧血伴原始細胞增多2型（RAEB-2）中高于綜合組：難治性貧血（RA）、 難治性貧血伴環狀鐵粒幼細胞（RAS）、5q?綜合征及RCMD相比較差異有統計學意義（P＜0.05），高危組乳酸脫氫酶高于中危1組及中危2組，其差異有統計學意義（P＜0.05），高危組鐵蛋白高于中危1組其差異有統計學意義（P＜0.05），其余差異無統計學意義（P＞0.05）。染色體異常率為39%，其中20例為復雜染色體核型，IPSS評分中危1最多見為52.4%（55/105）。 結論 MDS臨床表現多樣，缺乏特異性，需綜合骨髓涂片、活檢、細胞遺傳學的結果提高診斷率。