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（六）抗细胞因子的应用
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ACD发病中细胞因子起了重要的作用，这使人们开始注意抗细胞因子在患者中的价值，一组双盲资料显示用抗TNF双价抗体治疗RA伴贫血的患者，结果贫血得到了明显的改善。目前国外学者正在积极研究和开发Hepcidin拮抗剂，以增加肠道铁吸收，促进单核巨噬细胞系统铁的释放，在ACD的防治方面具有重要意义。
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参考文献
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[1] Cartwright GE. The anemia of chronic disease. Semin Hematol, 1966, 3
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[2] Baer AN, Dessypris EN, Goldwasser E, et al. Blunted erythropoietin response to anaemia in rheumatoid arthritis. Br J Haematol, 1987, 66
:559-64.
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[3] Roodman GD, Bird A, Hutzler D, et al. Tumor necrosis factor-alpha and hematopoietic progenitors: effects of tumor necrosis factor on the growth of erythroid progenitors CFU-E and BFU-E and the hematopoietic cell lines K562, HL60, and HEL cells. Exp Hematol, 1987, 15(9)
:928-935.
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[4] Ozguroglu M, Arun B, Demir G, et al. Serum erythropoietin level in anemia cancer patients. Med Oncol, 2000, 17(1)
:29-34.
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[5] Poveda Gómez F, Camacho Siles J, Quevedo Morales E, et al. Pattern of blood levels of erythropoietin and proinflammatory cytokines in patients with anemia of chronic disorders secondary to infection. An Med Interna, 2001, 18(6)
:298-304.
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[6] Alvarez-Hernandez X, Liceaga J, McKay IC, et al. Induction of hypoferremia and modulation of macrophage iron metabolism by tumor necrosis factor. Lab Invest, 1989, 61(3)
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[7] Means RT. Advances in the anemia of chronic disease. Int J Hematol, 1999, 70
:7-12.
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[8] North M, Dallalio G, Donath AS, et al. Serum transferring receptor levels in patiens undergoing evaluation of iron stores: correlation with other parameters, and observed versus predicted results. Clin Lab Haemat, 1997, 19
:93-7.
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[9] Moses V, Williams S, Heneveld ML. Human Immunodeficiency Viruses infection of bone marrow endothelium reduces induction of stromal hematopoietic growth factors. Blood, 1996, 87
:919-925.
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[10] 李蓉生．慢性病贫血的诊断与治疗．中国实用内科杂志，2006，26(7)
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[11] 张之南，沈悌．血液病诊断及疗效标准．第3版，北京：科学出版社，2008，17-19.
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[12] Mercuriali, F. The role of human recombinant erythropoietin in oncologic surgery. Tumori, 1997 Jul-Aug, 83（4 suppl 2): s16-9.
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[13] Nicolas G, Chauvet C, Viatte L, et al. The gene encoding the ironregulatorypeptide hepcidin is regulated by anemia, hypoxia, and inflammation. J Clin Invest, 2002, 110
:1037-1041.
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（赵小英）
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内科学新进展 第四节 造血干细胞移植新进展
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摘 要 造血干细胞移植是近半个世纪临床医学中重大的技术创新，已广泛应用于血液系统恶性疾病的治疗，同时也是某些免疫缺陷性疾病、遗传性疾病、代谢性疾病及部分实体瘤的有效治疗方法。随着造血干细胞来源的多元化、HLA配型技术的进步、移植物抗宿主病（GVHD）和移植物抗白血病（GVL）效应的基础和临床研究的深入以及支持治疗的发展，造血干细胞移植用于治疗各种疾病的适应证不断扩大、临床疗效日益提高。在过去几十年的发展中，造血干细胞移植后并发症仍是影响移植疗效的重要原因，有效预防、早期诊断、及时处理移植并发症是移植成功的关键。此外，随着分子生物学和细胞免疫学的研究进展及临床实践的不断探索，越来越多的过继性免疫治疗方法应用于造血干细胞移植领域，突破了传统药物治疗的局限。各种造血干细胞移植新技术的研究和应用旨在减少移植相关并发症发生的同时让更多的患者获得无病生存，针对不同患者的疾病特征，采用个体化的移植方案，进一步提高地移植疗效、改善移植患者的生活质量。
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Abstract Hematopoietic stem cell transplantation（HSCT）is a potentially curative therapy for many malignant and nonmalignant hematologic diseases, and the number of HSCT has been increasing gradually, especially since the 1990s. The development of novel strategies such as, unrelated donor HSCT, cord blood transplantation（CBT), haploidentical HSCT, non-myeloablative HSCT have helped expand the indications for allogeneic HSCT over the last several years. The outcomes of HSCT have improved considerably, while better HLA-matching techniques, improved supportive treatment, and integration of therapy in an overall strategy are responsible for this positive evolution. However, the acute graft-versus-host disease（GVHD), infection and some other severe complications with the toxicity of the treatment remain the sources of significant morbidity and mortality following allogeneic HSCT and limit its wider application. It’s really important to reduce the risk of transplant-related mortality with improvements in quality of life. In addition, the role of graft-versus-leukemia（GVL）effect is important in patients with malignant disease following transplantation and major advance in adoptive immunotherapy post-transplant have contributed to the success of allogeneic HSCT. HSCT as a curative modality appears more promising in the future.
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一、造血干细胞移植概论
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造血干细胞移植（hematopoietic stem cell transplantation, HSCT）是近半个世纪临床医学中具有巨大创新的新技术，已被广泛应用于血液系统恶性疾病的治疗，同时也是某些免疫缺陷性疾病、遗传性疾病、代谢性疾病及部分实体瘤的有效治疗方法。随着人们对人类白细胞抗原（human leukocyte antigen, HLA）的认识和HLA配型技术的发展、移植物抗宿主病（graft-versus-host disease, GVHD）和移植物抗白血病（graft-versus-leukemia, GVL）效应的深入研究以及临床实践的不断探索，造血干细胞移植技术有了显著的进步，造血干细胞移植用于治疗各种疾病的适应证不断扩大、临床疗效日益提高。
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（一）造血干细胞移植的历史与发展
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