无明显症状结核病患者血液学异常及骨髓象特点

The hematologic abnormity and the features of bone marrow in non-obvious symptomatic tuberculosises

目的观察有典型血液学异常而无明显结核病症状患者的血液学变化及其骨髓象特点,并与血液病相鉴别。方法观察有典型血液学异常而无明显结核病症状,但OT或PPD试验阳性或强阳性患者的临床表现、外周血异常改变和骨髓象特点,做中性粒细胞碱性磷酸酶(NAP)染色,计数其阳性率并计算NAP积分值。结果无明显症状结核病患者一般无明确感染灶,其血液学异常大部分仅表现为白细胞减少,部分表现为轻度全血细胞减少或仅血小板减少;骨髓涂片检查其外观油滴较多,骨髓增生程度不减低,骨髓象有轻度中毒性改变,淋巴细胞比例增高,常出现异型淋巴细胞,并有嗜酸性粒细胞增多,有的呈巨核细胞减少或出现类似于ITP的巨核细胞的改变,嗜中性粒细胞碱性磷酸酶NAP积分值极度减低。结论无明显症状结核病所引起的血液学异常也可多样性,实际工作中应注意与血液病鉴别,以防误漏诊影响及时治疗。

Objective To investigate the changes of hematologic abnormity and the features of bone marrow in patients with typical hematologic abnormity but non- obvious symptomatic tuberculosises and discriminate them from hematonosises.Methods The clinical manifestations,changes of hematologic abnormity and features of bone marrow of patients with typical hematologic abnormity and non-obvious tuberculotic symptom but OT or PPD test positive were investigated. The alkaline phasphatase staining was done and the NAP points was calculated.Results There were no definite focus of infection in nonobvious symptomatic tuberculosises. The majority of their hematologic abnormity was only hypocytosis and the minority was minor pancytopenia or only thrombocytopenia. There was much fat on bone marrow smears, but the proliferation degree doesn＇t decrease. There were minor toxic changes,high lymphocyte ratio,atypical lymphocyte,eosinophilia,megalokaryocyte like ITP and low NAP points in bone marrow. Conclusion The hemato-logic abnormity caused by non-obvious symptomatic tuberculosises is various. It should paid more attentions to discriminate them from hmatonosises in work in order to avoid erroneous diagnosis and non- timely therapy.