70例成人大红细胞症的病因分析

Etiologic analysis of 70 adult patients with macrocytosis

目的探讨大红细胞症(macrocytosis,MCV≥100fl)的病因及血液学意义。方法利用SysmexSE9000血细胞分析仪,筛查我院近18个月内科住院患者3886例,发现大红细胞症70例(1.8%),对上述大红细胞症患者进行详细的病史采集和体查、网织大红细胞计数、外周血及骨髓形态学、血清B12及叶酸浓度测定,甲状腺功能及肝功能测定等,依据上述资料确定病因诊断。结果本组70例大红细胞症中,巨幼细胞性贫血6例(8.6%),其中4例为维生素B12缺乏,1例为叶酸缺乏,1例为维生素B12和叶酸均缺乏。非巨幼细胞性大细胞性贫血(维生素B12和叶酸浓度正常)57例(81.4%),其中酒精中毒及慢性肝病5例,甲状腺功能减低症1例,化疗药物所致者7例,溶血或出血所致的网织红细胞增多症12例,慢性再生障碍性贫血9例,骨髓增生异常综合征12例,血液系统恶性肿瘤11例。单纯大红细胞症不伴贫血者7例(10.0%),其中慢性阻塞性肺病5例,糖尿病2例。结论与网织红细胞增多症、骨髓增生异常综合征、慢性再生障碍性贫血、化疗药物等所致的非巨幼细胞性大细胞性贫血相比,维生素B12和叶酸缺乏所致的巨幼细胞性贫血可能已不是深圳地区成人大细胞症最常见的病因。

Objective To evaluate the etiologyic and hematologic significance of macrocytosis. Methods 70 macrocytosis (mean corpuscular volume 100 fL or more) is detected by Sysmex SE-9000 multiparameter hematology instruments from 3886 consecutive hospitalized adult patients for 18 months.The cause of macrocytosis was investigated by a carefully obtained history and physical examination,reticulocyte count,blood and bone marrow morphology,serum vitamin B12 and folate levels,serum thyroid studies,liver function studies. Results Of the 70 patients with macrocytosis,6 cases (8.6%) had megaloblastic anemia,Of them,4 had low serum vitamin B12 concertrations.2 had low serum folate,or both.57(81.4%) patients had nonmegaloblastic macrocytic anemia (with normal B12 and folate values),the most commonly associated significant clinical conditions were alcoholism or hepatic disease (5 patients),hypothyroidism (1 patients),the effects of chemotherapy (7 patients),increased reticulocyte counts with hemolysis or hemorrhage (12 patients),chronic aplastic anemia(9 patients),myelodysplastic syndrome(12 patients),hematological malignant disease (11 patients).7(10%) had macrocytosis without anemia,of those,chronic obstructive lung disease (5 patients),diabetes(2 patients). Conclusions Megaloblastic anemia (folate and vitamin B12 deficiencies)may be relatively rare causes of macrocytosis,compared with nonmegaloblastic macrocytic anemia in hospitalized adult patients in ShenZhen City.