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。
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.
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.
目的 通过比较三种血液净化方式对炎症介质、甲状旁腺激素等中大分子毒素的清除效果，并观察促红细胞生成素（EPO）的治疗效果，探寻有利于肾性贫血改善的最佳透析模式。 方法 2011年5月－8月采用前瞻性、随机对照、开放式设计，选择维持性血透患者60例，随机分成3组，每组20例。血液灌流（HDP）组[每2周5次血液透析（HD）+1次HDP]、血液透析滤过治疗（HDF）组（每2周5次HD+1次HDF）、HD组（每2周6次HD），随访3个月。检测试验前后反应蛋白（CRP）、β2微球蛋白、甲状旁腺素（PTH）、白介素-6的水平以及各组患者肾性贫血指标的变化。 结果 3个月试验结束时，HDP组和HDF组4项尿毒症毒素水平均显著下降，其中HDP组CRP水平明显低于HDF组（P＜0.05）；HDP组和HDF组试验后的血红蛋白水平较试验前升高，ERI值下降。HD组试验前后的毒素水平无明显变化，ERI值升高。3组患者均未出现严重不良事件。 结论 HDP和HDF清除中大分子毒素的能力优于HD，有利于缓解微炎症状态，改善EPO治疗效果。HDP和HDF的远期效果哪种更好，尚有待于进一步的研究。
Objective To observe macular vascular density and structural characteristics in children with transfusion-dependent β-thalassemia (TDT). MethodsA retrospective clinical study. From October 2022 to December 2023, 29 TDT children (58 eyes) diagnosed and examined at the Department of Hematology, Affiliated Hospital of Guangdong Medical University were included in the TDT group, along with 29 age- and gender-matched healthy children (58 eyes) as the control group. All participants underwent optical coherence tomography and angiography. Measurements included central macular thickness (CMT), subretinal choroidal thickness (SFCT), choroidal thickness (ChT), choroidal vascularity index, blood flow density in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris layer (CC), and choroidal layer of the macular region, as well as the foveal avascular zone (FAZ) area of the SCP and DCP. A generalized estimating equation was used to compare differences in the above parameters between the two groups. Pearson correlation analysis was employed to examine the relationships between fundus structural parameters, blood flow density, and blood indices. ResultsCompared with the control group, the TDT group showed significantly thinner CMT (χ2=6.044) and ChT at 3.0 mm nasal (χ2=4.451) and temporal (χ2=4.767) to the fovea (P＜0.05). The TDT group also demonstrated reduced blood flow density in the inferior DCP (χ2=5.254), whole CC (χ2=3.996), and superior CC (χ2=5.094), as well as enlarged FAZ area in DCP (χ2=4.286) (P＜0.05). Correlation analysis revealed a negative correlation between SFCT and disease duration (r=−0.357, P=0.006). ConclusionsIn children with TDT, CMT and ChT become thinner and the area of FAZ expands. The blood flow densities of DCP and CC in the macular area decreased.
Objective To analyze the relationship between preoperative anemia and postoperative infection and death in children with acyanotic congenital heart disease (CHD) after elective cardiac surgery. Methods Medical records and follow-up data of 3 859 children with acyanotic CHD who underwent elective cardiac surgery in our hospital from 2011 to 2018 were retrospectively collected, including 2 081 males and 1 778 females with a median age of 32.2 (13.7, 61.5) months. The relationship between preoperative anemia and postoperative infection and death within 90 days was analyzed by univariate and multivariate regression analyses. Results Preoperative anemia was found in 325 (8.4%) patients. There were 716 (18.6%) patients of postoperative infection, including 281 (7.3%) patients of confirmed infection and 435 (11.3%) patients of suspected infection. Forty-six (1.2%) patients died within 90 days after the operation. Univariate analysis showed that age, infection history within 3 months before admission, degree of pulmonary hypertension, the risk adjustment in congenital heart surgery-1 (RACHS-1) score, cardiopulmonary bypass (CPB), disease diagnosis, chromosome abnormality, preoperative left ventricular ejection fraction (LVEF)<55% and preoperative anemia were associated with postoperative infection. Age, degree of pulmonary hypertension, RACHS-1 score, CPB, disease diagnosis and preoperative LVEF<55% were associated with postoperative death within 90 days. Logistic regression analysis showed that preoperative anemia was significantly associated with confirmed postoperative infection [OR=1.82, 95%CI (1.18, 2.82), P=0.007], suspected infection [OR=1.60, 95%CI (1.11, 2.30), P=0.012] and total infection [OR=1.64, 95%CI (1.20, 2.24), P=0.002]. The results of modified Poisson regression analysis showed that there was no significant association between preoperative anemia and death within 90 days after the surgery [RR=1.59, 95%CI (0.69, 3.69), P=0.276]. Conclusion Preoperative anemia may be a risk factor for infection after elective cardiac surgery in children with acyanotic congenital heart disease.