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老年钩虫感染致贫血的临床分析

【摘要】　目的　总结老年钩虫感染致贫血的临床特点和治疗方法。　方法　2004年9月—2010年12月，收治老年钩虫感染致贫血37例。其中男23例，女14例；年龄60~81岁，平均71岁；病程3周~2年。以头昏、乏力及上腹部不适、隐痛等消化道症状为主要临床表现。大便常规查见钩虫卵31例，胃镜于十二指肠球部及降段发现钩虫吸附于肠壁黏膜而诊断26例。给予左旋咪唑或甲苯达唑顿服驱虫治疗，连用3 d。　结果　经治疗，患者临床症状及贫血迅速改善。随访3~6个月，所有患者血红蛋白均升至110 g/L以上。　结论　钩虫感染是导致老年人贫血的原因之一，反复在大便中查找钩虫卵及胃镜检查是诊断钩虫病的重要方法。

Effect of mild anemia on prognosis of proliferative diabetic retinopathy after pars plana vitrectomy

ObjectiveTo observe the effect of mild anemia on prognosis of hyperplastic diabetic retinopathy (PDR) treated by pars plana vitrectomy (PPV). MethodsA retrospective case-control study. From January 2021 to December 2022, 147 PDR patients with 147 eyes who received PPV treatment at Shenyang He Eye Hospital were included in the study. There were 147 eyes in 147 cases, 82 eyes in 82 males and 65 eyes in 65 females. Age was 25-79 (53.54±12.74) years old. A hemoglobin (Hb) of 90 to 120 g/L in men and 90 to 110 g/L in women was defined as mild anemia. According to Hb results, the patients were divided into mild anemia group and non-anemia group, with 39 cases (39 eyes) and 108 cases (108 eyes), respectively. The best corrected visual acuity (BCVA) test was performed using the international standard logarithmic visual acuity scale before and after the surgery, which was statistically converted to minimum resolved logarithmic (logMAR) visual acuity. The logMAR BCVA of the affected eye was 0.2-2.5 (1.60±0.62) before surgery. According to whether the BCVA improved by more than 3 lines 6 months after surgery, the affected eyes were divided into BCVA improved by more than 3 lines and BCVA improved by less than 3 lines, 117 eyes and 30 eyes, respectively. The patient's body mass index (BMI), BCVA at 6 months after surgery, and the occurrence of neovascular glaucoma (NVG) and recurrence of vitreous hemorrhage (RVH) were recorded. Independent sample t test was used for comparison between groups. Multivariate logistic regression analysis was performed to analyze the influencing factors of increased BCVA ≥3 rows after surgery. ResultsSix months after surgery, the logMAR BCVA of patients in mild anemia group and non-anemia group were 0.97±0.87 and 0.68±0.63, respectively. BCVA increased ≥3 in 26 (66.7%, 26/39) and 91 (84.3%, 91/108) eyes, respectively. logMAR BCVA (t=2.234) and BCVA increased by ≥3 rows of eyes (χ2=5.460) between the two groups, the differences were statistically significant (P=0.027, 0.019). Logistic regression analysis showed that baseline logMAR BCVA [odds ratio (OR) =4.291, 95% confidence interval (CI) 1.918-9.600, P＜0.001)], BMI (OR=1.248, 95%CI 1.057-1.472, P=0.009), the number of retinal laser photocoagulation during surgery (OR=1.001, 95%CI 1.000-1.002, P=0.038), mild anemia (OR=0.360, 95%CI 0.131-0.993, P=0.048), postoperative NVG (OR=0.156, 95%CI 0.033-0.726, P=0.018) and RVH (OR=0.264, 95%CI 0.086-0.808, P=0.020) were independent factors for BCVA improvement ≥3 lines after PPV. ConclusionsMild anemia has a certain effect on BCVA improvement after PPV of PDR. Mild anemia, post-operative NVG and RVH were independent risk factors for increasing BCVA ≥3 lines after PPV in PDR patients.

甲亢合并巨幼红细胞性贫血临床研究(附2例报告)

目的:探讨甲状腺机能亢进(甲亢)所致巨幼红细胞性贫血(巨幼贫)原因及预防策略。方法:回顾性分析2例甲亢合并巨幼贫的临床资料。结果:长期甲亢耗竭维生素B12,叶酸造成缺乏和胃肠蠕动增强及伴发病如胃炎等致吸收障碍,导致营养缺乏性巨幼贫。结论:甲亢需要营养物质较正常人多,预见性补充维生素B12,叶酸可防止巨幼贫发生或减轻其贫血程度。

以鲑斑出血为表现的地中海贫血合并糖尿病视网膜病变一例

Clinical Research of Recombinant Human Erythropoietin in Treating the Cancer-related Anemia after Hemotherapy

目的:评价重组人红细胞生成素(Recombinant human erythropoietin injection, rHuEpo)治疗肿瘤化疗相关性贫血的疗效和安全性,以及对生存质量的影响。方法:采用随机分组方式,分为治疗组和对照组,分别于1～3周期化疗后6～24小时开始。治疗组(40例)行rHuEpo 治疗,150 U/kg皮下注射每周3次,疗程4～8周;对照组(24例)未用rHuEpo 治疗,其他治疗如中药及支持治疗两组均相同。所有64例患者若出现严重贫血则给予输血治疗,以保证化疗顺利进行。观察rHuEpo 对患者血红蛋白(Hb)、红细胞容积(Hct)、RBC、KPS评分、体重改善情况的影响以及rHuEpo 的毒副反应。结果:与对照组相比,治疗组治疗后Hb水平显著提高,8周有效率70%;2周内网织红细胞计数显著提高;应用无严重副反应发生,生存质量改善。结论:rHuEpo 治疗肿瘤化疗相关性贫血的疗效肯定,副反应少,能够改善患者生存质量。

Analysis of the clinical application of the reticulocyte parameters and different types of anemia in children

Objective To investigate the diagnostic value of the series parameters of reticulocyte in children with different types of anemia. Methods From January to August 2015, the reticulocyte parameters of 150 children with different types of anemia treated in the People’s Hospital of Dujiangyan were retrospectively analyzed. Another 150 healthy children aged 1-10 years examined in the same hospital at the same period were as the control group. Mindray BC-6900 automatic blood cell analyzer and suited reagent were used to determine the absolute value of reticulocyte (RET#), percentage of reticulocyte (RET%), immature reticulocyte ratio (IRF), low fluorescent intensity reticulocyte percentage (LFR%), moderate fluorescent intensity reticulocyte percentage (MFR%), and height fluorescent intensity reticulocyte percentage (HFR%). The data were statistically analyzed. Results Compared with the control group, RET%, RET# and IRF results in iron deficiency anemia group, hemolytic anemia group, aplastic anemia group, recent hemorrhagic anemia group, renal anemia group, leukemia and chemotherapy group had statistical difference (P<0.05). Compared with the control group, LFR%, MFR%, HFR% results in hemolytic anemia group and aplastic anemia group had statistical difference (P<0.05). LFR%, MFR% and HFR% results of other types of anemia had no statistical differences (P>0.05). Conclusion The series parameters of the reticulocyte, having an important reference value, can be used in the diagnosis of children with different types of anemia as a reference index, early diagnosis and early treatment of children with different anemia, which also can be used as a method to diagnose different types of anemia.

慢性阻塞性肺疾病患者贫血原因探讨

目的 探讨稳定期COPD 患者贫血的原因。方法 选择稳定期COPD 患者60 例, 测定其Hb、C 反应蛋白( CRP) 、促红细胞生成素( EPO) 、肺功能、身高和体重, 计算体重指数( BMI) 。根据Hb 浓度分为贫血组和非贫血组, 比较两组CRP、EPO、肺功能损害程度、BMI 的差异。结果 贫血组8例, 非贫血组52 例, 贫血发生率为13. 3% 。贫血组CRP 和EPO 水平显著高于非贫血组[ ( 20. 46 ±9. 43) mg/L比( 13. 75 ±2. 14) mg/L, ( 28. 7 ±5. 2) U/L 比( 14. 7 ±4. 5) U/L, P 均lt;0. 05] , 肺功能和BMI 在两组之间无显著差异( P gt;0. 05) 。贫血组的EPO 与CRP 水平呈明显负相关( r = - 0. 918, P lt;0. 01) , 这种相关性在非贫血组中不存在( P gt; 0. 2) 。结论 COPD 患者发生贫血可能与慢性炎症及EPO 抵抗有关。

Clinical study of recombinant human erythropoietin combined with iron to correct perioperative anemia in elderly patients with intertrochanteric fractures

Objective To investigate the effectiveness of recombinant human erythropoietin (rHuEPO) combined with iron in treatment of anemia in elderly patients with intertrochanteric fractures during perioperative period. Methods A clinical data of 71 patients with intertrochanteric fractures met the inclusion criteria between April 2016 and October 2017 was retrospectively analyzed. All patients were treated with closed reduction and proximal femoral intramedullary nail fixation. Thirty-one patients were treated with rHuEPO and iron before operation as trial group, and 40 patients were not treated with rHuEPO and iron as control group. There was no significant difference in gender, age, body mass index, cause of injury, fracture side and classification, American Society of Anesthesiologists (ASA) classification, combined medical diseases, time from fracture to admission, preoperative hospital stay, and operation time between the two groups (P>0.05).The hemoglobin levels before operation and at 1, 3, and 7 days after operation, number of blood transfusion, blood transfusion rate, blood transfusion volume, postoperative hospital stay, complications were recorded and compared. Results After operation, 8 patients (25.8%) in trial group and 22 patients (55.0%) in control group received blood transfusion; the blood transfusion volume was (1.96±0.85) units in trial group and (3.19±1.61) units in control group. There were significant differences in blood transfusion rate and volume between the two groups (P<0.05). There was no significant difference in preoperative hemoglobin level between the two groups (P>0.05). The postoperative hemoglobin level was higher in trial group than in control group, and the difference between the two groups was significant at 7 days (P<0.05). The postoperative hospital stay was (6.16±3.97) days in trial group and (9.25±4.47) days in control group, showing significant difference between the two groups (P<0.05). There were 8 patients (25.8%) with pulmonary infection in trial group and 14 (35.0%) in control group after operation; 6 patients (19.4%) with deep venous thrombosis in trial group and 8 (20.0%) in control group. There was no significant difference in the incidences of complications between the two groups (P>0.05). All patients were discharged from hospital normally, and no one died during hospitalization. Conclusion The application of rHuEPO combined with iron before operation in elderly patients with intertrochanteric fractures can rapidly increase the hemoglobin level after operation, shorten the hospital stay, and do not increase the risk of deep venous thrombosis after operation.

大剂量重组人红细胞生成素改善肿瘤患者化疗后贫血的护理

目的:了解大剂量重组人红细胞生成素(rHuEPO)改善化疗患者相关性贫血并提高其生活质量的情况。方法:44例患者随机分为治疗组和对照组,治疗组:rHuEPO 2×104 U第1～2天,1×104 U第3～10天,ih,同时铁剂力菲能150 mg po,tid,维生素C 100 mg po, tid。对照组:单用铁剂和维生素C,观察治疗前后血红蛋白和生活质量的变化及副反应。护理:加强患者心理护理、合理用药,严密观察病情,及时处理并发症,做好健康指导,以提高益比奥的治疗效果,避免不良反应的发生。结果:治疗组4周后的血红蛋白和红细胞比容分别升高21.0 g·L-1、5.31％,对照组分别下降12.5 g·L-1、3.36％(Plt;0.001);EPO治疗组总有效率为77.3％,而对照组为4.5％,差异有显著性(Plt;0.001);治疗组KPS评分升高,而对照组下降(Plt;0.001);治疗组与对照组在治疗后输血率和输血量相比差异无显著性;EPO副反应少,耐受性好。结论:大剂量EPO治疗肿瘤化疗相关性贫血安全有效,可提高Hb水平,改善生活质量。

Effectiveness and Safety of Astragalus Injection for Aplastic Anemia: A Systematic Review

Objective　To assess the clinical effectiveness and safety of astragalus injection plus androgen versus androgen alone for patients with aplastic anemia (AA). Methods　Such databases as The Cochrane Library (Issue 3, 2011), PubMed (1966 to March 2011), EMbase (1974 to March 2011), CNKI (1994 to March 2011), VIP (1989 to March 2011) and Wanfang Data (1997 to March 2011) were searched to include the randomized controlled trails (RCTs) according to the inclusive and exclusive criteria. The data were extracted, the quality was assessed, and meta-analysis was conducted by using Revman5.0.24 software. Results　Seven RCTs involving 518 patients with AA were included. The meta-analysis showed that the astragalus plus androgen treatment group was superior to the androgen alone group in the total effective rate with significant difference (OR=3.12, 95%CI 2.09 to 4.66, Plt;0.000 01); the adverse events in the treatment group were fewer than those in the control group with significant difference (OR=0.30, 95%CI 0.12 to 0.76, P=0.01); but the promotion degree of myelosis between the two groups was similar without significant difference (OR=1.93, 95%CI 0.85 to 4.38, P=0.11). Conclusion　The astragalus plus androgen treatment is superior to the androgen alone treatment in the total effective rate and fewer adverse events. More high-quality trails are required to verify this conclusion due to the low quality and small scale of the included studies.