感染相关性噬血细胞综合征早期骨髓细胞学等指标探讨  

The Analysis of bone marrow cytology in the early stage of infection - associated hemophagocytic syndrome

作　　者：孙培玉[1] 

机构地区：[1]山东省临沂市人民医院,山东临沂276003

出　　处：《医学检验与临床》2011年第5期6-8,22,共4页Medical Laboratory Science and Clinics

摘　　要：目的探讨感染相关性噬血细胞综合征（IAHS）的早期骨髓细胞学特点及常用实验指标变化的临床意义。方法对51例IAHS患者的临床特征、骨髓细胞形态学、外周血细胞、DIC、生化及血清铁蛋白等进行动态综合分析。结果IAHS患者起病急骤，临床表现缺乏特异性。常以高热、进行性衰竭和肝脾淋巴结肿大为临床特点。血细胞单系或二系、三系进行性下降。骨髓涂片中可见数量不一的吞噬型组织细胞，找到吞噬完整的红细胞及吞噬多个血小板的吞噬细胞具有重要价值，主要特点是成熟的组织细胞件有活跃的吞噬血细胞现象。而出现较多吞噬细胞，胞浆内出现大量空泡且见有吞噬多个红细胞或多个血小板现象时，提示患者病情危重。血清铁蛋白升高，早期甘油三酯正常或升高，血清乳酸脱氢酶及谷丙、谷草转氨酶升高。纤维蛋白原正常或降低，碱性磷酸酶染色积分增高或正常。结论持续或间歇性高热，血清铁蛋白增高，外周血细胞进行性下降，乳酸脱氢酶升高，骨髓涂片中可见数量不一的吞噬型组织细胞，找到吞噬完整的红细胞及吞噬多个血小板的吞噬细胞，可作为1AHS早期初步诊断依据；可为IAHS的早期治疗，改善预后提供证据。Objective To study the clinical significance of bone marrow cytology and serologic changes in the eady stage of infection - associated hemophagocytic syndrome（IAHS） patients. Methods 51 patients with IAHS were dynamiealy studied in their clinical features, bone nmrrow cytology,lactate dehydrogenase（LDH）, alanine aminotroansferose（ALT） and aspartate aminotransferase（AST）, DIC, and triglyceddes. Results IAHS is a dangerous syndrom. Most patients had persistent or intermittent high fever, magoly spleen, liver and lymphonode. The signifi- cant finding in bone marrow is hemophagocytic ceUs in the marrow smears of all IAHS patients. Especially, the phagocytosis cells of phagocytos- ing red cell and or platelets were of great dignosic value. The main marrow characteristics of IAHS is active phagocytosing phenomenon in mature phagocytes,so many cytoplasmic vacuoles and phagocytosing blood calls were significant characteristic. One senes of blood ceUs, two or three cell lines were decreased. The level of LDH, ALT, AST and serum ferritin were elevated. But the level of alkaline phosphatase, tnglycendes is increased or normal;fibrinogen is normal or reduced. Conclusion Persistent or intermittent higher fever, magoly spreen, liver and lym- phonode, elevated level of LDH,AST,ALT, serum ferrifin,and active phagocytosing phenomenon in bone marrow are the basic diagnosing cri- teria of IAHS.

关 键 词：感染相关性噬血细胞综合征 早期 骨髓细胞学 

分 类 号：R473.72[医药卫生—护理学]