临床血液学杂志
Journal of Clinical Hematology 림상혈액학잡지
- 主管单位： 中华人民共和国教育部
- 主办单位： 华中科技大学同济医学院附属协和医院 北京大学医学院血研所
- 影响因子： 1.06
- 审稿时间： 1-3个月
- 国际刊号： 1004-2806
- 国内刊号： 42-1284/R
- 论文标题 期刊级别 审稿状态
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获得性纯红细胞再生障碍性贫血10例报告并文献复习
To improve the recognition of acquired pure red cell aplasia (PRCA).We retrospectively analyzed clinical data of 10 patients with acquired PRCA,including 3 primary cases and 7 secondary cases.Among them,5 patients treated with glucocorticoids and 6 patients treated with cyclosporine,only 1 case was ineffective.Acquired PRCA is a heterogeneous disease.Glucocorticoid and cyclosporine are the first choices.
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同时诊断慢性淋巴细胞白血病及恶性实体瘤2例
Chronic lymphocytic leukemia (CLL) is a kind of indolent lymphoma originated from B cell.In western countries,CLL is one of the most common types of adult leukemia,but in our country and other Asian region,the incidence of CLL is relatively low.What's more,diagnosed with CLL and other non blood system solid malignant neoplasm at the same time is rare in clinic.Our hospital recently admitted 2 patients who had been diagnosed with CLL and malignant neoplasm at the same time.The occurrence of the second neoplasm in addition to be linked to the treatment of primary neoplasm,it was also linked to biological factors,the body's genetic background and immune abnormalities.The treatment should follow two lines,including comprehensive treatment and individualized treatment.
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嗜碱性粒细胞增多的急性白血病1例报告并文献复习
To explore the differential diagnosis of acute leukemia with basophilia,we analyzed clinical features,morphology,immunophenotyping,cytogenetics and molecular genetics from one case and reviewed relevant literatures.The patient had fatigue,fever,cough and splenomegaly.Mature basophils increased in the peripheral blood,bone marrow samples and electron microscopic evaluation.Bone marrow aspiration showed 54 ％ mature basophils.The blasts fulfilled the criteria of acute myeloid leukemia.Immunophenotyping revealed CD34+,HLA-DR+,CD117+,CD33+,CD13+,CD123+,CD38+.Fluorescence in situ hybridization found loss of P53/CEP17 and positive for BCR/ABL.The BCR/ABL p230 transcript determined by RT-PCR was 99.56％.Acute leukemia with basophilia is not common.Chronic myelogenous leukemia in blast crisis,acute myeloid leukemia with t(9;22)(q34;q11) or other abnormalities and basophilic leukemia can have basophilia,hence the differential diagnosis is useful in making a clear diagnosis and choosing an appropriate treatment.
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滤泡性淋巴瘤预后因素评估及个体化危险分层研究进展
Follicular lymphoma (FL) is a common and indolent lymphoma.The recently studies show that FL displays heterogeneity for clinical process and biological prognostic biomarkers.A large class FL patient is asymptomatic with indolent course which are vulnerable to the toxic chemo-therapies.However,a subset of FL develop chemo-resistance and undergo a transformation to aggressive lymphoma.These subtypes are needed for new therapies and alternative approaches.Following new biomarkers had been discovered,previous clinical prognostic indices for FL become limited.In this review,we introduce the clinical prognostic index in FL and novel prognostic markers for evaluating poor risk.A useful incorporation both clinical and molecular determinants for the risk stratification of FL will help to identify high-risk FL at diagnosis and choose rational targeted therapies.
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多发性骨髓瘤药物治疗进展
Multiple myeloma (MM) is the second most common malignancy in blood system,with the indepth study of the etiology and pathogenesis of MM,targeted therapy for myeloma cell signaling pathway and bone marrow microenvironment is developing rapidly.The advent of many new drugs provides a new hope for the treatment of MM.In spite of this,MM is still not curable and there is a potential for recurrence.
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单体核型急性髓系白血病特征及预后
Monosomal karyotype has recently been reported to identify a distinct subset of acute myeloid leukemia (AML) with adverse prognosis.Patients with monosomal karyotype have unique clinical features and biological characteristics.The incidence of monosomal karyotype-AML increases with the age of patients.The most common single autosomal monosomy is the loss of chromosome 7 which is followed by the loss of chromosome 5.Patients with monosomal karyotype-AML have significantly worse overall survival,disease-free survival,and complete response compared with the patients with other unfavorable karyotypes.Monosomal karyotype is an independent prognostic factor for patients with AML receiving chemotherapy and allogeneic hematopoietic stem cell transplantation.New agents and treatment regimen need to be investigated.
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Th17细胞在弥漫大B细胞淋巴瘤中的研究进展
Non-Hodgkin's lymphoma (NHL) is one of the common hematological malignancies,and diffuse large B cell lymphoma (DLBCL) is the most common type of NHL in adults.The clinical manifestations of DLBCL are highly heterogeneous,and the prognosis is significantly different.The exact pathogenesis of DLBCL is still unknown,however numerous researches indicate that DLBCL development is closely related to the autoimmune disorders.T lymphocytes are the most critical cells in the immune system,in which CD4+ T cells play a most important role in the immunoprotection.At least four CD4+ T cell subsets have been found so far,they are Th1,Th2,Treg and Th17 cells,respectively.Several recent studies have reported that Th17 cells play an important role in the development of DLBCL.The relationship between DLBCL and Th17 cells is controversial,and more studies have found that Th17 cells play a protective role in the tumor microenvironment of DLBCL.Therefore,understanding the relationship between Th17 cells and DLBCL may help us to discover a new biological immunotherapy.This article will review the regulation role of Th17 cells in the development of DLBCL.
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非输血依赖型地中海贫血铁过载治疗进展
The problem of iron overload in non-transfusion-dependent-thalassemia (NTDT) has gradually attracted people's attention.Invalid overproduction of red blood cells in vivo,which induces hepcidin expression decrease and prompts increased intestinal iron absorption,leads to iron overload.The second complications resulting from iron overload affect NTDT patient's quality of life and life expectancy.Iron chelator is the only effective therapy at present.The adverse events and other limits urge us to find novel ways to cure the iron over-load.Currently,in Hbbth3/+ mouse model,increasing hepcidin expression through different methods can achieve better therapeutic effect of chelation,however,the clinical safety and effect of this way is not yet clear.
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硼替佐米不同途径给药治疗多发性骨髓瘤化疗后感染的研究
多发性骨髓瘤(multiple myeloma,MM)是浆细胞克隆性增生的恶性肿瘤,患者多为免疫功能受损的中老年人,临床主要表现有骨痛、贫血、出血、感染等,其中感染是MM常见的并发症和导致死亡的主要原因之一.随着新药及大剂量化疗的应用,MM治疗有效率和生存期得到明显提高,但感染机会也在不断增加.硼替佐米为近年来治疗MM的新药,其疗效得到肯定.为探讨更为安全、有效的给药途径,笔者对我院收治的84例采用硼替佐米治疗的MM患者进行了不同途径给药分组治疗,并对化疗后感染进行研究,现将结果报告如下.
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口服复方黄黛片联合维甲酸治疗急性早幼粒细胞白血病合并大量心包积液、心律失常1例
急性早幼粒细胞白血病(APL)是一种特殊类型的白血病,特异基因与染色体核型改变为其分子遗传学特征,FAB分型为AML-M3.其临床表现主要有严重出血倾向、发热、骨痛、白细胞异常增高等,病程凶险,早期死亡多因发生弥散性血管内凝血及颅内出血.而通常情况下,该类型白血病浸润组织和器官并不常见,初起合并心脏浸润则更为罕见.现将1例APL初起即合并有心功能不全、严重心律失常及大量心包积液患者报告如下.
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3例丘疹性蕈样霉菌病临床分析
丘疹性蕈样霉菌病(papular mycosis fungoides,PMF)是一种原发皮肤T细胞淋巴瘤,也是蕈样霉菌病(MF)的特殊亚型[1].PMF典型的临床表现为长期皮肤丘疹,不痛不痒;病理特征为真皮层淋巴样细胞浸润,部分侵犯入表皮形成Pautrier微脓肿,亲表皮性CD4阳性及T细胞异常增生.PMF临床罕见,且有MF的病理表现.由此我们对3例PMF患者的临床特征、治疗及预后进行总结分析,以提高临床医师对PMF患者的认识.
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乙酰肝素酶在白血病细胞中的表达
目的:观察乙酰肝素酶(HPA)在不同类型白血病细胞中的表达.方法:研究组为白血病患者53例,对照组为缺铁性贫血患者20例.采用Western blotting方法检测骨髓单个核细胞HPA蛋白表达,比较研究组与对照组、研究组内急性髓系白血病与急性淋巴细胞白血病、初发急性白血病与慢性白血病HPA蛋白表达差异.结果:研究组患者骨髓中单个核细胞HPA蛋白表达与对照组比较均显著升高(均P＜0.05).研究组内比较,急性髓系白血病HPA蛋白表达显著高于急性淋巴细胞白血病(P＜0.05);初发急性白血病骨髓中单个核细胞HPA蛋白表达显著高于慢性白血病组(P＜0.05).结论:白血病细胞HPA蛋白高表达;不同类型白血病表达水平不同,急性白血病,尤其是急性髓系白血病表达更加明显.
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淋巴瘤化疗继发糖尿病临床分析
目的:分析淋巴瘤患者化疗继发糖尿病的发生率及相关因素,探索化疗继发糖尿病的危险因素.方法:对207例淋巴瘤化疗患者的年龄、性别、病理分型、临床分期、B症状、4～6个疗程化疗后评估是否完全反应等进行Logistic回归分析.结果:临床资料完整且符合条件的186例患者中,48例(25.8％)化疗后出现继发糖尿病.单因素分析显示,年龄≥40岁、有B症状、首次未完全反应为化疗继发糖尿病的危险因素.Logistic多因素回归分析结果显示,40岁以上患者发生继发糖尿病的风险是40岁以下患者的9.20倍(OR=9.200),有B症状是无B症状的2.90倍(OR=2.903),首次未完全反应是首次完全反应的2.08倍(OR=2.080).结论:继发糖尿病是淋巴瘤患者化疗期间的重要并发症,发生率为25.8％,年龄≥40岁、有B症状、首次未完全反应为化疗继发糖尿病的独立危险因素.
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骨髓增生异常综合征转化为急性白血病的高危因素分析
目的:探讨影响骨髓增生异常综合征(MDS)转化为急性白血病的高危因素.方法:回顾性分析我院收治的101例MDS患者的转白时间、转白亚型、临床特征、实验室数据等临床资料.结果:101例MDS患者中,34.6％(35/101)转化为急性髓系白血病,中位转白时间7.5(0.5～53)个月,中位生存时间40.7(1～87)个月.单因素分析发现,染色体核型、骨髓原始细胞比例、血细胞减少系数、病态造血累及系数、WHO分型均影响MDS患者的转白率(均P＜0.05).多因素分析发现,染色体核型、病态造血系数、WHO分型是MDS向急性白血病转化的独立危险因素(均P＜0.05).转白组患者较未转白组患者的生存期明显缩短(11个月:45个月).结论:MDS是一类高风险向急性白血病转化的疾病,根据相关高危因素,对其进行预后评估,从而为个体化治疗提供临床依据,对延长患者转白时间及总生存时间具有重要意义.
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CD123在成熟B淋巴细胞肿瘤中的表达及意义
目的:探讨CD123在不同类型成熟B淋巴细胞肿瘤诊断和鉴别诊断中的意义.方法:选取297例成熟B淋巴细胞肿瘤患者作为研究对象,疾病类型包括慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL),套细胞淋巴瘤(MCL),滤泡性淋巴瘤(FL),脾边缘区淋巴瘤(SMZL),毛细胞白血病(HCL)和变异型HCL(HCLv).采集患者的骨髓标本,通过流式细胞术分析其免疫表型,以及各类型疾病中异常淋巴细胞群CD123表达的抗原阳性比例及强度.结果:不同类型成熟B淋巴细胞肿瘤患者骨髓异常淋巴细胞群中,其CD123表达率及表达强度存在较大差异.其中156例CLL/SLL中CD123阳性比例约占3.21％,表达强度较低;45例MCL中CD123阳性比例约占8.89％,表达强度较高;62例FL中CD123阳性比例约占4.84％,表达强度较低;20例SMZLCD123阳性比例约占15.00％,表达强度较高;10例HCL CD123阳性比例占100％,且其表达强度高;但4例HCLv未见CD123阳性表达.结论:CD123在成熟B淋巴细胞肿瘤常见类型中广泛表达,其表达率和强度尤其可作为HCL与其他亚类进行鉴别的重要指标之一.
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国产伊马替尼与原研伊马替尼治疗初诊慢性髓性白血病慢性期的临床疗效及用药安全性对比分析
目的:对比分析国产伊马替尼(商品名:格尼可)和原研伊马替尼(格列卫)用于治疗慢性髓性白血病慢性期(CML-CP)患者的临床疗效与用药安全性差异.方法:回顾性分析42例接受格尼可治疗和83例接受格列卫治疗的CML-CP患者的临床资料,比较分析2组患者在3个月、6个月及12个月获得佳疗效发生率的差异,对比2组患者发生血液学及非血液学不良反应发生率的差异.结果:2组患者3个月、6个月及12个月的佳疗效发生率无统计学差异,不良反应发生率无统计学差异.结论:根据本次收集的临床资料分析结果,格尼可和格列卫治疗CML-CP患者的临床疗效相仿,患者对用药期间出现的不良反应均有良好的耐受性,显示出良好的用药安全性.
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破骨细胞促进多发性骨髓瘤免疫抑制微环境的形成
1 研究背景骨病是多发性骨髓瘤(MM)明显的特征之一,80％～90％骨髓瘤患者会发生包括骨痛、溶骨病变、高钙血症、病理性骨折和脊髓压迫在内的骨骼相关并发症.骨病的发生机制是破骨细胞活性增强及成骨细胞功能受抑.骨髓瘤细胞与骨髓微环境相互作用在激活破骨细胞及抑制成骨细胞活性中起重要作用[1].
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骨髓瘤骨病的发生机制及治疗进展
多发性骨髓瘤(multiple myeloma,MM)是浆细胞的一种恶性克隆性疾病,以患者骨髓中浆细胞恶性增生并分泌大量的单克隆免疫球蛋白为特征.患者就诊时往往伴有骨骼疼痛、骨质疏松、高钙血症、病理性骨折等溶骨性病变,称为骨髓瘤骨病(myeloma bone disease,MBD),MM伴有MBD为70％～80％[1-5].MBD的严重程度与患者的疗效及预后密切相关,与没有骨质损害者相比,伴有MBD患者的生活质量更差,肿瘤负荷更高,总生存率更低[6].
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具有临床意义的单克隆免疫球蛋白病
单克隆免疫球蛋白病由一组异质性疾病组成,其特征在于B淋巴细胞或浆细胞克隆性增殖产生免疫球蛋白.大多数患者血液或尿液中可检测到单克隆免疫球蛋白.具有临床意义的单克隆免疫球蛋白病疾病谱广泛(图1)、疾病表现多样,可侵及多器官,如心脏,肝脏,皮肤,肾脏和神经等,而且大多为少见甚至是罕见疾病,早期诊断与及时干预有助于改善预后.
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综合老年学评估在血液肿瘤诊疗中的应用
随着人类的进步,人口老龄化的趋势日益严重.一项针对12 380例健康人的全外显子测序显示,年龄大于65岁老年人的克隆造血发生率明显高于年轻人,这表明机体衰老会带来血液衰老,并带来更高的血液肿瘤发生率[1].现实世界的数据也表明,不论是急性白血病、淋巴瘤还是多发性骨髓瘤,血液肿瘤的发生率都随着年龄明显增加,特别是在50岁以后.
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IMWG多发性骨髓瘤诊断标准解读
多发性骨髓瘤(multiple myeloma,MM)是一种具有高度细胞遗传学异质性的恶性克隆性浆细胞病.随着对MM生物学特性的不断深入了解以及实验室和影像学新技术的应用,2014年国际骨髓瘤工作组(International Myeloma WorkingGroup,IMWG)对MM诊断标准进行了修订[1].尽管此标准已发布了2年余,但其在临床应用中明显不足.本文将对IMWG修订后的MM诊断标准作一解读,以更好地普及和应用新诊断标准.
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单克隆抗体在多发性骨髓瘤中的临床应用
多发性骨髓瘤(multiple myeloma,MM)是骨髓内单克隆浆细胞恶性增殖性疾病,其发病率居血液肿瘤第2位.随着蛋白酶体抑制剂以及免疫调节剂在临床的应用,MM患者预后取得显著改善.然而,几乎所有患者仍然不可避免的出现疾病进展、复发,并且对蛋白酶体抑制剂和免疫调节剂耐药.因此,寻找具有新的作用机制的药物成为近年来研究的热点.单克隆抗体靶向骨髓瘤细胞表面或骨髓微环境中的抗原,利用宿主免疫功能杀伤骨髓瘤细胞,是骨髓瘤治疗中非常重要的一类新药.
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干扰素联合全反式维A酸逆转NB4-R1细胞的耐药机制研究
目的:探讨干扰素(IFN)联合全反式维A酸(ATRA)逆转维甲酸耐药急性早幼粒细胞白血病(APL)的机制.方法:取指数生长期的NB4-R1细胞分为6组,分别加入ATRA、IFN-α、IFN-γ、IFN-α+ATRA、IFN-γ+ATRA(其中ATRA终浓度为2μmol/L,IFN-α和IFN-γ终浓度均为1000 IU/ml),以及不加药组的空白对照组,用MTT法检测细胞的增殖状况;蛋白免疫印迹试验测定各组NB4-R1细胞2 h IRF-1蛋白表达,以及IFN-α+ATRA组、IFN-γ+ATRA组诱导NB4-R1细胞观察8 h IRF-1蛋白表达的差异.结果:除ATRA组外,另外4个实验组均对NB4-R1细胞增殖有抑制作用,且联合用药的效果明显高于单独用药;5个实验组IRF-1蛋白均有表达,IFN-α+ATRA组、IFN-γ+ATRA组明显高于其他3组;IFN-α+ATRA组和IFN-γ+ ATRA组比较,2h内前者IRF-1蛋白表达量逐渐下降,而后者则无明显变化;至用药8h后,IFN-α+ATRA组IRF-1蛋白表达基本消失,而IFN-γ+ATRA组的表达量仍较前无明显变化.结论:ATRA联合2种干扰素诱导NB4-R1细胞分化均有作用,但ATRA+IFN-γ效果更加显著;而IFN-α+ATRA组与IFN-γ+ ATRA组比较,前者作用维持时间更长,可能与IRF-1蛋白持续表达有关.
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《中国弥散性血管内凝血诊断积分系统》解读
弥散性血管内凝血(disseminated intravascular coagulation,DIC)是在许多疾病基础上,致病因素损伤微血管体系,导致凝血活化,全身微血管血栓形成、凝血因子大量消耗并继发纤溶亢进,引起以出血及微循环衰竭为特征的临床综合征[1].它不是一个独立的疾病,而是众多疾病复杂病理过程中的中间环节,它使原发病复杂化,若不及时诊治,常危及患者生命.DIC发生、发展的过程中涉及到多个生理系统;其临床表现也多样化,没有一个单一的指标同时具有足够的灵敏性和特异性[2].
| 年 | 期数 |
| 2018 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2017 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2016 | 01 02 03 04 05 06 |
| 2015 | 01 02 03 04 05 06 |
| 2014 | 01 02 03 04 05 06 |
| 2013 | 01 02 03 04 05 06 |
| 2012 | 01 02 03 04 05 06 |
| 2011 | 01 02 03 04 05 06 |
| 2010 | 01 02 03 04 05 06 |
| 2009 | 01 02 03 04 05 06 |
| 2008 | 01 02 03 04 05 06 |
| 2007 | 01 02 03 04 05 06 |
| 2006 | 01 02 03 04 05 06 |
| 2005 | 01 02 03 04 05 06 |
| 2004 | 01 02 03 04 05 06 |
| 2003 | 01 02 03 04 05 06 |
| 2002 | 01 02 03 04 05 06 |
| 2001 | 01 02 03 04 05 06 |
| 2000 | 01 02 03 04 05 06 |
| 1999 | 01 02 03 04 05 06 |
