目的:研究弥漫大B细胞淋巴瘤(DLBCL)患者初诊时外周血中调节性T细胞(Treg)水平及其对疗效评估和预后判断的价值。方法:选取2018年1月至2022年2月安徽医科大学第二附属医院收治的72例初诊DLBCL患者作为研究对象,以17例健康志愿者为对照,使用流式细胞术检测所有纳入研究对象的外周血中CD4^(+)CD25^(+)CD127^(low)Treg水平,并结合患者的临床特征进行比较分析。结果:患者治疗前外周血Treg百分比与Ann Arbor分期、IPI评分、ECOG评分、血红蛋白(HB)相关;初诊时外周血Treg水平显著低于健康对照(3.85±0.22 vs 5.15±0.31,P=0.007);根据初诊时外周血CD4^(+)CD25^(+)CD127^(low)Treg占CD4^(+)T细胞百分比的中位数将DLBCL患者分为高Treg组和低Treg组,低Treg组患者的治疗总有效率明显低于高Treg组(P=0.035);ECOG评分(P=0.040)和治疗前低Treg(P=0.014)是影响DLBCL患者无进展生存期(PFS)的独立危险因素;有B症状(P=0.028)、ECOG评分≥2分(P=0.041)和治疗前低Treg(P=0.036)是影响患者OS的独立危险因素;低Treg组PFS(P=0.020)和OS(P=0.036)均显著低于高Treg组。结论:初诊DLBCL患者外周血CD4^(+)CD25^(+)CD127^(low)Treg百分比低提示预后不良。
目的:探讨转甲状腺素蛋白淀粉样变性(ATTR)的临床诊断、治疗及预后。方法:回顾性分析安徽医科大学第一附属医院2022年收治的1例ATTR患者的临床资料,并进行相关文献复习。结果:患者,男性,43岁,初期表现为间断腹泻,随后因双下肢麻木乏力行神经活检提示神经淀粉样变性,现因双下肢浮肿及尿失禁就诊,经综合检查考虑淀粉样变性多系统累及,完善心脏磁共振、99mTc-PYP核素显像及基因检测,确诊ATTR,现予以氯苯唑酸治疗,随访截至2024年12月,患者病情稳定。结论:ATTR为淀粉样变性中的罕见类型,病例少,病情进展快,临床表现缺乏特异性,虽有针对性的治疗药物,但需做到早期诊断及治疗,总体预后不佳。Abstract: To explore the clinical diagnosis, treatment, and prognosis of transthyretin amyloidosis (ATTR). Method: A retrospective analysis was conducted on the clinical data of a patient with ATTR admitted to the First Affiliated Hospital of Anhui Medical University in 2022, and relevant literature was reviewed. Result: The patient, a 43-year-old male, initially presented with intermittent diarrhea. Subsequently, nerve biopsy was performed due to numbness and weakness in both lower limbs, indicating neuroamyloidosis. The patient is now seeking medical attention due to edema and urinary incontinence in both lower limbs. After comprehensive examination, it was considered that amyloidosis involves multiple systems. After completing cardiac magnetic resonance imaging, 99mTc PYP nuclear imaging, and genetic testing, the patient was diagnosed with ATTR and is now receiving treatment with chlorpromazine. Follow-up until December 2024 shows that the patient’s condition is stable. Conclusion: ATTR is a rare type of amyloidosis with few cases, rapid disease progression, and lack of specificity in clinical manifestations. Although there are targeted therapeutic drugs, early diagnosis and treatment are necessary, and the overall prognosis is poor.
目的:本研究旨在探讨RPR水平与多发性骨髓瘤(MM)患者预后的预测价值。方法:我们回顾性分析了161例新诊断的MM患者,收集患者临床资料,根据MM的预后确定RPR的最佳截断值,将MM患者分为高RPR组和低RPR组,比较两组之间临床资料的差异性,分析RPR对MM患者预后的影响。结果:RPR最佳截断值为0.115时预测价值最高,高RPR组和低RPR组总生存期(OS)的中位数均未达到,Kaplan-Meier生存分析显示两者间差异具有统计学意义(P 0.115、肌酐 > 177 umol/L是OS的独立预后因素;RPR > 0.115是PFS的独立预后因素(P Objective: The aim of this study was to investigate the prognosis value of RPR of MM patients. Methods: We retrospectively analysed 161 newly diagnosed MM patients, collected patients’ clinical data. According to the best cut off value of RPR on the prognosis of MM, they were divided into high RPR group and low RPR group. The differences in clinical data between the two groups were compared and the influence of RPR on the prognosis of MM was analyzed. Results: The best RPR cut off value was 0.115 when the predictive value was the highest. The median overall survival (OS) was not reached in both the high and low RPR groups, and Kaplan-Meier survival analysis showed that the difference was statistically significant (P 0.115, and creatinine > 177 umol/L were independent prognostic factors for OS;RPR > 0.115 was an independent prognostic factor for PFS (P < 0.05). Conclusion: RPR is a practical and validated prognostic marker for newly diagnosed MM patients, and high RPR is an independent poor prognostic factor for OS and PFS in MM patients.
目的:通过分析住院患者耐碳青霉烯肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumoniae, CRKP)的临床特征与危险因素,旨在为CRKP的诊断和治疗给予理论支撑。方法:采用回顾性研究方法选取安徽医科大学第一附属医院2023年6月至2024年7月住院患者分离出的肺炎克雷伯菌(Klebsiella pneumoniae, KP)。按菌株对碳青霉烯类药物的敏感性划分成两个组别:碳青霉烯敏感肺炎克雷伯菌(Carbapenem-susceptible Klebsiella pneumoniae, CSKP)组(n = 106)与CRKP组(n = 74)。收集所有研究对象的临床数据,并采用单因素分析和多因素logistic回归分析来分析住院患者发生CRKP的危险因素,明确各因素之间的关联以及对感染风险的影响程度,为后续的预防和控制感染提供科学依据。结果:180例KP患者中检出CRKP 74例,其中男性43例,女性31例。CRKP菌株主要来自重症医学科,其次为感染科和康复科,标本主要来源于痰液、血液和尿液。单因素分析显示,住院天数 ≥ 10天、肺部疾病、泌尿道感染、入住ICU史、入住ICU ≥ 5天、抗生素使用 > 14天、联用抗生素、呼吸机、尿道插管、中心静脉置管、气管镜检、胃管置入均与CRKP感染有关(p 14天、中心静脉置管为CPKP感染的独立危险因素。结论:泌尿道感染、抗生素使用 > 14天、中心静脉置管是导致CRKP菌株感染形成的独立危险因素,在临床防治CRKP感染中应加以重视。Objective: To analyze the clinical characteristics and risk factors of Carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients, aiming to give theoretical support for the diagnosis and treatment of CRKP. Methods: Klebsiella pneumoniae (KP) isolated from patients hospitalized in the First Affiliated Hospital of Anhui Medical University from June 2023 to July 2024 were selected using a retrospective study. The strains were divided into two groups according to their susceptibility to carbapenems: the carbapenem-susceptible Klebsiella pneumoniae (CSKP) group (n = 106) versus the CRKP group (n = 74). Clinical data of all study subjects were collected. Univariate analysis and logistic regression analysis were used to analyze the risk factors for the occurrence of CRKP in hospitalized patients, to clarify the association between the characteristics and the degree of influence on the risk of infection, and to provide a scientific basis for the subsequent prevention and control of infection. Results: CRKP was detected in 74 of 180 KP patients, including 43 males and 31 females. CRKP strains were mainly from the Department of Intensive Care Medicine, followed by the Department of Infectious Diseases and the Department of Rehabilitation, and specimens were mainly from sputum, blood, and urine. Univar
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