【摘要】 目的 探討影響糖皮質激素治療特發性血小板減少性紫癜療效的主要因素。 方法 回顧分析2008年1月-2010年7月173例特發性血小板減少性紫癜患者的臨床資料，采用χ2檢驗及Logistic回歸分析影響糖皮質激素療效的相關臨床因素。 結果 單因素χ2檢驗分析顯示性別、骨髓巨核細胞計數水平、骨髓產板巨核細胞比例、乙型肝炎表面抗原（HBsAg）、血清免疫球蛋白水平對糖皮質激素療效的影響有統計學意義（Plt;0.05）。脾臟長大、抗核抗體（ANA）陽性、補體C3水平降低與糖皮質激素療效無關。多因素Logistic回歸分析顯示性別、HBsAg是影響糖皮質激素療效的相關因素。 結論 男性、骨髓巨核細胞計數增多、產板巨比例降低者對糖皮質激素治療反應較好。女性、血清免疫球蛋白水平異常、骨髓巨核細胞不增多者及HBsAg陽性的患者對糖皮質激素治療反應相對較差。性別、HBsAg是影響糖皮質激素療效的主要因素。【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.
ObjectiveTo prepare adipose-derived stem cells (ADSCs) and chitosan chloride (CSCl) gel complex to study the biocompatibility and the feasibility of repairing the wounds of deep partial thickness scald in rats. MethodsADSCs were prepared by enzymogen digestion and differential adherence method from the subcutaneous adipose tissue of SPF grade 6-week-old male Sprague Dawley (SD) rats. Temperature sensitive CSCl gel was prepared by mixing CSCl, β glycerol phosphate, and hydroxyethyl cellulose in 8∶2∶2.5 ratio. The proliferation of ADSCs was measured by cell counting kit 8 (CCK-8) assay and the survival of ADSCs was detected by the Live/Dead flurescent staining in vitro. A deep partial thickness burn animal model was made on the back of 72 SPF grade 6-week-old male SD rats by boiled water contact method and randomly divided into 3 groups (n=24). Group A was blank control group, group B was CSCl hydrogel group, group C was ADSCs/CSCl gel group. The wound closure rate at 3, 7, 14, 21 days was observed after operation. The number of inflammatory cells at 7 days and epidermal thickness at 21 days were observed by HE staining after operation. The angiogenesis at 7 days was evaluated by immunohistochemistry staining with CD31 expression. ResultsCSCl had a temperature sensitivity, at 4℃, the temperature-responsive hydrogel was liquid and became solid at 37℃. The CCK-8 assay and Live/Dead flurescent staining confirmed that ADSCs could grow and proliferate in the ADSCs/CSCl hydrogel complex. General observation showed the wound closure ratio in group C was superior to groups A and B after operation (P<0.05). HE staining showed that at 7 days after operation, the wound healing of the three groups entered fibrous proliferation stage. Collagen deposition and inflammatory cell infiltration were observed in the dermis of each group. The proportion of inflammatory cells in group C was significantly lower than that in groups A and B, and in group B than in group A (P<0.01). At 21 days after operation, the fibrous connective tissues of neoepithelium and dermis in groups B and C were arranged neatly, and fibroblasts and neocapillaries could be seen. In group A, neoepidermis could also be seen, but the fibrous connective tissues in dermis were arranged disorderly and sporadic capillaries could be seen. The thickness of neonatal epidermis in group C was significantly larger than that in groups A and B, and in group B than in group A (P<0.01). CD31 immunohistochemistry staining showed that the neovascularization could be seen in all groups. The number of neovascularization in group C was significantly higher than that in groups A and B, and in group B than in group A (P<0.05). ConclusionThe ADSCs/CSCl hydrogel complex has a good biocompatibility and possessed positive effects on promoting the deep partial thickness scald wound repairing in rats.
目的 探討骨髓增生異常綜合征（MDS）患者的臨床特點。 方法 選取我院2008年3月－2012年10月確診為MDS的231例患者臨床資料進行回顧性分析。患者年齡21～87歲，中位年齡59歲。 結果 231例患者中，難治性血細胞減少伴多系發育異常（RCMD）最多見，占45.0%（104/231）；以貧血乏力癥狀就診多見占66.7%（154/231）；血常規中以全血細胞均減少多見占61%（141例/231例）；網織紅細胞以正常或增高為主占61%（141/231）；低熒光值增高多見62%（144/231）。乳酸脫氫酶和鐵蛋白在各診斷亞型及各國際預后積分系統（IPSS）評分間存在差異，其中乳酸脫氫酶在難治性貧血伴原始細胞增多2型（RAEB-2）中高于綜合組：難治性貧血（RA）、 難治性貧血伴環狀鐵粒幼細胞（RAS）、5q?綜合征及RCMD相比較差異有統計學意義（P＜0.05），高危組乳酸脫氫酶高于中危1組及中危2組，其差異有統計學意義（P＜0.05），高危組鐵蛋白高于中危1組其差異有統計學意義（P＜0.05），其余差異無統計學意義（P＞0.05）。染色體異常率為39%，其中20例為復雜染色體核型，IPSS評分中危1最多見為52.4%（55/105）。 結論 MDS臨床表現多樣，缺乏特異性，需綜合骨髓涂片、活檢、細胞遺傳學的結果提高診斷率。