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二代酪氨酸激酶抑制剂一线、二线治疗慢性髓细胞白血病的临床研究
目的 探讨二代络氨酸激酶抑制剂(tyrosine kinase inhibitors,TKI)一线、二线治疗慢性髓细胞白血病(chronic myelocytic leukemia,CML)的临床价值.方法收集2008年2月-2012年3月于我院接受二代TKI治疗的56例CML患者的临床资料,其中20例接受达沙替尼一线治疗(一线组),36例接受达沙替尼二线治疗(二线组),既往接受伊马替尼一线治疗54例,对伊马替尼耐药51例,不耐受3例;其余2例曾接受除伊马替尼以外治疗),记录患者治疗反应性及安全性.结果 ①慢性期治疗3个月26例(86.67%)达到CHR,15例(50.00%)CCyR,15例(50.00%)PCyR,治疗12个月4例(13.33%)获得CMR,15例(30.00%)获得MMR;加速期治疗3个月8例(80.00%)获得CHR,治疗12个月无1例获得CyR,治疗12个月,2例(20.00%)获得MMR,1例(10.00%)获得CMR;急变期治疗12个月无1例获得CyR、MMR,治疗3个月6例(37.50%)获得CHR,1例(6.25%)获得CMR,治疗12个月1例(6.25%)获得CMR;②一线组随访CHR、CMR率均高于二线组,但其达CHR、CMR时间较二线组长(P<0.05);③一线、二线治疗各不良反应发生率比较差异无统计学意义(P>0.05);④慢性期患者OS、中位生存期高于加速期与急变期,加速期OS又高于急变期(P<0.05),TKI一、二线治疗CML患者OS、中位生存期对比差异无统计学意义(P>0.05).结论二代TKI达沙替尼一、二线治疗CML均可获取肯定的血液学反应、细胞遗传学反应及分子生物学反应,且以慢性期患者疗效佳,OS长,同时安全性肯定.
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发热、肺部肿块、关节酸痛、浅表淋巴结肿大
A 69-year-old man with fever,pulmonary nodules,joint pain and superficial lymphadenopathy was admitted to our hospital.The patient had a history of ten year hypertension.She smoked a pack of cigarettes daily for forty years and quitted for fifteen years.Family history of coronary heart disease,diabetes,cancer or other diseases was negative.Chest CT showed a nodule in the left lung lower lobe.Percutaneous lung biopsy revealed a large number of atypical B cell proliferation and infiltration which involved the vessel wall.The atypical B-cell phenotype and genotype was EBERs (+),CD20 (+),CD30 (+),CD15 (-).The patient was diagnosed as pulmonary lymphomatoid granulomatosis (LYG),an angiodestructive and angioinvasive lymphoproliferative disorder which is an Epstein-Barr virus associated B cell disorder with reactive T lymphocytes.The patient received six courses of chemotherapy.In this rare case,misdiagnosis of LYG often occurred due to the complex clinical presentation and non-specific imaging.Percutaneous or open lung biopsy is the main choice in the diagnosis of LYG.
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复杂性脾切除126例
目的 探讨复杂性脾切除的手术安全性.方法 回顾性总结2005年1月至2011年12月收治的126例复杂性脾切除患者的临床资料.采用x2检验和t检验比较各项指标的差异.结果 126例中无围手术期死亡病例,无胰漏和胃结肠损伤.14例出现术后并发症:分别为腹腔内出血5例；肺部并发症7例,其中6例左胸腔积液,有2例合并左膈下脓肿；脾静脉栓塞性静脉炎11例；大量腹水10例.经再次手术或非手术治疗后痊愈.乙型肝炎、肝硬化脾切除后脾静脉门静脉主干栓塞率7％ (6/84),而血吸虫肝硬化则为50％(6/12),差异有统计学意义(t=13.4,P＜0.01).结论 认真仔细的术前评估、精细轻柔的手术操作、脾蒂的正确处理和创面的腹膜化,是降低复杂性脾切除手术风险的重要环节.
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2016年血液系统疾病临床进展
2016年血液系统疾病基础和临床研究取得重大进展。本文就造血干细胞移植供者来源、移植物抗宿主病防治、急慢性白血病靶向治疗新突破以及免疫性血小板治疗再认识等血液病临床进展进行了总结和评价。
