目的 探讨不同贫血类型患者铁蛋白水平、甲状腺功能检测结果对比分析。方法 前瞻性选取2018年11月—2021年11月我院收治的240例贫血患者作为研究对象。将患者分为小细胞低色素性贫血组（n=75）,正细胞性贫血组（n=100）和大细胞性贫血组（n=65）。检查患者甲状腺功能[甲状腺素（TSH）、游离三碘甲腺原氨酸（FT₃）、游离甲状腺素（FT₄）]和铁蛋白（SF）表达水平。采用Spearman检验进行相关性分析;采用Logistics回归模型进行回归分析。结果 3组患者红细胞（RBC）、血红蛋白（Hb）、平均红细胞容积（MCV）、红细胞平均血红蛋白浓度（MCHC）、平均红细胞血红蛋白含量（MCH）、血清肌酐（Scr）间存在差异（P<0.05）;大细胞性贫血组TSH、FT₃和SF低于正细胞性贫血组和小细胞低色素性贫血组（P<0.05）,而FT₄高于正细胞性贫血组和小细胞低色素性贫血组（P<0.05）;贫血类型与TSH、FT₄、FT₃和SF呈正相关（P<0.05）;多因素Logistics回归分析结果显示,TSH、FT₄、FT₃和SF在3个模型中均为独立危险因素（P<0.05）。结论 不同贫血类型患者间甲状腺功能和铁蛋白表达水平存在显著差异,大细胞性贫血组TSH、FT₃和SF低于正细胞性贫血组和小细胞低色素性贫血组,而FT₄更高,甲状腺功能指标和铁蛋白均是各种类型贫血发生的危险因素。

Objective To explore the comparative analysis of ferritin level and thyroid function detection results in patients with different types of anemia．Methods A total of 240 anemia patients admitted to our hospital from November 2018 to November 2021 were prospectively selected as research objects．The patients were divided into microcytic hypochromic anemia group（n=75）,normocytic anemia group（n=100）,and macrocytic anemia group（n=65）．The expression levels of thyroid function[thyroxine（TSH）,free triiodothyronine（FT₃）,free thyroxine（FT₄）]and ferritin（SF）were examined．Correlation analysis was performed by Sperman test．The logistic regression model was adopted for regression analysis．Results There were significant differences in red blood cell,hemoglobin,mean corpuscular volume,mean corpuscular hemoglobin concentration,mean corpuscular hemoglobin content and serum creatinine among three groups（P<0.05）．TSH,FT₃ and SF in macrocytic anemia group were significantly lower than those in normocytic anemia group and microcytic hypochromic anemia group（P<0.05）,while FT₄ was significantly higher than that in normocytic anemia group and microcytic hypochromic anemia group（P<0.05）．The type of anemia was positively correlated with TSH,FT₄,FT₃ and SF（P<0.05）．The results of multi-factor logistics regression analysis showed that TSH,FT₄,FT₃ and SF were independent risk factors in the three models（P<0.05）．Conclusions There were significant differences in thyroid function and ferritin expression levels among patients with different types of anemia．Macrocytic anemia group TSH,FT₃ and SF were lower than those in normocytic anemia group and microcytic hypochromic anemia group,while FT₄ was higher．Both thyroid function indexes and ferritin were risk factors for various types of anemia．

目的 探讨四君寿胎汤对地中海贫血孕妇贫血状况的改善效果,以期指导地中海贫血孕妇的中药治疗。方法 选择2019年5月—2020年10月期间我院诊治的200例地中海贫血孕妇,根据随机数字表法将其分为两组,观察组与对照组,各100例,观察组患者给予四君寿胎汤,1剂/d,连续治疗3个月,对照组患者给与安慰剂,1剂/d,连续治疗3个月;治疗前、治疗3个月后,比较两组血液检测指标[血红蛋白(HGB)、红细胞(RBC)、红细胞比容(HCT)、平均红细胞体积(MCV)、平均血红蛋白含量(MCH)]、中医症候积分、肝肾指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cre)、尿素(ure)、总胆汁酸(TBA)],记录两组孕妇妊娠结局、新生儿情况并比较。结果 治疗前,两组HGB、RBC、HCT、MCV、MCH比较,差异无统计学意义(P＞0.05);治疗3个月后,两组均升高,且观察组高于对照组(P＜0.05);治疗前,两组食少纳呆、体倦乏力、食后或午后腹胀、大便异常症候积分比较,差异无统计学意义(P＞0.05);治疗结束后,两组症候积分均较治疗前降低,且观察组低于对照组,差异有统计学意义(P＜0.05);治疗前后,两组ALT、AST、TBA、Cre、Ure差异无统计学意义(P＞0.05)。两组胎儿宫内窘迫、宫内生长受限发生率、产妇产后出血率比较,观察组较对照组发生率低,但差异无统计学意义(P＞0.05)。观察组早产发生率较对照组明显下降,差异有统计学意义(P＜0.05);观察组孕妇分娩孕周大于对照组,剖宫产率低于对照组,差异有统计学意义(P＜0.05);两组新生儿窒息率、转PICU率比较,差异无统计学意义(P＞0.05);观察组新生儿出生体重、HGB高于对照组(P＜0.05)。结论 四君寿胎可以改善地中海贫血孕妇的整体贫血状况,对肝肾功能无不良影响,中医证候得到改善,且有利于减少早产发生风险,降低剖宫产率,改善新生儿情况。

Objective To investigate effect of Sijun Shoutai decoction in improving anemia status of pregnant women with thalassemia, and to guide the Chinese medicine treatment of thalassemia in pregnant women in the future. Methods Two hundred pregnant women with thalassemia who were diagnosed in the hospital from May 2019 to October 2020 were divided into observation group and control group randomly, with 100 cases in each group. The observation group was treated with Sijun Shoutai decoction,1 dose/d, with continuous treatment for 3 months. The control group was given placebo,1 dose/d, with continuous treatment for 3 months. The indicators of blood test [hemoglobin (HGB), red blood cell (RBC), hematocrit value (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH)], TCM symptom scores, hepatic and renal indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cre), urea (Ure), total bile acid (TBA)] were compared between the two groups before and after treatment for 3 months. The maternal pregnancy outcome and neonatal condition in the two groups were recorded and compared. Results There were no statistical difference in the HGB, RBC, HCT, MCV and MCH between the two groups before treatment (P>0.05); after 3 months the indicators above of two groups increased, and those in observation group were higher than those in control group (P<0.05). There were no statistical differences in the symptom scores of poor appetite, fatigue, abdominal distension after eating or after noon and fecal abnormalities between the two groups before treatment (P<0.05). The levels of ALT, AST and TBA in the two groups decreased after treatment for 3 months, while the Cre and Ure increased, but the differences were not statistically significant (P>0.05). There were no statistical differences in the rates of intrauterine fetal distress, intrauterine growth restriction, and postpartum hemorrhage between the two groups (P>0.05), though the results of observation group were lower than control group.The rate of premature birth was lower than that of control group(P<0.05) ; the gestational week of observation group was more than control group, and the cesarean section rate of observation group was lower than that of control group (P<0.05). There were no statistical differences in the rates of neonatal asphyxia and transfering to PICU between the two groups (P>0.05); the neonatal birth weight and HGB in observation group were higher than those in control group (P<0.05). Conclusion Sijun Shoutai decoction in the treatment of pregnant women with thalassemia can improve anemia status, with no adverse effect on liver or kidney function, improve TCM syndrome, reduce the risk of premature birth,reduce the rate of cesarean,and improve the neonatal condition.

目的 分析河源市学龄前儿童发生小细胞低色素性贫血的病因。方法 对我院进行健康体检小细胞低色素性贫血儿童287例进行血常规、血清铁蛋白及地中海贫血基因检测。结果 在所研究的287 例小细胞低色素性贫血儿童病例中,分别检出 α地中海贫血 127例,β地中海贫血 48例,α/β复合地中海贫血2例;铁缺乏 83例 (合并地中海贫血20例, 缺铁性贫血45例),不明原因贫血47例。地中海贫血检出率为61.67%,铁缺乏检出率为21.95% 。结论 地中海贫血是河源市学龄前儿童发生小细胞低色素性贫血最主要的原因,其次是铁缺乏,各年龄段儿童以轻度贫血为主,6月~1岁,1~3岁为铁缺乏高发年龄。α地中海贫血基因型以--^SEA/αα最常见,β地中海贫血以βIVS-II-654/β^N最常见,小细胞低色素症在静止型最常见。

Objective To analyze the causes of microcytic hypochromic anemia in preschool children in Heyuan City. Methods A total of 287 cases with microcytic hypochromic anemia were selected in our hospital. The indexes of hematology, serum ferritin were detected and genetic testing for thalassemia was performed. Results Through genetic analysis, 127 of 287 cases of microcytic hypochromic anemia were confirmed with α-thalassaemia,48 cases with β-thalassaemia,2 cases with compound α/β-thalassaemia and 83 cases with iron deficiency (20 thalassemia cases and 45 iron deficiency anemia cases). Thalassaemia detection rate was 61.67%, iron deficiency detection rate was 21.95%. Conclusion Thalassaemia was the main reason of microcytic hypochromic anemia in preschool children in Heyuan City, followed by iron deficiency. The mild anemia was the main type among all age groups, children aged 0.5-3 had higher iron deficiency rate. The main type of α-thalassaemia was --^SEA/αα, the main type of β-thalassaemia was βIVS-II-654/β^N and the main type of microcytic hypochromic was static type.

目的 探讨多维铁口服液联合维生素AD滴剂治疗婴幼儿缺铁性贫血的疗效。方法 将首次诊断缺铁性贫血的336例婴幼儿依家长意愿分为2个治疗组(A组和B组)与1个对照组,A组予多维铁口服液联合维生素AD滴剂治疗,B组予多维铁口服液联合维生素D滴剂治疗,对照组饮食调理并补充维生素AD,于治疗4周后(3天内)采末梢血行血细胞分析,比较三组患儿贫血治疗显效率、总有效率差异。结果 治疗4周后,A组显效率为71.70%,总有效率为97.17%;B组显效率为41.05%,总有效率为90.30%;对照组显效率为6.25%,总有效率为32.29%。A组贫血治疗显效率、总有效率高于B组和对照组,差异均有统计学意义(P<0.05)。结论 铁剂联合维生素A制剂可显著提高婴幼儿缺铁性贫血的治疗效果。

Objective To observe the curative effect of multivitamin iron oral solution combined with vitamin AD drops on the treatment of iron deficiency anemia in infants. Methods 336 cases of infants who was found with iron deficiency anemia for the first time were divided into two treatment groups (group A and group B) and one control group in accordance with their parents' will. Group A was treated with multivitamin iron oral solution combined with vitamin AD drops. Group B was treated with multivitamin iron oral solution combined with vitamin D drops. The control group was taken just dietary therapy combined with vitamin AD drops. All subjects were tested blood analysis after 4 weeks of treatment (within 3 days). The differences of the treatment excellence rates and the total effective rates were compared in the three groups. Results After 4 weeks of treatment, the excellence rate in group A was 71.70%. The total effective rate in group A was 97.17%. The excellence rate in group B was 41.05%. The total effective rate in group B was 90.30%. The excellence rate in control group was 6.25%. The total effective rate in control group was 32.29%. The differences of the treatment excellence rates and the total effective rates in group A were significantly higher than those in group B or in the control group. The differences were statistically significant (P<0.05). Conclusion Multivitamin iron combined with vitamin A can significantly improve the curative effect of the treatment of iron deficiency anemia in infants.

目的 对比分析巨幼细胞性贫血和难治性贫血患者骨髓形态的异同及其临床意义。方法 选取我院2010年4月—2016年4月收治的巨幼细胞性贫血(MA)35例,难治性贫血(RA)35例为研究对象。收集两组患者临床检验及检查资料,对比分析其临床表现、骨髓检查结果及血液检查等结果。结果 MA组患者红系病态率、粒系病态率、淋巴样小巨核率及PAS阳性率均明显低于RA组,差异明显(P<0.05);两组患者在发热、出血、消化系反应等临床表现率上相比差异不明显(P>0.05);两组患者血象检查中血红蛋白、血小板、及白细胞含量相似,两组差异不明显(P＞0.05)。结论 巨幼细胞性贫血与难治性贫血临床表现及外周血象相似,RA骨髓形态应重点观察淋巴样小巨核细胞;MA组则应强调红系巨幼变的胞体。

目的 探讨单倍体亲缘异基因造血干细胞移植治疗重型再生障碍性贫血(SAA)的可行性。方法 对1例诊断SAA 4年余,先后经CsA治疗、脐血移植治疗均无效并反复输注红细胞、血小板的12岁男性患者进行单倍体亲缘异基因造血干细胞移植,供者为其胞兄,高分辨HLA基因型5/10相合,预处理方案为BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d。干细胞来源为G-CSF动员的骨髓+外周造血干细胞,共计输注单个核细胞(MNC)4.055×10⁸/kg(受者体重),CD 34 2.331×10⁶/kg。GVHD预防:-1 d采用与受者HLA部分相合的第三方脐带血细胞,术后联合应用环孢素A、短程氨甲碟呤、霉酚酸酯。结果 造血缓慢重建,术后22天(+22 d)ANC>0.5×10⁹/L,术后3月血小板脱离输注。+26天DNA指纹图全部表现为供者基因型。+40天血型转为供者型“O”型。+29 d出现急性移植物抗宿主病aGVHD(胃肠型,Ⅲ度),+31 d、+34 d及+42 d予巴利昔单抗20 mg静滴,+40 d、+44 d、+63 d输注间充质干细胞,患者急性GVHD逐渐控制。期间曾出现肺部感染、口腔黏膜炎及巨细胞病毒血症,经抗感染后可控制。现随访3年,血象正常稳定,Kamofsky评分100分。结论 单倍体亲缘异基因造血干细胞移植治疗SAA,对无相合供者(包括亲缘或非亲缘)且强效免疫抑制治疗失败的患者,可考虑进行,GVHD和感染为主要并发症,需根据患者病情采用相应措施。

Objective To investigate the feasibility of haploid genetic allogeneic hematopoietic stem cell transplantation in the treatment of severe aplastic anemia(SAA) in our hospital. Methods A 12-year-old patient with acquired SAA for 4 years showed no response to CsA and cord blood transplant treatment and was transfusion-dependent. Lacking an HLA-identical sibling donor, the patient was treated with HSCT from his brother 5/10 matched at the generic level. Theconditioning regimen was BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d. Stem cells were the source of G-CSF mobilization of bone marrow and peripheral blood stem cells, dose of stem cells infused: mononuclear cells (MNC) 4.055×10⁸/kg (body weight of subject), CD34 2.331×10⁶/kg. Prevention of GVHD: -1 d Third-party umbilical cord blood cells which were HLA partially matched were used. Postoperative joint use included cyclosporine A, short-course methotrexate, mycophenolate mofetil. Results Hematopoiesis was slowly rebuilding, 22 d after surgery (+22 d) ANC> 0.5×10⁹/L, after three months departing from transfusion of platelets. +26 d suggesting that the DNA fingerprints showed donor genotypes. +40 d into donor blood type “O” type. + 29 d occurred acute GVHD (GI type, Ⅲ degrees), + 31 d, + 34 d + 42 d infusion of basiliximab 20mg, + 40 d, + 44 d, + 63 d infusion of mesenchymal stem cells. Gradually acute GVHD was controlled in the patient, who had lung infections, oral mucositis and cytomegalovirus viremia, could be controlled with anti-infective. Now followed up for 3 years, hemogram change has been normal and stable. Kamofsky score was 100 points. Conclusion It may be considered to have haploid genetic allogeneic hematopoietic stem cell transplantation for treatment of SAA, for those patients who have non-matched donor (including relatives and non-relatives) and potent immunosuppressive therapy failure. GVHD and infection are major complications. Need to adopt appropriate measures in accordance with the patient's condition.

目的 探讨生血宁片对缺铁性贫血孕妇的治疗效果。方法 选取90个缺铁性贫血孕妇为研究对象,随机分为A、B、C三组,每组30人,从孕28周开始治疗,A组服用多糖铁复合物,B组口服生血宁片,C组采用营养科建议的补铁食疗菜谱,一直治疗至分娩前,治疗前后各检测血常规,血红蛋白(Hb)、红细胞比容(HCT)、红细胞平均体积(MCV)、红细胞平均血红蛋白浓度(MCHC)对比治疗效果。结果 服药前各组孕妇的血Hb、RBC、HCT、MCV、MCH无统计学差异,A、B组服药后Hb、RBC、HCT、MCV、MCH均高于服药前,且结果有统计学意义(P＜0.05),C组食疗前、后Hb、RBC、HCT、MCV、MCH无统计学差异,A、B、C三组之间Hb、RBC、HCT、MCV、MCH对比结果为,A、B组之间Hb、RBC、HCT、MCV、MCH差异无统计学意义(P＞0.05),但均高于C组,差异有统计学意义(P＜0.05)。结论 生血宁对孕晚期缺铁性贫血的孕妇有治疗作用,且效果与多糖铁复合物相当。

Objective To investigate the therapeutic effect of Shengxuening tablets on iron deficiency anemia in pregnant women. Methods Selected A total of 90 pregnant women with iron deficiency anemia as the research objects, randomly divided into A, B, C three groups. Each group of 30 people was treated since 28 weeks of pregnancy. Group A was treated with polysaccharide iron complex, group B with Shengxuening tablets, group C with the nutritionist recommended iron diet recipes. They have been treated till delivery. Before and after treatment, blood routine examination, the value of Hb,RBC,HCT,MCV,MCH had contrast treatment. Results There was no significant difference of serum Hb,RBC,HCT,MCV,MCH in the pregnant women before treatment. After treatment, Hb,RBC,HCT,MCV,MCH of group A, B were higher than before, and the results were statistically significant(P＜0.05). Before therapy of group C, there was no significant difference, in the three groups, results of Hb,RBC,HCT,MCV,MCH, there was no statistical difference between group A, B (P＞0.05), but both were higher than group C, the difference was statistically significant(P＜0.05). Conclusion There was therapeutic effect of Shengxuening in late pregnant women with iron deficiency anemia, and it is equal to the effect of Polysaccharide iron complex treatment.

       目的   探讨淋巴细胞亚群在鉴别低增生性骨髓增生异常综合征（hypo-MDS）和再生障碍性贫血（AA）中的价值。方法   选取2020年7月—2023年6月在平顶山市第一人民医院治疗的80例hypo-MDS或和AA患者进行回顾性分析，其中hypo-MDS 48例、AA 32例，分析两组患者各类淋巴细胞（CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ 、CD3⁺ CD57⁺ T-大颗粒淋巴细胞、CD3^- CD16/CD56⁺ 自然杀伤细胞、CD19⁺ B淋巴细胞）的差异。结果   hypo-MDS组的CD3⁺ （78.42±8.02）%与AA组的（75.65±8.44）%对比差异无统计学意义（P＞0.05）；hypo-MDS组的CD4⁺ （47.54±6.88）%、CD4⁺ /CD8⁺（2.16±0.61）%高于AA组的CD4⁺ （40.11±5.71）%、CD4⁺ /CD8⁺ （1.49±0.48）%，CD8⁺ （23.12±6.42）%低于AA组CD8⁺ （31.77±6.79）%（P＜0.05）；hypo-MDS患者CD3⁺ CD57⁺ T-大颗粒淋巴细胞（13.45±3.77）%、CD3^- CD16/CD56⁺自然杀伤细胞（12.32±3.97）%高于AA组CD3⁺ CD57⁺ T-大颗粒淋巴细胞（9.77±2.15）%、CD3^- CD16/CD56⁺ 自然杀伤细胞（8.84±2.11）%，CD19⁺ B淋巴细胞（9.75±2.08）%低于AA组（12.65±3.35）%（P＜0.05）。结论   淋巴亚群变化情况可用于AA和hypo-MDS的鉴别诊断。

       Objective  To explore the value of lymphocyte subsets in differentiation between hypoplastic myelodysplastic syndrome（hypo MDS）and aplastic anemia（AA）．Methods  A  retrospective analysis was conducted on 80 patients with hypo MDS and AA who underwent treatment in the First People’s Hospital of Pingdingshan City from July 2020 to June 2023．Among them，there were 48 cases of hypo MDS and 32 cases of AA．The differences in lymphocytes（CD3⁺ ，CD4⁺ ，CD8⁺ ，CD4⁺ /CD8⁺ ，CD3⁺ CD57⁺  T-large granular lymphocytes，CD3^- CD16/CD56⁺  natural killer cells，and CD19⁺  B lymphocytes）between the two groups of patients were analyzed．Results  There was no statistically significant difference in CD3⁺ （78.42±8.02）% between the hypo MDS group and the AA group（75.65±8.44）%（P＞0.05）．The CD4⁺ （47.54±6.88）% and CD4⁺ /CD8⁺ （2.16±0.61）% in the hypo MDS group were higher than those in the AA group（40.11±5.71）% and （1.49±0.48）%，respectively．The CD8⁺（23.12±6.42）% was lower than that in the AA group（31.77±6.79）%（P＜0.05）．The levels of CD3⁺ CD57⁺  T-large granular lymphocytes（13.45±3.77）% and CD3^- CD16/CD56⁺  natural killer cells（12.32±3.97）% in hypo MDS patients were higher than those in the AA group（［9.77±2.15］%，［8.84±2.11］%），and CD19⁺  B lymphoid cells（9.75±2.08）% were lower than that in the AA group（［12.65±3.35］%，P＜0.05）．Conclusions  The changes in lymphatic subpopulations can be used for the differential diagnosis of AA or hypo MDS．