55例初诊再生障碍性贫血患者临床特征分析  

Clinical characteristics of 55 newly diagnosed aplastic anemia patients

作　　者：金焱 刘欣 汪安友 王兴兵 杨会志 张旭晗 朱薇波 蔡晓燕 JIN Yan;LIU Xin;WANG Anyou;WANG Xingbing;YANG Huizhi;ZHANG Xuhan;ZHU Weibo;CAI Xiaoyan(Department of Hematology,Anhui Provincial Hospital Affiliated to Anhui Medical University,Anhui,Hefei 230001,China;Department of Hematology,the First Affiliated Hospital of University of Science and Technology of China,Anhui,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院血液科,安徽合肥230001 [2]中国科学技术大学附属第一医院血液科,安徽合肥230001

出　　处：《中国医药科学》2021年第5期230-233,共4页China Medicine And Pharmacy

摘　　要：目的分析初诊再生障碍性贫血(AA)患者实验室检查的特点,探讨T细胞亚群分析、骨髓细胞学、骨髓病理、免疫表型及遗传学检查等对疾病诊断的意义。方法回顾性分析2014年1月至2019年12月在安徽省立医院住院的55例初诊AA患者资料,收集患者的T细胞亚群、骨髓细胞学、骨髓病理、免疫表型及遗传学等数据。结果12例患者进行外周血T细胞亚群检测,8例存在CD4^(+)/CD8^(+)T细胞比值异常。55例患者行骨髓细胞学检查,43例(78.18%)患者骨髓增生低下,3例(5.45%)患者存在红系病态造血,1例(1.82%)患者细胞学涂片检出21个巨核细胞。53例患者骨髓活检均表现为增生减低,未见异常细胞及幼稚前体细胞异常定位,3例患者检出网状纤维增多,为(-~+)。42例患者行流式免疫表型检测,患者CD34+细胞比例均不高,24例(60.00%)患者存在CD4^(+)/CD8^(+)T细胞比值异常,7例患者粒细胞分化发育模式异常,2例患者部分NKT细胞表型异常;1例患者部分NK细胞表型异常;2例患者存在抗原跨系表达。35例患者的白血病融合基因未见异常;23例成功送检染色体核型分析的患者均为正常核型;7例患者检测骨髓增生异常综合征相关基因,1例患者D7S486及D7S522位点缺失。结论除了血常规、骨髓细胞学和骨髓病理外,完善患者的外周血T细胞亚群、免疫表型分析及遗传学相关检查,综合分析患者的临床表现及实验室检查结果,有利于初诊AA患者的正确识别,对揭示疾病本质及预后判断亦具有重要意义。Objective To analyze the characteristics of laboratory examination of newly diagnosed aplastic anemia patients,and to explore the significance of T cell subsets analysis,bone marrow cytology,bone marrow pathology,immunophenotype and genetic examination in disease diagnosis.Methods The data of 55 newly diagnosed aplastic anemia patients hospitalized in Anhui Provincial Hospital from January 2014 to December 2019 were analyzed retrospectively,and the data of T cell subsets,bone marrow cytology,bone marrow pathology,immunophenotype and genetics were collected.Results The peripheral blood T cell subsets were detected in 12 patients,and the ratio of CD4^(+)/CD8^(+)T cells was abnormal in 8 patients.55 patients underwent bone marrow cytology examination,43 cases(78.18%)had low bone marrow hyperplasia,3 cases(5.45%)had erythroid pathological hematopoiesis,and 1 case(1.82%)had 21 megakaryocytes detected by cytological smear.Bone marrow biopsy of 53 patients showed the decreased proliferation,no abnormal cells and abnormal localization of immature precursor cells,and 3 patients had increased reticular fibers(-to+).42 patients were examined by flow immunophenotype,the ratio of CD34+cells was not high,24(60.00%)patients had abnormal CD4^(+)/CD8^(+)T cell ratio,7 patients had abnormal granulocyte differentiation and development pattern,and 2 patients had abnormal NKT cell phenotype.1 patient had abnormal NK cell phenotype.2 patients had cross-line expression of antigen.There was no abnormality in leukemia fusion gene in 35 patients.23 patients who successfully submitted for chromosome karyotype analysis were all normal karyotypes.The genes related to myelodysplastic syndrome were detected in 7 patients,and D7 S486 and D7 S522 loci were deleted in 1 patient.Conclusion In addition to blood routine,bone marrow cytology and bone marrow pathology,the improvement of peripheral blood T-cell subsets,immunophenotype analysis and genetic examination,and the comprehensive analysis of clinical manifestations and laboratory examination r

关 键 词：再生障碍性贫血 血细胞形态 免疫表型 细胞分子遗传学 

分 类 号：R556.5[医药卫生—血液循环系统疾病]