【摘要】 目的 探讨多发性骨髓瘤的临床特征及不同方案的疗效。 方法 回顾性分析2006年2月-2010年8月110例多发性骨髓瘤的临床特征及治疗情况，对不同方案的疗效进行比较。 结果 110例患者中Ⅲ期73例，40例伴发有基础疾病；24例接受MP方案，部分缓解10例，无变化1例，疾病进展8例，总有效率41.7%；其余86例接受联合化学疗法的患者完全缓解18例，部分缓解17例，轻微缓解30例，无变化17例，疾病进展4例，总有效率40.7%；两组总有效率差异无统计学意义（Plt;0.05）。联合化疗中PAD方案的总有效率最高，为62.5%。110例患者的中位生存期32.6个月，3年生存率为34.5%，加入沙利度胺组，总有效率为35.8%，3年生存率36.5%，联合硼替佐米治疗组总有效率为75%。 结论 多发性骨髓瘤患者多为晚期，有基础疾病，化疗后易感染，联合化疗组的有效率较MP方案高，但两组的总生存率无差异，加用新药沙利度胺或硼替佐米可以提高有效率。【Abstract】 Objective To analyze the clinical characteristics and clinical outcomes of patients with multiple myeloma treated with different regimens. Methods We retrospectively analyzed the clinical characteristics and treatments of 110 patients with multiple myeloma treated between February 2006 and August 2010, and compared the clinical outcomes of different treatment regimens. Results Seventy-three out of the 110 patients were at stage Ⅲ, and 40 patients had one or two more fundamental diseases. Twenty-two patients received MP regimen, among whom 10 gained partial alleviation, 1 had no change and 8 were aggravated with a total effective rate of 41.7%. Another 86 cases received combination chemotherapy, and among them, 18 gained complete alleviation, 17 attained partial alleviation, 30 achieved mild alleviation, 17 had no change, and 4 were aggravated with a total effective rate of 40.7%. In terms of the total effective rate, there was no statistical difference between these two groups. PAD-treated group had a highest effective rate of 62.5%. The median survival time for all the patients was 32.6 months; 3-year survival rate was 34.5%. For patients treated with thalidomide, the total effective rate and 3-year survival rate were 35.8% and 36.5% respectively, while for patients treated with bortezomib, the effective rate was 75%. Conclusions Patients with multiple myeloma at a late stage complicated with fundamental diseases can develop infections after chemotherapy. Total effective rate of combination chemotherapy is higher than that of MP treatment, but survival rate of the two treatments have no statistical difference. The effective rate can be increased after the using of novel agents such as thalidomide and bortezomib.
Objective Human acellular amniotic membrane (HAAM) contains collagens, glucoproteins, proteinpolysaccharide,integrin, and lamellar, which can supply rich nutrition to cell prol iferation and differentiation. To explore the possibil ity of HAAM with adi pose-derived stem cells (ADSCs) as a good engineered skin substitute for repairing skin defect. Methods Primary ADSCs were obtained from inguinal fat of 30 healthy 4-month-old SD rats, male or female, weighing 250-300 g, and cultured in vitro and purified. The 3rd passage ADSCs were used to detect CD44, CD49d and CD34 by immunocytochemistry staining. After physical and trypsin preparation, the HAAM was observed by HE staining and scanning electron microscope(SEM) respectively. ADSCs were seeded on epithel ial side of HAAM at the density of 2 × 105/cm2, cocultured, and observed by SEM at different time. MTT test was used to detect viabil ity of cells that seeded on HAAM, the group without HAAM was used as control. Thirty SD rats were made models of full-thickness skin wound and randomly divided into three groups (A, B, and C). Wound was repaired with HAAM/ADSCs composites in group A, with HAAM in group B, and with gauze as control in group C. The rats underwent postoperative assessment of wound heal ing rate and histological observation at the 1st, 2nd, and 4th weeks. Results HE staining showed that the 3rd passage ADSCs was spindle-shaped with an ovoid nucleus which located in the middle of cell; the immunocytochemistry staining showed positive result for CD44 and CD49d and negative result for CD34. There were no residues of cells in the HAAM by HE staining. SEM showed that there were different structures at the two sides of HAAM；one side had compact reticular structure and the other side had fibrous structure. After 3 days of co-culture, ADSCs showed good growth on HAAM; the cells were closely packed onto the HAAM, attached firmly and prol iferated to confluence on the stromal surface of HAAM. MTT test showed that the cells on the HAAM grew well and had b prol iferation vital ity. There was no significant difference between ADSCs cultured in the HAAM and control group (P gt; 0.05). One, 2, 4 weeks after graft, there were significant differences in wound heal ing rate between group A and groups B, C (P lt; 0.05), between group B and group C (P lt; 0.05). HE staining showed that wound healed faster in group A than in groups B, C. Cytokeratin 19 (CK19) immunohistochemical statining showed that there were more CK19 positive cells in group A than in groups B, C. Conclusion The graft of HAAM with ADSCs plays an effective role in promoting the repair of full-thickness skin wound
Objective To investigate the feasibil ity and effect of inducing adi pose-derived stem cells (ADSCs) treated with growth differentiation factor 5 (GDF-5) to undergo chondrogenic differentiation in vitro. Methods Six healthy Japanese rabbits aged 3 months (2-3 kg) of clean grade were chosen, irrespective of sex. ADSCs were isolated and cultured with collagenase digestion, then were detected and identified by vimentin immunohistochemistry and CD44, CD49d, CD106immunofluorescence staining. ADSCs at passage 3 were used and the cell density was adjusted to 1 × 106/mL, then the ADSCs were treated with 0, 10, 100 ng/mL GDF-5 and common cultural medium, respectively. The morphology changes of the induced ADSCs were observed by inverted contrast phase microscope and their growth state were detected by MTT. The mRNA quantities of Col II and proteoglycan expressed by the induced ADSCs were detected with RT-PCR. The Col II proteoglycan synthesized by the induced ADSCs were detected with alcian blue staining, toluidine blue staining, immunohistochemistry staining, and Western blot method. Results ADSCs mostly presented small sphere, fusiform and polygon shape with positive expression of CD44 and CD49d and negative expression of CD106 and vimentin. The ADSCs treated with 100 ng/mL GDF-5 presented sphere or sphere-l ike change and vigorous prol iferation. The mRNA quantities of Col II and proteoglycan synthesized by the induced ADSCs treated with 0, 10, 100 ng/mL GDF-5 and common cultural medium increased in a dose-dependent manner at 7 days. There were significant differences among all the groups (P lt; 0.05), except that no significant difference was evident between the 0 ng/mL group and the 10 ng/mL group (P gt; 0.05). When ADSCs were treated with 100 ng/mL GDF-5 for 14 days, the Col II and the mRNA and protein quantities of ptoteoglycan reached the peak, and the results of alcian blue, toluidine blue and Col IIimmunohistochemistry staining were positive. Conclusion ADSCs treated with certain concentration of GDF-5 have higher expression of Col II and proteoglycan and possess partial biological function of chondrocyte.