发热伴血小板减少综合征患者反应性浆细胞增多症的实验室研究  

Laboratory investigation of reactive plasmacytosis in patients with severe fever with throbocytopenia syndrome

作　　者：郑瑞[1] 戴美珍[1] 王青[1] 陈华忠[2] 林慧君[3] 陈葆国[1] 李伯利[1] 

机构地区：[1]浙江省台州医院中心实验室,浙江省临海市317000 [2]浙江省台州医院感染科,浙江省临海市317000 [3]浙江省人民医院检验科

出　　处：《中华传染病杂志》2017年第3期146-150,共5页Chinese Journal of Infectious Diseases

基　　金：浙江省医药卫生科技计划资助项目（2014KYB311;2016KYA031）

摘　　要：目的探索发热伴血小板减少综合征患者反应性浆细胞增多症的免疫学特点及临床意义。方法收集台州医院2015年3月至10月确诊为发热伴血小板减少综合征布尼亚病毒感染患者，形态学分析患者的外周血及骨髓涂片表现，流式细胞术分析外周血浆细胞免疫表型特点，并检测患者血清免疫球蛋白、Th1／Th2细胞因子的表达。不同类型患者外周血浆细胞数量及细胞因子水平之间的比较采用Mann-WhitneyU检验。结果16例患者外周血浆细胞均有不同程度增生，此类外周血浆细胞表型为CD38^＋＋CD138^＋CD45^＋CD19^＋为正常成熟浆细胞。其中10例患者外周血浆细胞比例〉0．030，2例患者浆细胞比例〉0．300。重型及危重型组患者外周血浆细胞比例较普通型患者显著增高（0．052比0．016，P〈0．05）。9例患者骨髓涂片均可见组织细胞及噬血细胞，其中3例患者达到噬血性淋巴组织细胞增生症的诊断标准，8例患者浆细胞比例≥0．030。患者极期血清IL-6、IL-10及7干扰素水平明显增高，中位数值分别为49．75、26．98及17．57ng／L，而IL-2、IL-4及TNFa血清水平无明显改变。重型及危重型组患者血清IL-6（132．36比22．81ng／L）和IL-IO（75．28比6．33ng／L）较普通型患者显著增高（均P〈0．05），而γ干扰素水平的差异无统计学意义（P〉0．05）。发热伴血小板减少综合征患者极期血清IgG、IgA及IgM水平中位数分别为11．6、2．56和1.60g／L，未见明显改变。结论本组发热伴血小板减少综合征患者表现出过度的体液免疫和细胞免疫现象，疾病的严重程度与外周血浆细胞比例及细胞因子IL-6和IL-10水平相关。Objective To investigate the immunologieal eharaeteristies and clinical significance of reactive plasmacytosis in patients with severe fever with throbocytopenia syndrome （SFTS）. Methods Bunyavirus-infected patients who were diagnosed with SFTS were collected from March 2015 to October 2015 in Taizhou Hospital. Morphology analysis of bone marrow and peripheral blood （PB） smear, as well as flow cytometry analysis of plasma cell immune phenotype from peripheral blood were conducted. Serum immunoglobulin levels and helper T hymphoeytes （Th）1/Th2 eytokine expressions were detected. Mann- Whitney U test was used. Results PB plasma cells from all of the SFTS patients increased in varying degrees, and the phenotype of the plasma cells was CD19＋ CD38＋＋ CD45＋ CD138＋ , which indicated normal mature plasma cells. The ratio of PB plasma cells was ~0. 030 in 10/16 patients, and ~0. 300 in 2/16 patients. The ratios of PB plasma cells in the patients with severe and critical groups were significantly higher than that in the mild group （0. 052 vs 0. 016, P〈0.05）. Monocytoid histioeytes and hemophagocytes were observed in the BM morphology of 9 patients. Three of them were diagnosed as hemophagocytic lymphohistiocytosis （HLH）. The ratio of plasma cells was more than 0. 030 in the bone marrow of 8 patients. The serum levels of interlewkin （IL）-6, IL-10 and interferon （IFN）-γ in acute phase were significantly elevated with the median level of 49.75 ng/L, 26.98 ng/L （reference value 2.6 to 4.9 ng/L） and 17. 57 ng/L, respectively. While the levels of IL-2, IL-4 and twmor necrosis fautor （TNF）-a were not significantly changed. The serum IL-6 and IL-10 levels in the patients with severe and critical groups were both significantly higher than those in the mild group （IL-6：132.36 vs 22.81 ng/L; IL-10：75.28 vs 6.33 ng/L, both P〈0.05）, but the difference of IFN-）, level was not significant （P〈0.05）. The serum IgG, IgA and IgM levels did not increase in acute stage, with the

关 键 词：新布尼亚病毒 发热伴血小板减少综合征 反应性浆细胞增多症 淋巴组织细胞增多 症 嗜血细胞性 细胞形态学 浆细胞 细胞因子类 

分 类 号：R510[医药卫生—内科学]