以雄黄为主方案治疗骨髓增生异常综合征伴多系病态造血患者的远期疗效

目的:观察雄黄为主方案治疗骨髓增生异常综合征伴多系病态造血(MDS-MLD)患者的远期疗效。方法:选取2007年8月至2015年4月中国中医科学院西苑医院收治的MDS-MLD患者130例作为研究对象并进行回顾性分析,给予青黄散(雄黄、青黛)、健脾补肾汤药,治疗36个月及以上,以患者治疗前后外周血中性粒细胞(ANC)、血红蛋白(Hb)、血小板(PLT)为观察指标,评价治疗前后血液学改善情况,并比较不同遗传学分型疗效。结果:130例患者完全缓解、血液学进步、稳定、疾病进展分别为18例(13.84%)、80例(61.54%)、24例(18.46%)、8例(6.15%);130例患者治疗前后外周血细胞ANC、Hb及PLT计数差异有统计学意义(P<0.05);外周血三系血细胞疗效比较,Hb与ANC、Hb与PLT血液学改善程度差异有统计学意义(P<0.01),而ANC与PLT血液学改善程度差异无统计学意义(P>0.05);不同遗传学分型血液学改善程度比较,差异无统计学意义(P>0.05)。结论:以雄黄为主方案能改善MDS-MLD外周血象,对红系改善更为明显。

骨髓增生异常综合征伴单系病态造血66例临床特征分析

目的对照评价骨髓增生异常综合征伴单系病态造血(myelodysplastic syndromes with single lineage dysplasia,MDS⁃SLD)和难治性血细胞减少伴单系病态造血(refractory cytopenia with unilineage dysplasia,RCUD)的临床特征。方法收集2012年至2017年于苏州弘慈血液病医院及张家港市第一人民医院就诊的MDS⁃SLD和RCUD病人病例资料,分析外周血象、骨髓病态造血、染色体异常、预后分组及随访结果。结果共66例MDS⁃SLD,58例符合RCUD分型,另8例无法按照RCUD分型。所有病人外周血均未见原始细胞。MDS⁃SLD和RCUD外周血单系减少分别为27例、25例,两系减少39例、33例。分别有20例、18例合并染色体异常,以预后良好及中等为主。IPSS预后分组中,MDS⁃SLD仅有1例为较高危组,RCUD均属较低危。国际预后积分系统(IPSS⁃R)预后分组中,两组病人均仅有1例为较高危组。6例病人随访期内出现疾病进展,其中1例转为急性髓系白血病(AML)。MDS⁃SLD与RCUD间染色体异常比例、IPSS及IPSS⁃R预后分组各组间差异无统计学意义(均P>0.05)。结论MDS⁃SLD和RCUD病人外周血表现为单系或两系减少均常见,但部分病例血细胞减少与骨髓病态造血不完全一致,按照RCUD标准无法分组,但能够符合修订后的MDS⁃SLD标准。MDS⁃SLD和RCUD临床特征、预后类似,RCUD和无法按照RCUD分类的单系病态造血或单系/两系血细胞减少的MDS可以归为MDS⁃SLD。

减低剂量地西他滨治疗骨髓增生异常综合征伴单系发育不良患者的疗效观察

目的:探讨减低剂量地西他滨治疗骨髓增生异常综合征伴单系发育不良(MDS-SLD)患者的临床疗效和安全性。方法:使用减低剂量地西他滨[15 mg/(m^2·d),连续5 d]治疗12例MDS-SLD患者,观察其疗效和不良反应。结果:2例(16.6%)获完全缓解,1例(8.3%)获部分缓解,5例(41.6%)达血液学改善,总反应率达66.6%。在5例可行细胞遗传学评估的患者中,1例(20.0%)获PR。Ⅳ级血液学毒性发生率50.0%,Ⅲ～Ⅳ级感染发生率33.3%,无Ⅲ～Ⅳ级出血,无Ⅲ～Ⅳ级恶心呕吐和Ⅲ～Ⅳ级肝功能损伤。中位随访时间16(2～32)个月,随访期间无患者死亡。结论:减低剂量地西他滨治疗骨髓增生异常综合征完全缓解及部分缓解率高,药物不良反应发生率低。

Endovascular management of patients with coronary artery disease and diabetic foot syndrome： A long-term follow-up

Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients. Methods We retrospectively included 220 diabetic patients （78.5 ±15.8 years, 107 females, all with Fontaine Ⅲor Ⅳclass） who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010. Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease （CAD） and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions. Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure （TcPO2） before and after the procedure were performed as well as stress-echocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly. Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography. In the rest of 126 patients, combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients. Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients. For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients （77.7%） and contralateral cross-over in 40/220 patients （18.8%） and popliteal retrograde ＋ femoral antegrade in 10/220 patients （4.5%）. Balloon angioplasty was performed in 252 legs （32 patients had bilateral disease）： the procedure was successful in 239/252 legs with an immediate success rate of 94.8% and a significant improvement in TcPO2 and ABI with ulcer healing in 233/252 legs （92.4%）. Freedom from major amputation was 82.8% at a mean follow-up of 3.1 ±1.8 years （range 1 to 5 years） whereas survival was 88%. Conclusions Global coronary and peripheral endovascular management of diabetic foot syndrome patients seems to lead to an high immediate success and limb salvage rates and increasing survival compared to historical series.

辐射防护药物研究最新进展

电离辐射损伤不仅是一个公众健康问题，同时也是一个国家安全问题。如何获得治疗效果优良、安全性高和不良反应小的辐射防护药物一直是科学家努力研究的目标。近年来，伴随着分子生物学、免疫学等学科的发展，辐射防护药物的研究也取得了较大的突破。目前，诸如5-雄烯二醇（5-AED）、CBLB502、Ex—RAD和HemaMax等药物已获得美国食品药品监督管理局的批准进入临床试验；而新发现的具有潜在价值的LY294002和17-DMAG等药物也正处于研发之中。笔者基于近年来辐射防护领域国外相关刊物和专利的最新发现和进展进行综述。重点放在近几年来出现的药物新进展以及这一时间内治疗急性放射综合征的抗辐射新药上。