探讨白细胞减少症患者T淋巴细胞亚群等六项指标分布特征

The distribution of six indicators including lymphocyte subsets in white blood cell reduction patients

目的调查了解白细胞减少症患者淋巴细胞亚群等6项指标的分布特征与临床意义。方法选择2013年1月至2014年12月期间在同济大学附属第十人民医院住院治疗的白细胞减少症患者103例（外周血WBC计数均＆lt;4.0×10~9/L）,按骨髓穿刺的粒系增生活跃与否分为骨髓粒系增生欠活跃组（阳性组23例）和骨髓粒系增生活跃组（阴性组80例）。回顾性分析两组白细胞减少症患者中的C反应蛋白（C reactive protein,CRP）、乳酸脱氢酶（lactate de hydrogenase,LDH）、血清总补体活性（complement Hemolytic activity,CH50）、补体C3（complement 3,C3）、红细胞沉降率（erythrocyte sedimentation rate,ESR）、淋巴细胞亚群百分比等指标的差异与分布特征;及评价其对骨髓穿刺辅助诊断白细胞减少症原因的效能。结果 T淋巴细胞、辅助性T淋巴细胞和自然杀伤细胞（natural killer cell,NK）在阳性组分别为（62.42±3.21）%、（21.39±2.39）%、（22.94±1.81）%,阴性组分别为（72.00±3.97）%、（29.73±4.02）%、（11.32±0.38）%,两组差异有统计学意义（t值分别为3.791、3.268、8.658,前两项P值均＆lt;0.05,后一项P＆lt;0.001）。阳性组的CRP（P_（50）=14.70）高于阴性组（P_（50）=4.25,U=7.008,P=0.03）。结论白细胞减少症骨髓粒系增生欠活跃患者中T淋巴细胞和辅助性T淋巴细胞比例降低、NK细胞比例升高,CRP表达增高,对辅助判断白细胞减少症患者骨髓穿刺粒系增生欠活跃有参考价值。

Objective To evaluate the distribution and clinical significance of 6 indicators including lymphocyte subsets in patients with white blood cell reduction. Methods One hundred and three patients with white blood cells reduction who were diagnosed between January 2013 and December 2014 were divided into two groups according to the results of bone marrow examination（hyperplasia degree of granulocyte system）. Methods to retrospective analyze the characters of C reactive protein（CRP）, lactate dehydrogenase（LDH）, 50% complement hemolysis（CH50）, complement C3（C3）, erythrocyte sedimentation rate（ESR） and lymphocyte subsets between two white blood cell reduction groups, and to evaluate their effectiveness on bone marrow biopsy for white blood cell reduction diagnosis. Results T lymphocytes, T helper lymphocytes and natural killer（NK） cells in the bone marrow examination positive groups [（62.42 ±3.21） %,（21.39 ±2.39） %,（22.94 ± 1.81） %] and negative groups [（72.00 ±3.97） %,（29.73 ± 4.02） %,（11.32 ± 0.38） %],results were statistically significant differences（t=3.791, 3.268, 8.658. P0.05 or P0.001）. CRP in bone marrow puncture positive group（P_（50）=14.70） was higher than negative group（P_（50）=4.25, U=7.008, P=0.03）. Conclusions Results show reduction of T lymphocytes and T helper lymphocytes, increase of NK cells and high expression of CRP in white blood cell reduction patients with less active marrow myeloid hyperplasia, which has reference value for auxiliary judging white blood cell reduction patients with less active marrow myeloid hyperplasia.