[Clinical analysis of six cases with the de novo glomerulitis after allogeneic hematopoietic stem cell transplantation]

目的

探讨异基因造血干细胞移植（allo-HSCT）后肾小球肾炎的发病、诊断及治疗情况。

方法

回顾性分析2008年1月至2016年12月河南省肿瘤医院allo-HSCT后肾小球肾炎患者的临床资料。

结果

478例allo-HSCT患者中6例（1.26%）发生肾小球肾炎，男3例，女3例，中位年龄22（12~36）岁；重型再生障碍性贫血（SAA）2例，急性髓系白血病（AML）4例，移植前均无明确的肾脏病病史，中位发生时间为移植后447（272~1 495）d。4例患者肾功能异常，5例尿潜血阳性，3例高血压，2例高血脂。5例患者曾发生急性GVHD，4例发病时伴有慢性GVHD。肾脏病理：微小病变型肾病1例，膜性肾病4例，系膜增生性肾小球肾炎伴缺血性损伤1例。肾脏免疫组化：IgG阳性4例，IgM阳性1例，C3阳性3例，C1q阳性1例。2例血清抗核抗体阳性，IgG和IgM升高各1例。仅1例患者糖皮质激素治疗有效。5例患者采用低剂量环磷酰胺联合霉酚酸酯治疗，2例完全有效，3例部分有效。4例患者生存良好，2例患者死于肺感染。

结论

allo-HSCT后肾小球肾炎的病理类型以膜性肾病为主，低剂量环磷酰胺联合霉酚酸酯可获得较好疗效。

[Synchronous lymphoma and carcinoma-clinical analyses of 17 patients]

目的

探讨淋巴瘤合并实体肿瘤的多原发癌临床特征，以提高临床工作者对多原发癌的认识。

方法

回顾性分析2012年3月至2017年10月收治的17例明确诊断为淋巴瘤合并原发实体肿瘤的患者资料，并结合文献对其临床特征、治疗及转归进行总结。

结果

①17例患者中，男8例，女9例，中位年龄57（30~78）岁。②淋巴瘤：分类：霍奇金淋巴瘤1例，B细胞淋巴瘤2例，边缘区淋巴瘤6例，弥漫大B细胞淋巴瘤3例，套细胞淋巴瘤1例，结外NK/T细胞淋巴瘤（鼻型）3例，间变大细胞淋巴瘤1例；Ann Arbor分期：Ⅰ期6例，Ⅱ期1例，Ⅲ期2例，Ⅳ期4例，不确定4例。③实体肿瘤：分类：消化道恶性肿瘤8例（食管癌3例，胃癌3例，结直肠癌2例），甲状腺癌7例（乳头状癌3例，微小乳头状癌4例），肝癌1例，肺癌1例；分期：Ⅰ期10例，Ⅲ期3例，Ⅳ期2例，不确定2例。④17例患者中有15例接受手术治疗，部分患者联合化疗、放疗、auto-HSCT治疗。3例患者治疗未结束，2例失访，4例死亡，3例完全缓解，3例病情稳定，2例复发或进展。

结论

淋巴瘤与实体肿瘤之间的关系目前虽暂无定论，但二者在发生、发展过程中存在一定的相关性，淋巴瘤合并实体肿瘤虽然少见但并不罕见，临床工作者应该提高认识，避免误诊和漏诊。

[Clinical outcome of allogeneic hematopoietic stem cell transplantation in the treatment of 9 myeloid leukemia patients with granulocytic sarcoma]

To explore the efficacy and influencing factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myeloid leukemia and granulocytic sarcoma (GS). Clinical outcome including hematopoietic reconstitution, transplant-related complications, survival and relapse were collected and retrospectively analyzed in 9 patients with myeloid leukemia and GS after allo-HSCT. Hematopoiesis reconstitution was achieved in all the 9 recipients. Four cases developed acute graft-versus-host disease (GVHD), and 1 with chronic GVHD. The median follow-up time after transplantation was 10(4-81) months. Only 2 cases survived, the other 7 died of relapse. The median time of relapse after transplantation was 5(3-19) months. Allo-HSCT is relatively effective treatment for patients with myeloid leukemia and GS. Relapse after transplantation remains the major factor of mortality.

[A study on the effects of RF coil for the static magnetic field]

In the paper, we introduce the studies on some abnormal points in static magnetic field, find out the causes and mean while, give the methods of exclusion, thus the adjustment of MRI can be made perfectly.

[Study on the permanent MRI technology]

This paper describes the open permanent MRI technology, introduces the special technology such as main magnet field, gradient magnetic field coil, Transmitter/Receiver coils and so on, and points out that the installation and adjustment of the MRI are also very important for optimal operation and best image quality.

[Prenatal diagnosis of Duchenne's muscular dystrophy fetus at risk]

Prenatal diagnosis of Duchenne's muscular dystrophy (DMD) have been carried out on 12 fetus at risk. The gene mutations have been identified by hybridization with cDNA probes and/or multiplex PCR. The fetus examined were 7 males and 3 females. Three of the male fetus inherited the same deleted mutations as the probands, and other 4 appeared normal. Among the 3 female fetus, one carried a deleted gene, two were considered normal. The diagnosis of the fetus were confirmed after birth or abortion. As the multiplex PCR can quickly detect about 98% of the deletions on the dystrophin gene, it is not only an idea method for screening the gene deletion but can also be applied to prenatal diagnosis immediately after the nature of the deletion have been identified among the probands. The strategy of prenatal diagnosis of DMD in our country was also discussed.

[Changes in T-lymphocyte subsets of peripheral blood in unexplained habitual abortion]

T-lymphocyte subsets of peripheral blood were examined by flow cytometry (FCM) in 20 cases of unexplained habitual abortion (UHA) before and after active immunization treatment, with 10 normal pregnant (NP) women and 20 normal nonpregnant (NNp) women as control.

THE RESULTS

there was no difference in the percentage of CD3 cells between the UHA cases and NNP. Before immunization the percentage of CD8 cells was significantly lower (P < 0.001) and the ratio of CD4/CD8 was increased (P < 0.05) in UHA as compared with the NNP. However, after immunization, the percentage of CD8 cells greatly increased (P < 0.05) and CD4/CD8 ratio decreased significantly (P < 0.05) nearly to that of NP. These findings suggest that: (1) the increase of CD4/CD8 ratio due to the decreasing CD8 cells is the underlying immunomechanism of UHA; (2) immunization may induce the proliferation of CD8 cells and the lowering of CD4/CD8 ratio. Therefore, CD8 cells might play an important role in maintaining the balance of fetal-maternal immunological relationship; (3) the ratio of CD4/CD8 may served as parameter for observing the clinical efficacy of immunization therapy.

[Investigation of the association between autoantibodies and recurrent abortions]

Two hundred and forty five patients with recurrent abortions were studied for autoantibodies in this paper. The total positive rate of autoantibodies was found to be 18.4% (45/245). The presence of antiphospholipid antibodies was in 33 (13.5%), antinuclear antibodies in 17 (6.9%) and anti-ENA in 7 (2.9%) patients. According to the clinical data, these 45 patients were classified into three types: (1) cases with antiphospholipid antibodies; (2) cases with anti-ENA (SLE); (3) cases with simple antinuclear antibodies. All the patients except SLE cases were treated with low-dose prednisone (5 mg/day) and aspirin (60-80 mg/day). The total pregnancy success rate was 80.0%. Excluding SLE cases, the success rate was up to 92.9%. The outcome of pregnancy was usually related to whether the autoantibodies especially LAC turned negative or not. Hemorheology and coagulative state in 19 patients with autoantibodies revealed hypercoagulative condition. It suggests that autoantibodies may cause intravascular coagulation leading to recurrent abortions.

[Immunologic diagnosis and treatment in the cases of unexplained habitual abortion]

One hundred and fourty-eight cases of habitual abortion were screened for etiologies. We found 40.5% (60/148) were unexplained. Among them, 34 cases were volunteers for receiving repeated active immunolization with low-dose of lymphocyte from their husbands or other donors, and 12 cases were taken as control. The successful pregnant rate was 86.4% (19/22) in treatment group which is higher significantly than in control (P < 0.05). meanwhile, used by microlymphocytotoxic antibody test and one-way mixed lymphocyte reaction and its inhibition test, the observations on immunologic state before and after vaccination were made in 19 cases. We found both the positive rate of microlymphocytotoxic antibody test and the relative suppressive rate of lymphocyte response were increased significantly post-vaccination than pre-vaccination. These results not only confirmed that active immunization was effective, but also suggested that habitual abortion may be associated with the lack of protective antibody and/or block antibody.

[Immunopathological study on the uterine spiral arteries in pregnancy-induced hypertension]

The uterine spiral arteries were studied by the immunohistochemical ABC method in 30 cases of Pregnancy Induced Hypertension (PIH) and 10 cases of normal pregnant women. Depositions of IgM and/or C3 on the vessel wall were significantly observed only in PIH cases (15 cases, 50.0%; P < 0.05). Depositions of IgG were seen in 5 cases of PIH 16.7% showing significantly decrease. (P < 0.001), as compared with the normal pregnant women (9 cases, 90.0%). The results suggest that PIH is related to chronic rejection reaction resulting possibly from the decrease of local immunosuppression in pregnancy. Meanwhile the positive stain of IgG, IgM and C3 seen in the nuclei of decidual cells in some of PIH cases were discussed.

[The subpopulations of T lymphocyte and the function of suppressor T cell in normal pregnancy and pregnancy-induced hypertension]

T-lymphocyte subpopulations were determined by the monoclonal antibodies (OKT3, OKT4, OKT8) in 20 cases of normal pregnancy, 36 cases of pregnancy-induced hypertension (PIH) and 20 cases of normal non-pregnant women. The assaying of ConA-induced suppressor T cell (Ts cell) function was carried out in another 20 cases of late pregnancy, 20 cases of moderate and severe PIH, and 10 cases of normal non-pregnant women. The results showed: the percentage of Ts cell increased significantly and the ratios of Th/Ts decreased significantly during normal pregnancy as compared with normal non-pregnant women. As compared with the late pregnant women, a lowering of Ts cell and elevating ratio of Th/Ts were found in PIH cases with statistical significance in severe PIH. A decrease of Ts cell function was also seen in moderate and severe PIH cases. All these findings suggest that the changes of Ts cell in amount and function may play an important role in maintaining normal pregnancy and in the pathogenesis of PIH.