深圳市122例获得性免疫缺陷综合征患者的血液学特点

Hematological changes in 122 patients with acquired immunedeficiency syndrome in Shenzhen

目的探讨获得性免疫缺陷综合征(AIDS)患者血液学特点及其影响因素。方法收集2013年1月至2015年6月本院收治的122例AIDS患者的临床资料、骨髓涂片、外周血、HIV RNA病毒载量和T淋巴细胞亚群检测结果,并进一步分析外周血及骨髓象等血液学指标。结果 122例AIDS患者中,112例(91.80%)患者出现外周血异常,其中白细胞计数减少者47例(38.52%),淋巴细胞计数减少者102例(83.61%),血红蛋白水平下降者89例(72.95%),血小板计数减少者40例(32.79%);骨髓涂片有核细胞增生减低者57例(46.72%),巨核细胞计数减少者92例(75.41%),部分患者甚至未见巨核细胞;红系比例降低者90例(73.78%),粒系比例增高者79例(64.76%)。骨髓细胞形态未见明显异常,主要表现为感染性骨髓象、粒细胞胞浆内颗粒增多增粗、易见空泡和组织细胞。在CD4^+T细胞<10个/μl的患者骨髓中,发现噬血现象8例,马尔尼菲青霉菌感染4例,合并组织胞浆菌感染1例,弓形虫感染1例;另外,在6例可见分类不明细胞的患者中,1例经组织病理活检和免疫组化诊断为淋巴瘤细胞,1例经PET-CT提示为淋巴瘤肾转移,1例全身淋巴结肿大的患者,经形态学和免疫分型诊断为急性白血病;CD4^+T细胞水平51~200个/μl组和0~50个/μl组患者的骨髓有核细胞增生减低程度显著高于CD4^+T细胞201~500个/μl组(P均<0.05)。结论 AIDS患者外周血常规指标改变与HIV RNA病毒载量和是否接受抗病毒治疗相关;骨髓增生程度随着CD4^+T细胞计数减少而减低,免疫功能下降时血液系统易合并感染;外周血和骨髓检查方法简单、快速,可直观反映患者骨髓造血功能,且能及时发现真菌和寄生虫感染及肿瘤细胞,对AIDS患者并发症诊断、及时提示临床加强机会性感染的一级预防具有重要的临床意义。

Objective To investigate the hematological changes of patients with acquired immunedeifciency syndrome (AIDS) and to explore the inlfuencing factors.Methods Total of 122 patients with AIDS treated in our hospital from January 2013 to December 2014 were collected. The clinical materials, including the results of bone marrow smears and peripheral blood indexes, HIV RNA viral roads and T cell subgroups were analyzed, respectively. All the hematological indexes were compared.Results Among the 122 cases with AIDS, 112 patients (91.80%) were with abnormal peripheral blood, among whom, 47 patients (38.52%) with leukocytopenia, 102 patients (83.61%) with lymphocyte reduction, 89&nbsp;patients (72.95%) with hemoglobin reduction, 40 patients (32.79%) with thrombocytopenia. The results of bone marrow smears showed that 57 patients (46.72%) were with reduced hyperplasia of the nucleated cells, 92 patients (75.41%) with reduced hyperplasia of the megakaryocytes. Megakaryocytes were hardly seen among patients with AIDS. Furthermore, 90 cases (73.78%) were with lower red blood cell ratio. In contrast, the granulocyte ratio was increased in 79 cases (64.76%). As for bone marrow cell morphology, there was no significant abnormality, except for infectious bone marrow signs, increased and enlarged cytoplasmic granules in granulocyte, bubbles and tissue cells. In patients with CD4+ T cells < 10/μl, bone marrow smears showed 8 cases with hemophagocytic phenomenon, 4 cases withPenicillium marneffei infection, 1 case withHistoplasma infection, and 1 case with toxoplasma infection. Among the 6 patients with cells of unknown classiifcation, 1 case was diagnosed as lymphoma cells by histopathological biopsy and immunohistochemistry, 1 case as possibly lymphoma renal metastases as indicated by PET-CT result, 1 case with systemic lymph node enlargement as acute leukemia through morphology and immunological classiifcation. The levels of CD4+ T cell hyperplasia of bone marrow nucleated cells of 51-200/μl group and 0-50/μl group were signiifcantly higher than that of 201-500/μl group (bothP < 0.05).ConclusionsPatients with AIDS were easily to be aflficted by abnormal peripheral blood, peripheral blood was associated with whether HIV RNA load or antiviral therapy, moreover, the hyperplasia degree of the bone marrow was found to be reduced with the reduction of both the CD4+ T cell count and immunological functions, AIDS patients with delined immune function were easily complicated with blood system infection. Peripheral blood and bone marrow method was simple, quick and could relfect bone marrow hematopoietic function intuitively, and findfungi and parasitic infection and tumor cells timely, and had important clinical significance to complications diagnosis of patients with AIDS, timely reminder to strengthen the primary prevention of opportunistic infections.