肉毒素中毒患者血小板计数及中性粒细胞形态学变化

Platelet counting and morphologic alteration of neutrophils in patients with botulinum toxin intoxication

目的探讨肉毒素中毒患者血小板计数及中性粒细胞形态学改变的临床意义。方法将43例肉毒素中毒患者按诊断标准分为轻、中、重度中毒组,常规取血2 ml,应用Backman-Coulter Gens五分类血常规分析仪进行血小板计数、白细胞计数及分类,同时做血涂片,瑞氏染色后,观察血小板、中性粒细胞形态学改变,分类200个中性粒细胞,计算毒性指数和核突积分,与健康对照组30例进行比较。结果各肉毒素中毒组血小板、中性粒细胞较对照组明显升高(P<0.01);轻度肉毒素中毒患者中性粒细胞胞浆未见中毒颗粒,白细胞计数、胞核核突与对照组比较差异无统计学意义;中、重度肉毒素中毒患者中性粒细胞均有毒性颗粒出现,且中毒越严重,中毒颗粒粗大,毒性指数也越高;中、重度肉毒素中毒患者中性粒细胞核有多种形态的核突出现,与正常对照组比较差异有统计学意义(P<0.01),且病情越重,差异越显著。结论动态监测肉毒素中毒患者外周血血小板、白细胞计数及中性粒细胞形态的变化,对于了解中毒程度、指导临床治疗、判断预后及转归以及与其他疾病的鉴别等方面有重要意义。

Objective To study the clinical meaning of platelet counting and morphologic alteration of neutrophils in the patients with botulinum toxin intoxication. Methods Forty-three patients were divided into three groups：mild,moderate and severe group according to the clinical diagnostic standards. Phlebotomized two milliliters venous blood,counted platelet and classified WBC with Backman-Coulter Gen blood cell analyser. Blood smears were made with Wright staining, the morphologic alteration of platelet and neutrophils and counted 200 neutrophils and calculated toxicity index and nuclear throne integral were observed, compared with those of control group. Results Platelet counting and neutrophils of botulinum toxin intoxication groups were significantly higher than those of control group（ P 〈0.01）. There was no toxic granule appreance in the neutrophils of mild toxic group. Compared with control group,there was no markedly difference in WBC counting and cell crest accumulate points. Toxic granules emerged in the neutrophils of moderate and severe toxic groups, and the more severe intoxication, the more granules, the higher toxicity index. Various kinds of nucleus thrones emerged in the nucleus of moderate and severe toxic groups, compared with that of control group, there was significant difference（ P 〈0.01）, and the more severe patient conditions, the more significant changes. Conclusion Dynamic observation on the changes of WBC and platelet counting,neutroptlils and the neutrophils morphology in the patients of botulinum toxin intoxication is of great help to direct clinical therapy.