丙型病毒性肝炎肝硬化和酒精性肝硬化患者骨髓象特点分析  

Bone marrow image analysis of patients with hepatitis C cirrhosis and alcoholic liver cirrhosis

作　　者：杨宁[1] 丁扬[1] 李妍[1] 蔡硕[1] 王大刚[1] 洪炜[1] 朱剑功[1] 王晗[1] YANG Ning;DING Yang;LI Yan;CAI Shuo;WANG Da gang;HONG Wei;ZHU Jian-gong;WANG Han(Center of Clinical Laboratory, The 302 Military Hospital of China, Beijing 100039, China)

机构地区：[1]解放军第三〇二医院临床检验医学中心,北京100039

出　　处：《中国病毒病杂志》2018年第2期146-150,共5页Chinese Journal of Viral Diseases

摘　　要：目的探讨丙型病毒性肝炎(简称丙肝)肝硬化和酒精性肝硬化(alcoholic cirrhosis,ALC)患者骨髓细胞形态学变化特点。方法回顾性分析2010年3月至2017年1月在解放军第三〇二医院诊治的119例丙型病毒性肝炎(丙肝)肝硬化和103例酒精性肝硬化患者骨髓增生及各系细胞比例情况、骨髓有核细胞发育情况和骨髓细胞形态学诊断分析结果。结果 222例患者的全血细胞均减少。丙肝肝硬化组患者骨髓增生比例(95.8%)高于酒精性肝硬化组患者(73.8%);丙肝肝硬化组患者同酒精性肝硬化组患者比较:淋巴细胞[(17.3±5.0)%vs(8.9±3.0)%]、单核细胞[(2.8±1.1)%vs(1.4±0.5)%]、巨核细胞[(31.0±10.0)%vs(16.0±10.0)%]比例,粒细胞系发育异常[(18.6±8.3)%vs(11.3±6.1)%]和红细胞系发育异常[(15.7±5.3)%vs(7.4±3.7)%],巨核细胞发育异常(15.1%vs 0)及异形淋巴细胞(26.9%vs 1.9%)比例均高于酒精性肝硬化组患者(P均<0.01);丙肝肝硬化组患者外周血细胞减少的因素主要为粒细胞系(10.1%)和巨核细胞的成熟障碍(19.3%),酒精性肝硬化组患者外周血细胞减少的主要因素为再生障碍性贫血(aplastic anemia,AA)(3.9%)、单纯红细胞再生障碍性贫血(pure red cell aplasia,PRCA)(5.8%)和巨核细胞生成不良(11.7%)。结论两种不同诱因所致的肝硬化均可导致其患者造血系统发生改变,且患者巨核系统均存在明显的成熟障碍。Objective To investigate the morphological changes of bone marrow cells in patients with hepatitis C cirrhosis and alcoholic cirrhosis. Methods A retrospective study was conducted for a total of 119 cases of hepatitis C cirrhosis and 103 cases of alcoholic liver cirrhosis to analyze the patients′bone marrow cell images such as bone marrow hyperplasia,the proportion of each cell type,bone marrow nucleated cell development and bone marrow cell morphology. Results All 222 patients demonstrated a decrease in the whole blood cell counts.Higher percentage of bone marrow hyperplasia was seen in hepatitis C cirrhosis patients（95.8%）than that in alcohol cirrhosis patients（73.8%）.Other cell type comparisons of hepatitis C cirrhosis with alcoholic liver cirrhosis include：lymphocytes（17.3±5.0）% vs（8.9±3.0）%],monocytes（2.8±1.1）% vs（1.4±0.5）%,megakaryocyte（31.0±10.0）% vs（16.0±10.0）%,granulocytic dysplasia（18.6±8.3）% vs（11.3±6.1）%,red blood cell dysplasia（15.7±5.3）%vs（7.4±3.7）%,megakaryocyte dysplasia（15.1%vs 0%）and abnormal lymphocytes（26.9% vs 1.9%）（P〈0.01）.Dysmature granulocyte（10.1%）and megakaryocyte maturation disorder（19.3%）are the main features of peripheral blood changes in hepatitis C cirrhosis group while in the alcoholic liver cirrhosis patients,aplastic anemia（AA）（3.9%）,pure red blood cell aplastic anemia（PRCA）（5.8%）and poor megakaryocyte（11.7%）are the major peripheral blood changes. Conclusions Both hepatitis C and alcohol caused liver cirrhosis can lead to the changes in patients′bone marrow system,especially the dysplasia of megakaryocytes.

关 键 词：丙型病毒性肝炎 肝硬化 酒精性肝硬化 骨髓细胞学 

分 类 号：R575.2[医药卫生—消化系统] R589.2[医药卫生—内科学]