目的 系統(tǒng)評(píng)價(jià)自體骨髓干細(xì)胞移植治療糖尿病周圍神經(jīng)?。╠iabetic peripheral neuropathy，DPN）的療效和安全性。方法 計(jì)算機(jī)檢索CBM（1978～2011.6）、CNKI（1979～2011.6）、MEDLINE（1950～2011.6）、PubMed（1950～2011.6）、EMbase（1970～2011.6） 和The Cochrane Library（2011年第3期），收集自體骨髓干細(xì)胞移植治療DPN的隨機(jī)對(duì)照試驗(yàn)（RCT），并追溯納入研究的參考文獻(xiàn)。由2位研究者按照納入與排除標(biāo)準(zhǔn)篩選文獻(xiàn)、提取資料并評(píng)價(jià)質(zhì)量后，采用RevMan 5.0軟件進(jìn)行Meta分析。結(jié)果 最終納入4個(gè)RCT，共計(jì)68例DPN患者、136條患肢，但大多數(shù)納入研究的方法學(xué)質(zhì)量較差。Meta分析結(jié)果顯示：自體骨髓干細(xì)胞治療糖尿病周圍神經(jīng)病變可使肢體疼痛、麻木、冷感、間歇性跛行、靜息痛顯著好轉(zhuǎn)甚至消失；與常規(guī)治療相比，自體骨髓干細(xì)胞治療DPN可顯著提高雙下肢脛神經(jīng)的感覺(jué)神經(jīng)傳導(dǎo)速度［MD=5.75，95%CI（3.86，7.64），Plt;0.000 01］及脛神經(jīng)運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度［MD=4.04，95%CI（0.90，7.18），P=0.001］，也能顯著提高腓神經(jīng)的感覺(jué)神經(jīng)傳導(dǎo)速度［MD=7.47，95%CI（4.00，10.94），Plt;0.000 1］及運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度［MD=3.83，95%CI（0.07，7.58），P=0.05］，且無(wú)不良反應(yīng)報(bào)告。結(jié)論 現(xiàn)有證據(jù)顯示，自體骨髓干細(xì)胞移植治療對(duì)DPN有一定療效。但由于缺乏高質(zhì)量的RCT支持，上述結(jié)論尚需開(kāi)展更多高質(zhì)量RCT加以驗(yàn)證。
目的 系統(tǒng)評(píng)價(jià)外周血干細(xì)胞支持下大劑量化療（APBSCT+HDC）治療小細(xì)胞肺癌（SCLC）的療效及安全性。方法 計(jì)算機(jī)檢索MEDLINE（1970～2011.1）、EMbase（1980～2011.1）、Science Direct（1980～2011.1）、Cochrane圖書(shū)館（2010年第3期）、CNKI、CBM和WanFang Data（檢索截至2010年12月），查找APBSCT+HDC治療SCLC的隨機(jī)對(duì)照試驗(yàn)（RCT）。按納入與排除標(biāo)準(zhǔn)選擇試驗(yàn)、提取資料和評(píng)價(jià)方法學(xué)質(zhì)量后，采用RevMan 5.0軟件進(jìn)行Meta分析。結(jié)果 共納入6個(gè)RCT，737例患者，其方法學(xué)質(zhì)量評(píng)級(jí)B級(jí)5篇，C級(jí)1篇。Meta分析結(jié)果顯示：APBSCT+HDC治療SCLC的總有效率和總生存率明顯優(yōu)于常規(guī)化療，其差異有統(tǒng)計(jì)學(xué)意義［分別為RR=1.14，95%CI（1.07，1.21），Plt;0.000 1；RR=3.74，95%CI（2.13，6.58），Plt;0.000 01］。在Ⅲ/Ⅳ度紅細(xì)胞及血小板降低的發(fā)生率方面，APBSCT+HDC治療組高于常規(guī)化療組，差異有統(tǒng)計(jì)學(xué)意義［分別為RR=1.97，95%CI（1.15，3.38），P=0.01；RR=1.93，95%CI（1.06，3.54），P=0.03］；但在Ⅲ/Ⅳ度白細(xì)胞降低方面，兩組差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 與常規(guī)化療相比，APBSCT+HDC治療SCLC能提高總有效率及總生存率，但有增加重度血液學(xué)毒副反應(yīng)發(fā)生率的風(fēng)險(xiǎn)。因本研究納入樣本量較少，方法學(xué)質(zhì)量不夠高，故所得結(jié)論尚需更多高質(zhì)量多中心大樣本RCT證實(shí)。
【摘要】 目的 探討自體造血干細(xì)胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）治療侵襲性NK/T細(xì)胞淋巴瘤的療效?！》椒ā?duì)我科2005年1月16日收治的1例侵襲性NK/T細(xì)胞淋巴瘤患者的造血干細(xì)胞移植和隨訪資料進(jìn)行回顧性分析，并復(fù)習(xí)國(guó)內(nèi)外相關(guān)文獻(xiàn)?！〗Y(jié)果 患者為37歲女性，診斷結(jié)外鼻型NK/T細(xì)胞淋巴瘤，系統(tǒng)性，經(jīng)CHOAP和ICE方案化學(xué)療法、手術(shù)、局部放射治療控制病情良好后，采集自體骨髓造血干細(xì)胞，行auto-HSCT，預(yù)處理方案為全身放射治療+ECy；移植+29 d造血功能即順利重建；移植后密切隨訪，患者一直處于完全緩解，至今已存活67個(gè)月?！〗Y(jié)論 auto-HSCT治療侵襲性NK/T細(xì)胞淋巴瘤療效肯定、可靠。【Abstract】 Objective To explore the therapeutic effect of autologous hematopoietic stem cell transplantation (auto-HSCT) on aggressive NK/T lymphoma. Methods The clinical data of one patient with aggressive NK/T lymphoma diagnosed in January 2005 were retrospectively analyzed, and the relevant domestic literatures were analyzed. Results This thirty-seven-year-old female patient had good disease control after undergoing chemotherapy with CHOAP and ICE regimens, surgery, and locoregional radiotherapy. After that, she had been collected enough bone marrow-derived hematopoietic stem cells, then underwent auto-HSCT with these cells. The conditioning regimen was TBI plus ECy. On the +29th day after transplantation,the hematopoietic reconstruction was successful. During the follow-up period, the patient was in complete remission status all along and her disease-free survival (DFS) was 67 months. Conclusion Auto-HSCT is effective on aggressive NK/T lymphoma.
【摘要】 目的 分析異基因造血干細(xì)胞移植術(shù)（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后并發(fā)毛細(xì)血管滲漏綜合征（capillary leak syndrome，CLS）的發(fā)生率、危險(xiǎn)因素和結(jié)局，并探討其防治措施?！》椒ā』仡櫺苑治?005年6月-2011年2月住院的allo-HSCT術(shù)后14例并發(fā)CLS的臨床資料?！〗Y(jié)果 CLS發(fā)生率為9.2%（14/152）。年齡、性別、診斷、HLA配型、預(yù)處理、CD34+細(xì)胞量、粒細(xì)胞集落刺激因子（granulocyte colony-stimulating factor，G-CSF）用量、植入時(shí)間均不能認(rèn)定為造血干細(xì)胞移植后CLS誘發(fā)因素?！〗Y(jié)論 HSCT術(shù)后CLS誘因尚不清楚，采用限水、減量G-CSF、使用糖皮質(zhì)激素和羥乙基淀粉等措施及時(shí)治療，有助于控制CLS。【Abstract】 Objective To study the occurrence rate, risk factors and outcomes of capillary leak syndrome (CLS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and discuss its prevention and treatment. Methods We retrospectively analyzed the clinical records of 14 allo-HSCT recipients complicated with CLS from June 2005 to February 2011. Results Fourteen out of 152 patients developed CLS with a cumulative incidence of 9.2 %. None of the 8 clinical parameters including age, gender, underlying disease, donor type, conditioning regimen, CD34+ cell dose, granulocyte colony-stimulating factor (G-CSF) dosage, and days to neutrophil engraftment could be identified as risk factors for the occurrence of CLS. Conclusions Risk factors for CLS after allo-HSCT have not been fully established. Restriction of water intake, administration of corticosteroids and hydroxyethyl starch can be beneficial for patients with CLS.
【摘要】 目的 分析異基因造血干細(xì)胞移植術(shù)（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相關(guān)的危險(xiǎn)因素，動(dòng)態(tài)監(jiān)測(cè)受者尿BK病毒（BK virus，BKV），分析其與HC發(fā)病的關(guān)系?！》椒ā』仡櫺苑治?003年3月-2008年1月期間接受allo-HSCT的121例患者的資料，選擇8個(gè)臨床參數(shù)[年齡、性別、疾病類型、移植時(shí)疾病狀態(tài)、供者類型、預(yù)處理方案、急性移植物抗宿主?。╝cute graft-versus-host disease，aGVHD）、aGVHD的預(yù)防方案]作COX回歸分析。采用SYBR Green染料實(shí)時(shí)熒光定量聚合酶鏈反應(yīng)法對(duì)2006年9月-2008年1月42例allo-HSCT患者尿BKV載量進(jìn)行動(dòng)態(tài)監(jiān)測(cè)，分析被檢查者尿液BKV基因載量與HC發(fā)生以及嚴(yán)重程度的關(guān)系?！〗Y(jié)果 121例患者中有24例發(fā)生HC，發(fā)病時(shí)間為術(shù)后0~63 d，中位時(shí)間40 d；持續(xù)時(shí)間7~150 d，中位時(shí)間22 d。Ⅱ~Ⅳ度aGVHD為HC的獨(dú)立危險(xiǎn)因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV檢出率為100%（42/42）。與正常人及未發(fā)生HC的allo-HSCT受者相比，HC患者尿中BKV基因載量具有更高平均峰值?！〗Y(jié)論?、騸Ⅳ度aGVHD，尿中BKV DNA高載量與HC的發(fā)生有相關(guān)性。【Abstract】 Objective To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC. Methods The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC. Results Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load. Conclusions Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.
【摘要】 目的 探討對(duì)自體造血干細(xì)胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）后復(fù)發(fā)的非霍奇金淋巴瘤患者再進(jìn)行異基因造血干細(xì)胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治療的臨床療效?！》椒ā∈占?000年1月-2010年12月難治性惡性淋巴瘤采用auto-HSCT后復(fù)發(fā)患者11例，病程27個(gè)月~6.5年。所有患者在auto-HSCT前均為復(fù)發(fā)難治性病例，auto-HSCT后，完全緩解8例，部分緩解3例，自體移植后中位復(fù)發(fā)時(shí)間15個(gè)月，患者復(fù)發(fā)后采用異基因親緣造血干細(xì)胞移植，人類白細(xì)胞抗原（human leukocyte antigen，HLA）全相合（6/6）6例，5/6相合3例，4/6相合2例；性別相同6例，性別不同5例。預(yù)處理方案為FBC方案，即氟達(dá)拉濱30 mg/m2 1~5 d，白消安12~14 mg/kg分4 d口服，環(huán)磷酰胺120 mg/kg分2 d使用。移植物均為外周血造血干細(xì)胞加骨髓。移植物抗宿主?。╣raft-versus-host disease，GVHD）的預(yù)防：HLA全相合采用環(huán)孢素+短程甲氨蝶呤+嗎替麥考酚酯，不全相合采用抗胸腺細(xì)胞球蛋白+環(huán)孢素+短程甲氨蝶呤+嗎替麥考酚酯?！〗Y(jié)果 11例患者全部獲得造血重建，急性GVHD發(fā)生6例（54.55%），其中Ⅰ度、Ⅱ度4例，Ⅲ度、Ⅳ度各1例；1例Ⅳ度GVHD因合并感染死亡，5例均得到有效控制；發(fā)生慢性GVHD 7例（63.64%），其中有2例急性GVHD轉(zhuǎn)為慢性，4例局限型，3例廣泛型。隨訪8個(gè)月~9年，有4例分別于移植后8、15、21、34個(gè)月疾病復(fù)發(fā)，另外6例仍生存?！〗Y(jié)論 allo-HSCT對(duì)于auto-HSCT后復(fù)發(fā)的非霍奇金淋巴瘤患者仍是一種有效的挽救性治療手段?！続bstract】 Objective To explore the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on relapsing non-Hodgkin′s lymphoma after autologous stem cell transplantation (auto-HSCT). Methods The clinical data of 11 patients with recurrent non-Hodgkin′s lymphoma after auto-HSCT from January 2000 to December 2010 were collected, including nine males and 2 females with the median age of 39 years (13-48 years old), and the median duration of the disease was 3 years (27 months-6.5 years). All patients were relapsed or refractory cases. After auto-HSCT, complete remission was found in 8 and partial remission was in 3. The recurrence median time after auto-HSCT was 15 months. The patients underwent allo-HSCT after the recurrence of the disease. In the 11 patients, human leukocyte antigen (HLA) full matched (6/6) in 6, 5/6 matched in 3, and 4/6 matched in 2; the same gender in 6 and different gender in 5. FBC conditioning regimen: fludarabine 30 mg/m2 for 1-5 days, BU 12-14 mg/kg in 4 days of oral, CY 120 mg/kg in 2 days. Grafts are peripheral blood stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA full-matched by CsA+short-term MTX+MMF and mismatched by ATG+CsA+short-term MTX+MMF. Results All of the 11 patients received hematopoietic reconstruction, acute GVHD occurred in 6 cases (54.55%), including degree Ⅰ plus Ⅱ in 4, degree Ⅲ in 1 and degree Ⅳ in 1. One patient died of infection due to degree Ⅳ GVHD, and the rest had been effectively controlled. Chronic GVHD occurred in 7 patients (63.64%); limited type was in 4 in and extensive type was in 3. During the follow-up period of 8 months-9 years, 4 patients relapsed 8, 15, 21, and 34 months after transplantation, and the other 6 patients was still alive. Conclusion Allo-HSCT is effective on relapsing non-Hodgkin′s lymphoma after auto-HSCT.
【摘要】 目的 了解人工肝支持系統(tǒng)搶救造血干細(xì)胞移植合并重癥肝靜脈閉塞病的臨床療效?！》椒ā?duì)2002年1月-2010年12月因造血干細(xì)胞移植并發(fā)重癥肝靜脈閉塞病的6例患者，利用人工肝支持系統(tǒng)，選用血漿置換程序進(jìn)行血漿置換。 結(jié)果 6例患者經(jīng)血漿置換治療后，膽紅素均明顯下降，3例最終恢復(fù)，2例因肝功能再次惡化死亡，1例死于嚴(yán)重混合性感染。 結(jié)論 人工肝支持系統(tǒng)搶救造血干細(xì)胞移植合并重癥肝靜脈閉塞病是一種新的嘗試，是有效和可靠的?！続bstract】 Objective To explore the therapeutic efficacy of artificial liver support system on severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation. Methods Between January 2002 and December 2010, six patients with severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation underwent plasma exchange with plasma exchange procedures using artificial liver support system. Results After plasma exchange treatment, the bilirubins of six patients significantly decreased; three patients eventually recovered, two died because of liver function deteriorated again, and one died of severe mixed infections. Conclusion Artificial liver support system is effective and reliable for hematopoietic stem cell transplantation accompanied with severe hepatic veno-occlusive disease.
【摘要】 從改善造血干細(xì)胞移植患者就醫(yī)環(huán)境、完善儀器維護(hù)和保管制度、加強(qiáng)醫(yī)護(hù)患間的溝通、應(yīng)用設(shè)置安全警示標(biāo)識(shí)、建立病房危急值報(bào)告登記制、患者參與用藥安全管理、提供出院后連續(xù)性醫(yī)療護(hù)理、制定突發(fā)事件應(yīng)急預(yù)案和計(jì)劃等方面論述了對(duì)造血干細(xì)胞移植患者治療中所采用的安全防范措施。提出造血干細(xì)胞移植患者安全管理的實(shí)質(zhì)，是將以往發(fā)生的不安全事件的被動(dòng)處理，變?yōu)槭虑暗姆e極預(yù)防，確保患者治療安全的根本。
目的：觀測(cè)外周造血干/祖細(xì)胞采集術(shù)對(duì)造血干/祖細(xì)胞采集的臨床效果。方法：對(duì)14例患者及11例健康捐獻(xiàn)者進(jìn)行外周造血干/祖細(xì)胞采集術(shù)52例次，觀測(cè)采集前后外周血WBC、RBC、Hb、Hct、Plt，采集后CD34+細(xì)胞、CFU-GM量，以及不良反應(yīng)。結(jié)果：經(jīng)過(guò)1～3次采集，采集量達(dá)到造血干/祖細(xì)胞移植所需量，不良反應(yīng)輕微。結(jié)論：外周血干/祖細(xì)胞采集具有處理量大,副作用小,安全高效等優(yōu)點(diǎn)。
間質(zhì)性肺炎（IP）是造血干細(xì)胞移植后嚴(yán)重的并發(fā)癥之一，臨床表現(xiàn)缺乏特異性，病情重，死亡率高，直接影響造血干細(xì)胞移植患者的移植后存活率?，F(xiàn)對(duì)四川大學(xué)華西醫(yī)院1999~2005年期間110例造血干細(xì)胞移植患者中發(fā)生IP的18例患者臨床資料進(jìn)行回顧性分析，探討其發(fā)病相關(guān)危險(xiǎn)因素及防治措施