目的:探索CD19 CAR-T细胞治疗复发/难治性B-ALL后细胞因子水平的变化及其临床意义。方法:选取2015年8月至2018年2月我院血液科接受CD19 CAR-T细胞治疗的复发/难治性B-ALL患者23例,应用CBA技术和免疫比浊法检测输注前后血清中IL-6、IFN-...目的:探索CD19 CAR-T细胞治疗复发/难治性B-ALL后细胞因子水平的变化及其临床意义。方法:选取2015年8月至2018年2月我院血液科接受CD19 CAR-T细胞治疗的复发/难治性B-ALL患者23例,应用CBA技术和免疫比浊法检测输注前后血清中IL-6、IFN-γ、IL-10、TNF-α和CRP水平。然后根据CTCAE v4.0将发生CRS的患者分为轻度CRS组(1~2级)和重度CRS组(3~5级),比较两组细胞因子水平的差异及治疗反应。结果:①CD19 CAR-T细胞输注前后患者血清中IL-6(2.00~28.50 vs 34.50~112.00)、IFN-γ(2.13~3.12 vs 4.35~10.07)、IL-10(1.00~1.80 vs 4.01~39.92)、TNF-α(2.91~4.60 vs 4.99~40.18)差异均具有统计学意义(P=0.000,0.000,0.001,0.002);②轻度CRS组和重度CRS患者相比,血清中IL-6(28.75~61.25 vs 91.00~1 074.00)、IFN-γ(3.93~7.28 vs 12.53~15.30)、IL-10(3.13~7.47 vs 39.92~84.97)、TNF-α(4.60~15.77 vs 40.18~62.51)和CRP(4.95~46.86 vs 37.81~120.17)差异均具有统计学意义(P=0.004、0.004、0.003、0.000、0.045);③CD19 CAR-T治疗后完全缓解(包括血象未完全恢复患者)组与未缓解组间上述细胞因子与CRP水平均差异无统计学意义;④IL-6显著升高的重度CRS患者,应用IL-6受体拮抗剂治疗后均好转。结论:IL-6、IFN-γ、IL-10、TNF-α细胞因子的水平可作为判断CRS严重程度的实验室参考指标,并可指导临床靶向选择细胞因子拮抗剂,但对CD19 CAR-T疗效预测价值有待进一步验证。展开更多
This thesis has collected 156 business letters and analyzed their characteristics within the framework of V. K. Bhatia＇s cognitive structuring model. Each kind of the business letters follows different moves and with...This thesis has collected 156 business letters and analyzed their characteristics within the framework of V. K. Bhatia＇s cognitive structuring model. Each kind of the business letters follows different moves and within moves, a wide range of strategies are employed. This paper on the one hand illustrates the different structures of business letters and on the other hand demonstrates that the sequencing of the moves enjoys a great flexibility, which to some degree reflects the dynamic nature of genre.展开更多
文摘目的:探索CD19 CAR-T细胞治疗复发/难治性B-ALL后细胞因子水平的变化及其临床意义。方法:选取2015年8月至2018年2月我院血液科接受CD19 CAR-T细胞治疗的复发/难治性B-ALL患者23例,应用CBA技术和免疫比浊法检测输注前后血清中IL-6、IFN-γ、IL-10、TNF-α和CRP水平。然后根据CTCAE v4.0将发生CRS的患者分为轻度CRS组(1~2级)和重度CRS组(3~5级),比较两组细胞因子水平的差异及治疗反应。结果:①CD19 CAR-T细胞输注前后患者血清中IL-6(2.00~28.50 vs 34.50~112.00)、IFN-γ(2.13~3.12 vs 4.35~10.07)、IL-10(1.00~1.80 vs 4.01~39.92)、TNF-α(2.91~4.60 vs 4.99~40.18)差异均具有统计学意义(P=0.000,0.000,0.001,0.002);②轻度CRS组和重度CRS患者相比,血清中IL-6(28.75~61.25 vs 91.00~1 074.00)、IFN-γ(3.93~7.28 vs 12.53~15.30)、IL-10(3.13~7.47 vs 39.92~84.97)、TNF-α(4.60~15.77 vs 40.18~62.51)和CRP(4.95~46.86 vs 37.81~120.17)差异均具有统计学意义(P=0.004、0.004、0.003、0.000、0.045);③CD19 CAR-T治疗后完全缓解(包括血象未完全恢复患者)组与未缓解组间上述细胞因子与CRP水平均差异无统计学意义;④IL-6显著升高的重度CRS患者,应用IL-6受体拮抗剂治疗后均好转。结论:IL-6、IFN-γ、IL-10、TNF-α细胞因子的水平可作为判断CRS严重程度的实验室参考指标,并可指导临床靶向选择细胞因子拮抗剂,但对CD19 CAR-T疗效预测价值有待进一步验证。
文摘目的比较瓦里安Trilogy直线加速器6MV X射线均整模式(FF)和非均整模式(FFF)下容积旋转调强(VMAT)在食管癌放疗中的剂量学差异。方法选取20例食管癌患者,在瓦里安Eclipse 15.5版本的计划系统上分别进行VMAT-FF和VMAT-FFF计划设计。处方剂量为PCTV1总剂量6000 cGy/28-29F,PCTV2总剂量5400 cGy/28-29F。在95%的靶区体积达到处方剂量前提下,比较两种计划的剂量体积直方图(DVH)、靶区和危及器官剂量、适形度指数(CI)、均匀性指数(HI)、机器跳数(MU)及加速器出束时间(DT)。结果 VMAT-FF跳数低于VMAT-FFF(473.9±70.5 VS 735.7±98.2,P<0.05),VMAT-FF的出束时间大于VMAT-FFF(57.0±6.6s VS 36.6±17.0s,P<0.05)。两种计划的均匀性、适形性及危及器官受剂量未见明显区别。结论两种计划均能满足临床治疗需求,而VMAT-FFF相比于VMAT-FF具有更短的出束时间,提高了治疗效率。
文摘This thesis has collected 156 business letters and analyzed their characteristics within the framework of V. K. Bhatia＇s cognitive structuring model. Each kind of the business letters follows different moves and within moves, a wide range of strategies are employed. This paper on the one hand illustrates the different structures of business letters and on the other hand demonstrates that the sequencing of the moves enjoys a great flexibility, which to some degree reflects the dynamic nature of genre.
