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KL-6联合肺功能在多发性肌炎/皮肌炎合并间质性肺疾病中的应用价值

目的 探讨血清KL-6和肺功能检测在多发性肌炎（polymyositis，PM）/皮肌炎（dermatomyositis，DM）合并间质性肺疾病（interstitial lung disease，ILD）中的临床应用价值。方法 采用回顾性分析，纳入初发PM/DM患者（n=64）临床资料，分为间质肺组（n=40）和无间质肺组（n=44），另选健康对照组40例，比较三组患者血清KL-6水平及肺功能在两组的差异并分析其在PM/DM-ILD组中的应用价值。结果 间质肺组患者KL-6水平明显高于无间质肺组（P<0.01）；间质肺组患者VC%pred、MVV%pred、FEV1%pred、DLCO%pred、DLCO/VA%pred、TLC%pred均低于无间质肺组（P均<0.05）；ROC曲线分析得出PM/DM患者中血清KL-6诊断ILD敏感性为84%，特异性为87.5%，DLCO%pred诊断ILD的敏感性为97.7%，特异性为57.5%，而二者联合检测敏感性为90.5%，特异性为82.5%；间质肺组血清KL-6与VC%pred、MVV%pred、FVC%pred、FEV1%pred、DLCO%pred成反比，与FEV1/FVC%pred成正比（P均<0.05）；PM/DM发生ILD的危险因素：AST降低、KL-6升高及DLCO%pred降低。结论 PM/DM患者联合检测血清KL-6和肺弥散功能可提高ILD诊断效能，KL-6和肺功能可能预测ILD的发生及疾病活动度，可指导临床。

多发性骨髓瘤患者白内障术后眼内炎一例

硼替佐米治疗多发性骨髓瘤的应用进展

多发性骨髓瘤（MM）作为中老年常见的血液肿瘤之一，预后相对较差，常规化学疗法（化疗）疗效欠理想。硼替佐米作为一种新药，属于蛋白酶体抑制剂，通过全新的机制达到抗骨髓瘤的作用。国内外临床研究表明硼替佐米单药以及同常规化疗药物组成的联合化疗方案对初始治疗，以及复发难治的MM患者均有良好疗效。因此以硼替佐米为主的联合化疗方案已被美国国家综合癌症协作网推荐作为MM患者治疗的重要选择之一。现将硼替佐米在MM治疗上的进展作一综述。

A New Method to Segment Multiple Sclerosis Lesions Using Multispectral Magnetic Resonance Images

Magnetic resonance (MR) images can be used to detect lesions in the brains of patients with multiple sclerosis (MS). An automatic method is presented for segmentation of MS lesions using multispectral MR images in this paper. Firstly, a Pd-w image is subtracted from its corresponding T1-w images to get an image in which the cerebral spinal fluid (CSF) is enhanced. Secondly, based on kernel fuzzy c-means clustering (KFCM) algorithm, the enhanced image and the corresponding T2-w image are segmented respectively to extract the CSF region and the CSF-MS lesions combinatoin region. A raw MS lesions image is obtained by subtracting the CSF region from CSF-MS region. Thirdly, based on applying median filter and thresholding to the raw image, the MS lesions were detected finally. Results were tested on BrainWeb images and evaluated with Dice similarity coefficient (DSC), sensitivity (Sens), specificity (Spec) and accuracy (Acc). The testing results were satisfactory.

Clinical Analysis of Heart Manifestations in Patients with Polymyositis or Dermatomyositis

ObjectiveTo analyze the incidence of heart disease, its clinical manifestations and risk factors in patients with polymyositis (PM) and dermatomyositis (DM). MethodWe collected the clinical data of 138 PM (n=78) and DM (n=60) patients treated between January 2008 and March 2014, among whom there were 64 males and 74 females with an average age of (48.5±19.6) years old, and an average disease course of (84.5±6.9) months. We analyzed their incidence of heart disease, its clinical manifestations and the risk factors. Subsequently, we adopted single-factor analysis to analyze such factors as age, gender, disease course, kinds of disease, creatine kinase (CK), CK-MB, CK-MB/CK, troponin T, antinuclear antibodies, anti-SSA antibody, erythrocyte sedimentation rate, C-reactive protein, disease activity score, muscle force, pulmonary interstitial lesions and pulmonary artery hypertension. ResultsThere were 59 (42.7%) patients with heart disease, 48 (34.8%) with abnormal electrocardiogram, and 52 (37.7%) with abnormal color Doppler ultrasound results. Logistics multiple factors regression analysis found that the course of the disease (OR=1.669, P=0.010), myositis disease activity score (OR=7.456, P<0.001), pulmonary interstitial lesions (OR=4.568, P=0.014) were risk factor for heart disease in PM/DM patients. ConclusionsLong disease course duration, high myositis activity score and pulmonary interstitial lesions are strong predictors for heart damage in PM/DM patients.

重组人促红细胞生成素在多发性骨髓瘤中的应用进展

多发性骨髓瘤（MM）是一种源于浆细胞的恶性肿瘤，其典型临床表现有贫血、骨痛、肾功能损害和感染，而贫血是其最常见表现。临床上仍以药物化学治疗和骨髓移植作为其治疗方案。随着对重组人促红细胞生成素（rHuEpo）作用机制及MM的发病机制深入研究，rHuEpo在MM治疗中的临床应用日益广泛。近年的研究表明，rHuEpo既能改善MM相关性贫血、还有一定抗骨髓瘤效应，抗骨髓瘤机制还有待进一步研究。

Efficacy and safety analysis of glucocorticoid and tacrolimus in the treatment of anti-synthetase syndrome-associated interstitial lung disease

Objective To evaluate the efficacy and safety of glucocorticoids (GC) monotherapy and GC combined with tacrolimus (TAC) therapy in patients with anti-synthetase syndrome-associated interstitial lung disease (ASS-ILD). Methods Through retrospective analysis and propensity score matching (PSM) analysis, the 2-year progression-free survival (PFS) and related side effects of ASS-ILD patients in TAC+GC group and GC monotherapy group were compared. Predictors associated with PFS were analyzed with COX. Results The 2-year PFS rate of TAC+GC group was better than that of GC group [P=0.0163; hazard ratio (HR) 0.347]; Univariate and multivariate analysis of the COX regression model for 2-year PFS in the two groups suggested that creatine kinase level (P=0.0019, HR 1.002) and initial treatment selection [(TAC+GC) vs. GC, P=0.0197, HR 0.207] were independent predictors of PFS; PSM analysis showed that the 2-year PFS rate of TAC+GC group (54.5%) was higher than that of GC group (18.2%) (P=0.0157, HR 0.275). In terms of adverse effect, there was no significant increase in GC+TAC group compared with GC group. Conclusion Compared with GC monotherapy, initial TAC+GC treatment significantly prolonged PFS in ASS-ILD patients and did not increase the incidence of drug-related complications.

多发性骨软骨瘤病例分析

目的对多发性骨软骨瘤进行病例分析，以提高对该病的认识。 方法回顾分析2008年1月－2013年4月收治的14例多发性骨软骨瘤患者的临床资料。 结果男9例，女5例；年龄6～45岁，中位年龄17岁；4例有家族史。5例全身多发，1例双上肢多发，1例累及双侧膝关节，7例累及单侧膝关节。合并畸形包括2例前臂尺桡关节脱位，1例下肢短缩。合并疾病包括1例肋骨软骨瘤伴胸腔积血，1例肝功能异常及1例额部毛细血管瘤。所有患者行局部肿瘤切除术，手术史：1例7次，1例4次，2例2次，10例1次；每次手术切除部位：2例3个，5例2个，7例1个。1例患者术后（在外院行局部病灶切除术）20年复发再次行局部肿瘤切除术。1例术后发生右腓深神经运动支损伤。术后1例失访，余随访时间6～68个月，中位时间38个月。随访期内无恶变患者。 结论多发性骨软骨瘤可能是累及全身组织的一组临床综合征，诊断容易，畸形比例小、程度轻，局部肿瘤切除术效果确切，恶变几率小。

The Administration of Highdose Recombinant Human Erythropoietin in Multiple Myeloma Patients with Anemia

目的:多发性骨髓瘤(Multiple Myeloma,MM)患者约有80%伴有贫血,临床上多数患者以输血方式纠正贫血。重组人促红细胞生成素(recombinant human erythropoietin, rHuEPO)用于治疗MM患者的贫血尽管有效,但以何等剂量、应用多长时间疗效较佳尚无定论。目的: 观察持续使用大剂量rHuEPO对MM患者贫血的纠正作用及效果。方法:87例诊断明确的多发性骨髓瘤伴有贫血的患者,开始连续每天使用重组人促红细胞生成素4万单位,皮下注射,共5d;以后每周使用一次,每次4万单位皮下注射,间断补充铁剂。对照组90例选自同期住院的诊断明确的多发性骨髓瘤患者,当其贫血症状明显时或血红蛋白水平低于60 g/L时,给予输血纠正其贫血,使多数患者血红蛋白水平维持在80 g/L～100 g/L以上。两组患者化疗方案不做特殊规定,整过研究观察期6月。结果: rHuEPO组在使用rHuEPO后2周其血红蛋白开始上升,中位反应时间16d;1月半至2月血红蛋白可升至正常水平,达正常血红蛋白水平的中位时间51d。进入研究后3月和6月时,rHuEPO组生活幸福感指数(INLH)明显优于输血组,分别为6927±318(Plt;005)和7216±283(Plt;001)与5835±289和5776±324。6月后,rHuEPO组平均每例直接费用成本1075440元,明显低于输血组需要达到同样效果所需的每例2070420元。结论:大剂量rHuEPO治疗MM相关性贫血优于输血,其起效快、疗效好,患者生活幸福感改善明显,费用成本低,安全性较好。

Current status and advancement of medical imaging management for multiple pulmonary nodules

The widespread use of low-dose computed tomography (LDCT) in lung cancer screening has enabled more and more lung nodules to get identified of which more than 20% are multiple pulmonary nodules. At present, there is no guideline or consensus for multiple pulmonary nodules whose management is based primarily on the pulmonary imaging characteristics and associated risk factors. Herein, this review covers the imaging methods, CT appearances and management of multiple pulmonary nodules.