目的：通过经外周静脉穿刺中心静脉置管（PICC）或锁骨下静脉置管与前臂静脉留置针在血液病患者并发深部真菌感染时应用两性霉素B中的比较，探讨如何减少患者静脉炎及并发症发生率和再次静脉穿刺的发生率，从而提高患者生活质量。方法：80例血液病患者分为两组，40例PICC置管或锁骨下静脉置管组为A组，40例前臂静脉留置针为B组，记录静脉炎、疼痛发生情况、留置时间。结果：A组留置时间30～68天，B组留置时间1～5天；A组静脉炎率5%，B组静脉炎率45%；A组疼痛率5%，B组疼痛率35%；结论：在血液病患者并发深部真菌感染时应用两性霉素B治疗中，选用PICC置管或锁骨下静脉置管效果明显优于前臂静脉留置针，值得临床推广。
目的:观察血液病患者造血干细胞移植后外周血细胞参数的近期动态变化,了解骨髓恢复情况。方法:使用SE-9500血细胞分析仪对28例血液病患者造血干细胞移植前后血液进行检测,观察移植后一个月内各参数的变化。结果:28例外周血干细胞移植前后各细胞参数的观察发现,红细胞平均容积(MCV)、红细胞平均血红蛋白含量(MCH)、红细胞平均血红蛋白浓度(MCHC)和红细胞体积发布宽度(RDW-CV%)等参数其结果在干细胞移植前后进行比较,虽然有变化,但无显著性差异(Pgt;0.05);红细胞计数(RBC)、血红蛋白(HGB)、红细胞压积(HCT)、网织红细胞绝对数(RET)、低荧光强度网织红细胞百分率(LFR%)、高荧光强度网织红细胞百分率(HFR%)和中荧光强度网织红细胞百分率(MFR%)等参数变化较大,有显著性差异(Plt;0.05)。RBC、HGB和HCT在移植后第14天降至最低,以后逐渐升高;在干细胞移植后第7天RET＃、MFR％和HFR％降至最低,LFR％相对增高,随着干细胞移植后骨髓功能逐渐恢复,RET＃也随之升高,HFR在第14天升至最高,MFR在第21天升至最高。结论:观察干细胞移植后外周血细胞参数的变化,对了解干细胞移植后骨髓的恢复有一定的临床价值,本次结果表明HFR可作为了解骨髓恢复的早期指标。
ObjectiveTo evaluate the diagnostic value of T-SPOT.TB assay in patients with hematological disorders and tuberculosis. MethodsA total of 82 patients with hematological disorders and suspected tuberculosis diagnosed between March 2012 and April 2013 received T-SPOT. TB assay in the peripheral blood mononuclear cells. ResultsThe positive detection rate of T-SPOT.TB assay for patients with hematological disorders and tuberculosis was 59.09% (13/22), which was higher than the positive detection rate of anti-TB antibody test[13.64% (3/22)]. The sensibility and specificity of T-SPOT.TB assay for patients with hematological disorders and tuberculosis was 59.09% (13/22) and 68.33% (41/60), respectively. ConclusionT-SPOT.TB assay is of great value on diagnosis of tuberculosis for patients with hematological disorders and suspected tuberculosis. The diagnostic value of T-SPOT.TB assay is more important for tuberculosis infected patients; it can be used as an accessorial diagnostic method for patients with hematological disorder and suspected tuberculosis.
Objective To explore the prognostic value of red cell volume distribution width (RDW) for hematological malignancies. Methods PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were searched for related literatures on myelodysplastic syndrome, leukemia and other hematological malignancies and pretreatment RDW from the establishment of databases to April 5, 2022. The main statistical indicators were Hazard ratio (HR) and its 95% confidence interval (CI). Stata 12.0 SE software was used for analysis, and Q test was used to evaluate literature heterogeneity. Subgroup pooled analysis was used to evaluate the prognostic value of RDW. Results A total of 7 articles were included, with a total of 804 patients. A fixed-effect model was selected for meta-analysis, and the results showed that patients with elevated pretreatment RDW had worse overall survival [HR=2.91, 95%CI (2.01, 4.22), I2=0%, P=0.714]. The results of subgroup analysis for different types of diseases showed that in myelodysplastic syndrome group [HR=2.61, 95%CI (1.28, 5.31), I2=22.0%, P=0.258)], chronic myeloid leukemia group [HR= 3.24, 95%CI (1.91, 5.51), I2=0%, P=0.546], and adult T-cell leukemia/lymphoma group [HR=2.64, 95%CI (1.22, 5.70)], the overall survival rate of patients with elevated pretreatment RDW were worse. Sensitivity analysis showed that the study was stable and there was no heterogeneity in the overall study result.Conclusion Elevated pretreatment RDW is associated with overall survival and can be used as an indicator for evaluating the prognosis of hematological malignancies, but large sample studies are still needed to determine the best predictive cutoff for various diseases.
Objective To explore the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of severe and complex infection of malignant hematological disorder. Methods The mNGS test results, traditional etiology test results and general clinical data of inpatients with malignant hematological disorder in the Department of Hematology, the Affiliated Hospital of Southwest Medical University between June 2020 and February 2022 were retrospectively analyzed. To explore the clinical application value of mNGS in the diagnosis and treatment of severe complicated infection of hematological disorder. Results A total of 21 patients were included. The samples included 18 peripheral blood samples, 2 pleural fluid samples and 1 alveolar lavage fluid sample. In the included patients, through mNGS, pathogenic bacteria were directly detected in 17 patients, including 8 fungi, 9 bacteria and 10 viruses, of which 9 were mixed infections. The positive rate (81.0% vs. 33.3%, P=0.002), sensitivity (85.7% vs. 30.0%), granulocytopenia (9 vs. 3 cases, P=0.031) and the types of pathogen (Z=−3.416, P=0.001) detected by mNGS were all higher than those by traditional method. The infection control of 17 patients improved in varying degrees after adjusting the treatment plan according to the test results. ConclusionsmNGS has significantly higher detection rate and sensitivity for bacteria, fungi, viruses and mixed infections. Compared with the traditional method, mNGS has more efficient characteristics. Its clinical application can further improve the diagnosis and treatment efficiency of severe complicated infection of malignant hematological disorder, and thus improve the survival rate of patients.