粒细胞缺乏症患者血象及骨髓象特点分析

Analysis of the Characteristics of Blood Routine and Bone Marrow in Patients with Agranulocytosis

目的探讨粒细胞缺乏症的外周血常规、骨髓象及铁染色特点,为临床诊断治疗粒缺提供实验室依据。方法收集2010年1月至2016年4月我院108例确诊为粒细胞缺乏症患者的外周血常规、骨髓象及铁染色结果进行回顾性总结分析。结果 108例粒缺患者血常规按年龄共分为8组,>80岁组粒缺患者HGB,RBC明显减低,RDW明显升高,差异均具有统计学意义(P<0.05),余各组间比较差异无统计学意义(P>0.05)。骨髓象按照增生情况可分为成熟障碍型和再生障碍型,其中成熟障碍型78例(72.2%),再生障碍型30例(27.8%),再生障碍型组淋巴细胞、单核细胞及浆细胞比例明显高于成熟障碍型组(P<0.05);粒系、粒红比值比明显低于成熟障碍型组(P<0.05);铁染色结果显示,粒缺患者平均外铁为1+,铁粒幼红细胞比例平均为22%,内外铁均不缺。结论加强粒细胞缺乏症患者的外周血常规及骨髓象的监测,了解骨髓中各类细胞的数量及形态变化,有助于粒细胞缺乏症骨髓象的诊断与分型,结合铁染色结果及病因分析有助于粒细胞缺乏症的及时诊断与治疗。

Objective To investigate the characteristics of peripheral blood routine, bone marrow and iron staining of agranulocytosis, so as to provide a laboratory basis for clinical diagnosis and treatment of it. Methods A retrospective analysis of the results of peripheral blood routine, the bone marrow image and the iron staining of 108 patients diagnosed with agranulocytosis in our hospital from January 2010 to April-2016 was carried out. Results 108 patients with agranulocytosis were divided into 8 groups according to age. In over 80 years old group, the HGB and RBC in patients with agranulocytosis decreased significantly, and the RDW increased significantly,the differences wereall statistically significant（P 〈 0. 05 ）, but there was no significant difference between the rest groups （P 〉 0. 05）. According to the hyperplasia condition, bone marrow could be divided into mature obstruction type and aplastic type, among which 78 cases were mature obstacle type （72. 2% ）, 30 cases were aplastic （27.8%）. The proportion of lymphocytes, monocytes and plasma cells in the aplastic group was significantly higher than that in the mature obstacle group （P 〈 0. 05 ） ; The ratio ofgranulocytic system tograin red systemin the aplastic group was significantly lower than that in the mature group （ P 〈 0. 05 ） ; Results of iron staining showed that the average external iron content was 1 ＋ in patients with agranulocytosis and the average percentage of sideroblast was 22%, and there were no internal or external iron deficiency. Conclusion To strengthen the monitoring of peripheral blood routine and bone marrow in patients withagranulocytosis and to understand the number and morphological changes of all cells in the bone marrow are helpful for diagnosis of agranulocytosis in bone marrow and its classi- fication,which combined with the results of iron stainingand analysis of the causes will be helpful for theearly diagnosis and treatment of agranulocytosis.