【摘要】 目的 采用多柔比星（doxorubicin，DOX）制备心肌损伤动物模型，评价各种检测心功能变化方法的意义。 方法 14只新西兰大白兔，DOX耳缘静脉注射，每周3 mg/kg，共10周。分别于给药前、第4周末及实验结束时测定血清肌钙蛋白Ⅰ（cTnI）和脑钠肽（BNP）水平，彩色多普勒超声心动图检测心功能变化，并观察心肌组织病理形态学改变及心肌细胞凋亡情况。 结果 使用DOX前后对比，血清cTnI和BNP浓度升高（Plt;0.05）；左室射血分数（LVEF）和左室短轴缩短率（LVFS）下降（Plt;0.05）；心肌组织病理显示心肌细胞出现不同程度的空泡变性与水肿，细胞间隙明显增宽，大量炎性细胞浸润。心肌细胞凋亡明显增加。 结论 结合心脏超声检查和血清cTnI、BNP指标检测可判断心肌损伤程度。【Abstract】 Objective To observe the changes of heart function caused by doxorubicin in rabbits. Methods A total of 14 New-Zealand white rabbits were intravenous-injected with doxorubicin with a dosage of 3 mg/kg intravenously once a week, and the accumulative dose was 30 mg/kg. Before the medication and at the 4th and 10th weekend after the medication, the serum levels of cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) were measured; left ventricular ejection function (LVEF) and left ventricular fractional shortening (LVFS) were performed on the rabbits respectively. At the 10th weekend, the pathological changes of cardiac tissue and the apoptosis of myocardial cell were detected. Results The levels of cTnI and BNP significantly increased (Plt;0.05), and the LVEF and LVFS markedly decreased (Plt;0.05) after the administration of doxorubicin. Uneven vacuolar degeneration and edema of cardiocytes could be observed with a wide cell spaces and inflammatory cell infiltration in the histopathological slices. Conclusion The combined application of heart sonography with the detection of the serum levels of cTnI and BNP can evaluate the degree of myocardial damage of the rabbits models very well.
【摘要】 目的 探讨影响糖皮质激素治疗特发性血小板减少性紫癜疗效的主要因素。 方法 回顾分析2008年1月-2010年7月173例特发性血小板减少性紫癜患者的临床资料，采用χ2检验及Logistic回归分析影响糖皮质激素疗效的相关临床因素。 结果 单因素χ2检验分析显示性别、骨髓巨核细胞计数水平、骨髓产板巨核细胞比例、乙型肝炎表面抗原（HBsAg）、血清免疫球蛋白水平对糖皮质激素疗效的影响有统计学意义（Plt;0.05）。脾脏长大、抗核抗体（ANA）阳性、补体C3水平降低与糖皮质激素疗效无关。多因素Logistic回归分析显示性别、HBsAg是影响糖皮质激素疗效的相关因素。 结论 男性、骨髓巨核细胞计数增多、产板巨比例降低者对糖皮质激素治疗反应较好。女性、血清免疫球蛋白水平异常、骨髓巨核细胞不增多者及HBsAg阳性的患者对糖皮质激素治疗反应相对较差。性别、HBsAg是影响糖皮质激素疗效的主要因素。【Abstract】 Objective To discuss the influencing factors associated with the efficacy of glucocorticoid for idiopathic thrombocytopenic purpura. Methods We retrospectively analyzed the clinical data of 173 patients with idiopathic thrombocytopenic purpura who accepted their first treatment in West China Hospital between January 2008 and July 2010. The affecting factors on the efficacy of the treatment were analyzed by means of Chi-square test and binary logistic regression analysis. Results The results of Chi-square test showed that gender, bone marrow megakaryocyte count, the percentage of platelet-producing megakaryocytes, HBsAg, and the level of serum immunoglobulin could have a significant influence on the outcome of glucocorticoid treatment (Plt;0.05), while splenomegaly, positive ANA and decreasing of the level of complement C3 were not correlated with the outcome of glucocorticoid treatment. The results of multivariate logistic regression analysis showed that gender and HBsAg were correlated with the glucocorticoid treatment for patients with idiopathic thrombocytopenic purpura. Conclusion Male patients, patients with increasing bone marrow megakaryocytes and patients with decreasing percentage of platelet-producing megakaryocytes have better responses to glucocorticoid, while female patients, patients with abnormal serum immunoglobulin level and patients with non-increasing number of bone marrow megakaryocytes have poor responses toward glucocorticoid treatment. Gender and HBsAg are the main influencing factors for the response to glucocorticoid.
目的 总结多发性骨髓瘤（multiple myeloma, MM）的发病特征及临床特征，分析比较不同治疗方案对MM的疗效及不同类型与不同临床特征的MM治疗效果。 方法 回顾性分析2003年1月-2008年1月128例MM患者的发病和临床特征，以及与治疗效果的关系，并对不同治疗方案、不同类型间的疗效进行比较。 结果 MM患者发病的中位年龄为59岁，临床上以不明原因的骨痛、贫血、感染和球蛋白增高为主要表现。128例患者中行方案一（马法兰、强的松/地塞米松、反应停）的总有效率为53.3%（32/60）；方案二（环磷酰胺、长春新碱、马法兰、强的松、卡氮芥、阿霉素）为44.4%（8/18）；方案三（长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松）为68.5%（24/35），方案四（硼替佐米、地塞米松/反应停）的总有效率为86.6%（13/15）。方案一和方案二间、方案三和方案四间疗效差异无统计学意义（Pgt;0.05），方案三、方案四的疗效均优于方案一和方案二（Plt;0.05）。IgG型总有效率为63.2%（48/76），IgA型为60.9%（14/23），kappa轻链型为42.8%（6/14），lammda轻链型为46.2%（6/13）。IgG型和IgA型间的疗效差异无统计学意义（Pgt;0.05），但IgG型、IgA型的疗效均优于kappa轻链型和lammda型（Plt;0.05）。不同类型及使用不同方案的患者，其中位生存期及3年和5年的生存率差异无统计学意义（Pgt;0.05）。 结论 MM患者发病高峰年龄介于40～70岁，骨痛和贫血是最常见的首发症状。长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松以及硼替佐米、地塞米松/反应停方案总体疗效相当，但后者完全缓解率高于前者。
ObjectiveTo improve the understanding, diagnosis and treatment of special clinical characteristics of Waldenstrom macroglobulinemia (WM). MethodsWe described one case of WM which initially presented with jaundice, and discussed the clinical characteristics, diagnosis and therapeutics based on the literature review. ResultsWM is a B-cell lymphoproliferative disorder characterized by an immunoglobulin M (IgM) monoclonal gammopathy and bone marrow infiltration by lymphoplasmacytic lymphoma, which generally affects elderly patients. WM with primary jaundice is rare in clinic, which is usually misdiagnosed and has missed diagnosis. Patients should have their IgM monitored first before accepting therapeutic regimen including rituximab in order to avoid IgM flare or related complications. ConclusionsThe potential diagnosis of malignant plasma cell disorder should be considered for those patients who presented with jaundice initially, after liver system diseases are excluded. Liver biopsy and related examinations are necessary without delay. Prophylactic plasmapheresis is an active means to lower the incidence of IgM flare, especially for patients with a pre-therapy IgM level of higher than 50 g/L.
After the occurrence of public health emergencies, as the most direct front position, how to carry out medical treatment orderly, effectively, rapidly and safely in a short time has become the focus and difficulty of epidemic control. After the outbreak of 2019 novel coronavirus pneumonia (2019-nCoV), West China Hospital of Sichuan University, as a large-scale general hospital under the supervision of the CPC central committee, put people's life safety and health first, and attach great importance to the prevention and control of the epidemic. This paper introduces the ten measures taken by West China Hospital of Sichuan University to fight against the 2019-nCoV pneumonia, in order to provide reference for other hospitals.