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异位胸腺瘤合并单纯红细胞再生障碍性贫血一例

Research progress of fundus changes in severe beta thalassemia

β thalassemia is a hereditary hemolytic disease caused by the defect of β globin gene. Transfusion-dependent β thalassemia patients need long-term blood transfusion to survive, and a series of systemic and ocular complications will occur in the disease itself and long-term blood transfusion. Retinal blood vessel density decreases, retinal thickness thinned and elastic pseudoxanthoxanoma syndrome are found in fundus due to long-term anemia and side effects of iron chelating agent. At present, there are few reports about eye changes in thalassemia patients, and the cognition is relatively scarce. Therefore, it is necessary to be vigilant for physicians, deeply explore the cause and symptomatic treatment, combined with individual disease characteristics, to provide a more scientific and accurate plan for clinical treatment.

The Administration of Highdose Recombinant Human Erythropoietin in Multiple Myeloma Patients with Anemia

目的:多发性骨髓瘤(Multiple Myeloma,MM)患者约有80%伴有贫血,临床上多数患者以输血方式纠正贫血。重组人促红细胞生成素(recombinant human erythropoietin, rHuEPO)用于治疗MM患者的贫血尽管有效,但以何等剂量、应用多长时间疗效较佳尚无定论。目的: 观察持续使用大剂量rHuEPO对MM患者贫血的纠正作用及效果。方法:87例诊断明确的多发性骨髓瘤伴有贫血的患者,开始连续每天使用重组人促红细胞生成素4万单位,皮下注射,共5d;以后每周使用一次,每次4万单位皮下注射,间断补充铁剂。对照组90例选自同期住院的诊断明确的多发性骨髓瘤患者,当其贫血症状明显时或血红蛋白水平低于60 g/L时,给予输血纠正其贫血,使多数患者血红蛋白水平维持在80 g/L～100 g/L以上。两组患者化疗方案不做特殊规定,整过研究观察期6月。结果: rHuEPO组在使用rHuEPO后2周其血红蛋白开始上升,中位反应时间16d;1月半至2月血红蛋白可升至正常水平,达正常血红蛋白水平的中位时间51d。进入研究后3月和6月时,rHuEPO组生活幸福感指数(INLH)明显优于输血组,分别为6927±318(Plt;005)和7216±283(Plt;001)与5835±289和5776±324。6月后,rHuEPO组平均每例直接费用成本1075440元,明显低于输血组需要达到同样效果所需的每例2070420元。结论:大剂量rHuEPO治疗MM相关性贫血优于输血,其起效快、疗效好,患者生活幸福感改善明显,费用成本低,安全性较好。

含呋喃唑酮与四环素四联疗法根除幽门螺杆菌致急性溶血性贫血一例

端粒酶基因突变与再生障碍性贫血

近年来，端粒酶基因突变引起的端粒酶活性降低和端粒缩短，成为再生障碍性贫血（再障）发病机制的研究热点之一。大多数获得性再障患者是由免疫异常引起的，对免疫抑制治疗有效。约1/3的再障患者存在端粒缩短、端粒酶活性降低的情况，他们对免疫抑制剂治疗通常无效，而对雄激素治疗有效。雄激素在人体内可以通过芳香化转化为雌激素，与端粒酶基因启动子上的雌激素受体成分相结合而发生作用，从而增加端粒酶活性，恢复骨髓造血和外周血细胞数，彰显出治疗再障的作用。端粒酶基因突变和端粒酶活性异常是现今又一被肯定的再障发病机制，为临床治疗再障开辟了新的思路。

Evaluation of Clinical Application of Hb-A2 Level for Detection of Thalassemia Carrier

Objective　To evaluate the clinical application of Hb-A2 detection of thalassemia including-alpha-thalassemia and beta-thalassemia. Methods　There were 70 Southeast Asia type alpha-thalassemia heterozygosity and 43 normal gene type resulted from Gap-PCR, and 33 beta-thalassemia heterozygosity and 36 normal gene type diagnosed by reverse dot blot (RDB). Cutoff value of Hb-A2 in finding of alpha-thalassemia and beta-thalassemia was present.The sensitivity, specificity, positive and negative likelihood ratio, and receiver operator characteristic curve (ROC) were used to evaluate the significance of Hb-A2 level in screening thalassemia in adults. Results　The borderline values between normal and pathological range of Hb-A2 were ≤2.6% in alpha-thalassemia and ≥3.8% available in beta-thalassemia. Sensitivity and specificity were 59% and 54% in alpha-thalassemia, 76% and 83% in beta-thalassemia, respectively. ROC showed that the area covered beneath the curve of beta-thalassemia was more than that of alpha-thalassemia. Conclusions　The cutoff between normal and pathological range of Hb-A2 is ≤2.3% in alpha-thalassemia and ≥3.8% in beta-thalassemia. Hb-A2 detection has higher sensitive and specific in beta-thalassemia diagnosis, but lower in alpha-thalassemia diagnosis.

Analysis of the incidence and influencing factors of anemia in patients with colorectal cancer

ObjectiveTo investigate the incidence of perioperative anemia and the influencing factors of preoperative anemia in patients with colorectal cancer.MethodsThe clinicopathological data of 1 250 patients with colorectal cancer who underwent surgery in our hospital from January 1, 2019 to December 31, 2019 were analyzed retrospectively. According to the preoperative hemoglobin level, patients were divided into anemia group and non-anemia group. Univariate analysis and multivariate logistic regression analysis were used to explore the influencing factors of preoperative anemia in patients with colorectal cancer, and the effects of preoperative anemia on intraoperative blood transfusion, postoperative complications, and postoperative hospital stay were analyzed.ResultsThe incidence of preoperative anemia in patients with colorectal cancer was 40.6% (508/1 250), and the incidence of preoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 66.0% (192/291), 41.1% (139/338), and 28.5% (177/621), respectively. The incidence of postoperative anemia in patients with colorectal cancer was 69.4% (867/1 250), and the incidence of postoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 81.8% (238/291), 68.9% (233/338), and 63.8% (396/621), respectively. Multivariate logistic regression analysis showed that age >60 years old, nutritional risk screening 2002 ≥3, right colon cancer, T3–4 stage, and M1 stage were risk factors for preoperative anemia in patients with colorectal cancer (P<0.05). The rate of intraoperative blood transfusion and the incidence of postoperative complications in the preoperative anemia group of patients with colorectal cancer were higher than those in the non-anemia group (P<0.05). The postoperative hospital stay in the preoperative anemia group of patients with colon cancer was longer than that in the non-anemia group (P<0.05).ConclusionsThe incidence of perioperative anemia in patients with colorectal cancer is high. Advanced age, high nutritional risk, right colon cancer, T3–4 stage, and distant metastasis were the risk factors of preoperative anemia in patients with colorectal cancer. Preoperative anemia can increase the demand for intraoperative blood transfusion and the incidence of postoperative complications in patients with colorectal cancer, and prolong postoperative hospital stay of colon cancer patients.

地中海贫血并发胆源性急性胰腺炎一例

Investigation of roxadustat compliance and related influencing factors in patients undergoing maintenance peritoneal dialysis

ObjectiveTo investigate the status of roxadustat in patients undergoing maintenance peritoneal dialysis and analyze the factors affecting drug compliance. MethodsPatients with renal anemia undergoing maintenance peritoneal dialysis in West China Hospital of Sichuan University from July 2020 to March 2021 were selected. All patients took roxadustat orally. According to the medication compliance, the patients were divided into good compliance group and poor compliance group. The general information questionnaire and Morisky Medication Adherence Scale-8 (MMAS-8) were used to investigate and analyze the included patients, and their clinical examination indexes were collected. ResultsA total of 100 patients were included, Including 39 cases (39%) in the good compliance group and 61 cases (61%) in the poor compliance group. The average score of medication compliance of roxadustat was 5.19±1.72. Logistic regression analysis showed that drug cognition [odds ratio (OR)=0.099, 95% confidence interval (CI) (0.027, 0.365), P=0.001], medication troubles/complex protocol [OR=5.330, 95%CI (1.567, 18.132), P=0.007], and adverse drug reactions [OR=5.453, 95%CI (1.619, 18.368), P=0.006] were factors affecting patient compliance. Hemoglobin in the good compliance group was lower than that in the poor compliance group (Z=−2.259, P=0.024); there was no significant difference in other clinical examination indexes (P>0.05). ConclusionsThe overall compliance of oral roxadustat in maintenance peritoneal dialysis patients is poor, and the corresponding follow-up management system should be improved. Nurses should provide comprehensive and systematic medication guidance to patients, encourage them to fully understand the clinical manifestations, treatment schemes and prognosis of renal anemia, clarify the time, dose, possible adverse reactions and mitigation methods of roxadustat, etc., and help them to treat the disease with correct cognition and attitude, so as to improve their drug compliance.

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。