儿童不典型再障的临床特点及骨髓活检的诊断意义  

Clinical characteristics of children with atypical aplastic anemia and diagnostic significance of bone marrow biopsy

作　　者：王玲[1] 杨长虹[1] 尹春燕[1] 肖延风[1] 

机构地区：[1]西安交通大学医学院第二附属医院,陕西西安710004

出　　处：《中国妇幼健康研究》2015年第4期735-737,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的比较并分析不典型再障与典型再障患儿的临床资料,为再障的临床治疗提供一定的指导,减少误诊和漏诊的发生。方法 2008年1月至2014年12月西安交通大学医学院第二附属医院儿科收治的再障患儿31例,入院后收集病史,进行体格检查,采集外周血及骨髓进行检查,并进行骨髓活检。结果不典型再障组患儿发病到确诊时间明显长于典型再障组,差异具有统计学意义(t=4.79,P<0.05)。不典型再障患儿与典型再障患儿相比,白细胞计数(WBC)、红细胞计数(RBC)及网织红细胞计数(REI')均无显著性差异(t值分别为2.01、1.78、1.98,均P>0.05;而血红蛋白含量(HB),血小板计数(PLT),中性粒细胞计数(ANC)均具有显著性差异(t值分别为2.42、2.53、3.29,均P<0.05)。典型再障患儿骨髓图片结果中,粒系、红系比例及巨核细胞数均明显低于不典型再障患儿,而淋巴细胞及浆细胞比例均明显高于不典型再障患儿(t值分别为6.98、2.28、2.25、4.96、2.57。均P<0.05)。结论不典型再障患儿初期临床表现较轻,外周血象及骨髓改变不显著,仅靠骨髓涂片不能及时有效地做出准确诊断,因此,骨髓活检在不典型再障诊断中具有重要作用。Objective To compare and analyze the clinical data of children with atypical aplastic anemia （ AA） and those with typical AA so as to provide guidance for clinical treatment and reduce misdiagnosis and missed diagnosis.Methods From January 2008 to December 2014 totally 31 cases of AA were admitted in the Second Affiliated Hospital of Xi＇an Jiaotong University.After admission, medical history was collected, and physical examination, peripheral blood and bone marrow examination were also conducted.Bone marrow biopsy was performed.Results The duration from onset to diagnosis of atypical AA was significantly longer than that of typical AA （ t=4.79, P〈0.05）.Comparison of two groups showed that WBC, RBC and RET were not significantly different （t value was 2.01, 1.78 and 1.98, respectively, all P〉0.05）, but HB, PLT and ANC were significantly different （t value was 2.42, 2.53 and 3.29, respectively, all P〈0.01）.Myeloid and erythroid proportions and megakaryocyte number of typical AA children were significantly lower than those of atypical AA children, but the proportion of lymphocytes and plasma cells increased （t value was 6.98, 2.28, 2.25, 4.96 and 2.57, respectively, all P〈0.05）.Conclusion Children with atypical AA have mild early clinical manifestations and their peripheral hemogram and bone marrow slightly change, therefore, accurate diagnosis can not be made only with bone marrow smear.Thus, bone marrow biopsy plays an important role in the diagnosis of atypical AA.

关 键 词：儿童 不典型再障 外周血象 骨髓涂片 骨髓活检 

分 类 号：R556.5[医药卫生—血液循环系统疾病] R725.5[医药卫生—内科学]