成人斯蒂尔病血液学异常变化及临床意义  

Changes and clinical significance of hematological aabnormalities in adult onset Still's disease

作　　者：陆翠 胡喜梅 周水阳 孙艮[2] 戴岷[3] 胡大伟[3] 

机构地区：[1]上海松江区中心医院血液风湿科,上海201600 [2]南通大学附属建湖医院风湿免疫科,江苏建湖224700 [3]上海交通大学医学院附属仁济医院风湿科,上海200001

出　　处：《中国医刊》2017年第11期65-68,共4页Chinese Journal of Medicine

摘　　要：目的通过对成人斯蒂尔病(AOSD)患者血液学临床资料的分析,提高对AOSD血液学改变的特点及其临床意义的认识。方法回顾性分析31例AOSD患者的全血细胞计数、骨髓细胞学、骨髓活检病理等的临床血液学资料。结果 31例患者白细胞升高67.7%,中性粒细胞升高67.7%;合并贫血41.9%。29例骨髓细胞学显示,骨髓增生活跃21例(72.4%),明显活跃6例(20.7%);粒系胞浆内颗粒增粗16例(55.2%)。21例骨髓活检中骨髓组织增生活跃7例(33.3%),明显活跃10例(47.6%),见形态成熟淋巴浆细胞11例(52.4%)。结论 AOSD血液学异常改变主要表现为外周血白细胞及中性粒细胞升高,可合并轻中度贫血及血小板轻度增高或减少;骨髓细胞和骨髓病理检查多数增生活跃,粒系颗粒增多增粗多见,可见反应性组织细胞、嗜血细胞及浆细胞增多。总之外周血像和骨髓改变类似感染后的血象和骨髓象的改变,无特异性改变,故对AOSD诊断需慎重,需寻找其他诊断依据以排除感染。Objective Through the analysis of the clinical data of patients with adult onset Still＇s disease, to improve the understanding of the characteristics and clinical significance of hematological changes in AOSD. Method Review and analyze the clinical hematology data of 31 patients who was diagnosed with AOSD including hemogram, bone marrow cytology,bone marrow biopsy pathology. Result In 31 patients, the white blood cells were increased by 67.7%, and the neutrophils were increased by 67.7%, and the anemia was 41.9%.In 29 cases of bone marrow cytology, 21 （72.4%） cases of bone marrow hyperplasia were active, 6（20.7%） cases were significantly active, 16 （55.2%） cases of the granules in the cytoplasm of the granular cells were increased.In 21 cases of bone marrow biopsy, bone marrow hyperplasia was active in 7（33.3%） cases, 10（47.6%） cases were significantly active, 11（52.4%） cases could be seem in the form of mature lymph cells. Conelusion The abnormal changes of hematology in AOSD were mainly expressed as elevating of peripheral blood leukocytes and neutrophils, and could be combined with mild anemia and mild increase or decrease of platelets. The majority of bone marrow biopsy and bone marrow pathological examination were active.Most of the granules in the cytoplasm of the granular cells were increased.We also could see the increasing of reactive tissue cells, hematophagocyte and plasma cells. Outside, peripheral blood and bone marrow changes of hemogram were similar with the changes after infection. There were no specific changes, it is necessary for the diagnosis of AOSD need to be cautious. In particular, except for infection.

关 键 词：斯蒂尔病 成人 血液学异常 

分 类 号：R563.1[医药卫生—呼吸系统]