AIDS合并播散性马尔尼菲篮状菌感染患者的白细胞散点图及血细胞形态特点

White blood cell scatter diagrams and morphology characteristics in AIDS patients complicated with disseminated Talaromyce marneffei infection

目的回顾分析27例AIDS合并播散性马尔尼菲篮状菌感染患者的白细胞散点图、外周血涂片特点及其他实验室指标,寻找早期识别AIDS合并马尔尼菲篮状菌病(talaromycosis marneffei,TSM)的指标。方法收集通过外周血涂片诊断的27例AIDS合并TSM患者作为AIDS合并TSM组;同时选取单纯HIV感染者、AIDS合并其他并发症患者分别作为对照组,对3组的白细胞散点图特点、白细胞手工分类计数、外周血细胞形态学特点进行分析,并对3组的血常规、CD4+T淋巴细胞计数、转氨酶及1,3-β-D真菌葡聚糖(BDG)结果进行比较。结果AIDS合并TSM组的白细胞散点图均在有核红细胞区域出现散点,外周血涂片均可见有核红细胞,同时可见幼稚、畸形的中性粒细胞。单纯HIV感染组的白细胞散点图和血涂片形态未见异常。AIDS合并其他并发症组的散点图有部分出现中性粒细胞散点上移,血涂片可见幼稚、畸形的中性粒细胞。3组的白细胞分类总体差异均有统计学意义(P均<0.05)。3组的白细胞、红细胞、血红蛋白、血小板、AST、ALT、BDG、CD4^(+)T淋巴细胞水平比较,差异均有统计学意义(P均<0.05)。结论AIDS合并TSM组的白细胞散点图和外周血形态有异常表现,有核红细胞的出现为特异性提示,且中性粒细胞比例、AST和BDG水平增高,CD4^(+)T淋巴细胞、血小板水平降低更明显。

Objective To retrospectively analyze the white blood cell scatter diagrams,peripheral blood smear characteristics and other laboratory indicators of 27 AIDS patients with disseminated Talaromyces marneffei(TM)infection,and find the indicators for early identification of AIDS combined with talaromycosis marneffei(TSM).Methods Twenty-seven AIDS patients combined with TSM diagnosed by peripheral blood smear were taken as the AIDS combined with TSM group.Meanwhile,2 control groups were set,including simple HIV infected patients and AIDS patients complicated with other diseases.The characteristics of white blood cell scatter diagrams,manual classification and count of white blood cells,and morphological characteristics of peripheral blood cells in the three groups were analyzed.The routine blood test,CD4^(+)T lymphocyte count,transaminase and(1,3)-β-D-glucan(BDG)results were compared.Results The white blood cell scatter diagrams of the AIDS combined with TSM group all showed scattered dots in the nucleated red blood cells area,and peripheral blood smears showed nucleated red blood cells.At the same time,immature and deformed granulocytes were visible.The white blood cell scatter diagrams and blood smear morphology of the simple HIV infection group were not abnormal.In the scatter diagrams of the AIDS with other complications group,some granulocytes were scattered upward,and the blood smear showed immature and deformed granulocytes.The overall differences in leukocyte classification were statistically significant among 3 groups(P<0.05).Comparison of white blood cells,red blood cells,hemoglobin,platelet,AST,ALT,BDG,CD4^(+)T lymphocyte count levels among 3 groups showed statistical significance(P<0.05).Conclusions The white blood cell scatter diagrams and peripheral blood morphology of AIDS combined with TSM group show abnormal manifestations with the specific indication of the emerging nucleated red blood cells.The neutrophil ratio,AST and BDG levels increase,CD4^(+)T lymphocyte count and platelet decrease significantly.