失代偿期肝硬化患者全血细胞减少的临床病因与血象、骨髓象分析

目的探讨失代偿期肝硬化患者全血细胞减少的临床病因和外周血、骨髓细胞形态学特点,以提高对此类疾病的认识。方法对2012年1月-2015年6月本院87例失代偿期肝硬化合并全血细胞减少患者的临床资料进行回顾性分析。结果 87例患者主要病因为乙型肝炎肝硬化(64.4%);血象主要表现为三系轻度异常,以血小板为主;骨髓象主要表现为脾功能亢进(47.1%);失代偿期肝硬化患者的骨髓细胞学检查增生度呈多样性,以增生活跃为主,骨髓细胞分类主要表现为红细胞系增生、粒细胞系和巨核细胞系成熟障碍。增生减低组、增生活跃组和增生明显活跃组3组间的粒细胞系与红细胞系比值、粒细胞系、红细胞系、巨核细胞数不全相同,差异有统计学意义(P0.05)。结论失代偿期肝硬化全血细胞减少的病因是多方面的,肝炎后肝硬化是主要病因,脾亢是肝硬化患者全血细胞减少的主要骨髓象。肝硬化患者骨髓细胞学检查对明确全血细胞减少的诊断、治疗和估计预后有重要的临床意义。     

再生障碍性贫血的诊断与治疗

再生障碍性贫血（简称再障）是一组由于物理、化学、生物及其他不明原因引起的以骨髓造血功能衰竭 ,造血干细胞损伤 ,外周血全血细胞减少为特征的疾病。在临床上发生血细胞减少的疾病很多 ,如何准确诊断及治疗再障是基层医生经常面临的临床问题。本文以基层医院医疗条件为基础 ,介绍再障的诊治常规及其进展。１临床表现再障病人的临床表现是因外周血全血细胞减少引起的贫血、出血、感染及发热。根据临床表现、血象及骨髓象 ,通常将再障分为急性再障及慢性再障。１ １急性型再障此型发病急 ,短期内进展迅速 ,常以感染及出血为首发症状及主要…     

苯慢性毒作用的临床分析及预防

苯慢性毒作用的临床分析及预防江苏省职业病防治研究所张芹慢性苯中毒对造血系统的损害，最终可导致全血细胞减少，发生再障或／和白血病。然而，在重度苯中毒中，尚有一部分病例，在临床表现、血象、骨髓象方面，既不符合再障，又不符合白血病的诊断标准。这一部分病例，...     

全血细胞减少240例病因分析

目的分析临床常见的全血细胞减少的原因,使在诊治此病时降低误诊率。方法对240例全血细胞减少患者临床资料(年龄、性别、临床表现、体征、血象、骨髓象)进行整理分析。结果全血细胞减少最常见症状是贫血、发热、出血;由造血系统疾病引起的全血细胞减少220例, 占91．7％;非造血系统疾病20例,占8．3％,分别为脾功能亢进(最常见为肝硬化)、恶性肿瘤、结缔组织病及某些感染性疾病。结论临床常见的全血细胞减少除造血系统疾病外,非造血系统疾病必须予以充分重视。     

全血细胞减少症91例病因分析

目的 探讨全血细胞减少症(PCP)的病因与临床鉴别.方法 对91例PCP患者的临床资料进行回顾性总结.结果 91例中查明病因90例,病因不明1例.病因以血液病为主,占70.3%,其中白血病占第一位,其次为骨髓增生异常综合征、再生障碍性贫血,噬血细胞综合征也是常见病因.非血液病引起的全血细胞减少占28.6%,其中系统性红斑狼疮(SLE)占绝大多数,其次为肝脏疾病、恶性肿瘤及某些感染性疾病.血液病与非血液病三系血细胞减少程度构成比,两组间比较,差异无统计学意义(P均＞0.05).结论 通过病史、外周血象、骨髓象和辅以相关的特殊检查,绝大多数病例可明确诊断.对PCP病因不明的患者,可进行多次和多部位的骨髓象检查,长期随访也是诊断PCP的重要方法.     

妊娠合并骨髓增殖异常综合征的诊治

骨髓增生异常综合征(myelodysplasticsyndrome,MDS)是一种造血干细胞克隆性疾病,该病以骨髓造血功能不全和无效性血细胞生成为特征,伴有不同程度的外周血细胞减少,并有向白血病转化的危险[1].妊娠合并MDS是妊娠期非常少见的一种内科并发症,病死率高,临床处理尚有争议.我院2001年1月～2007年12月共收治孕妇19183例,根据FAB分型分类标准[2],其中确诊MDS 7例,现对其临床表现、血象、骨髓象、处理及转归等进行回顾.     

以血细胞学异常为首发表现的系统性红斑狼疮31例临床分析

目的　了解系统性红斑狼疮 (SLE)血液学变化、临床意义及其对药物治疗的反应。方法　对 31例以血液系统异常为主要表现的SLE病人进行骨髓细胞检查及骨髓活检 ,并与血象等其他临床资料综合分析 ,同时观察激素和细胞毒药物治疗后血象的变化。结果　SLE骨髓表现从增生明显活跃到增生受抑 ,以至再生障碍。最具意义的是增生受抑 ,但较外周血轻 ,且未见细胞形态异常。受抑发生率依次为巨核细胞 /血小板抑制 (4 5 .2 % ) ,红系(38.7% )和粒系 (9.7% )。 3例呈再生障碍骨髓象。网状巨噬细胞 (9例 )及浆细胞 (4例 )增多 ,5例铁染色减少。 15例肝脾淋巴结肿大者均呈增生性骨髓象。 4例骨髓活检未见骨髓纤维化。治疗后血细胞减少均得以改善 (P <0 .0 0 0 1)。结论　SLE骨髓损害主要为骨髓各系受抑 ,少数再生障碍 ,骨髓受累程度较外周血轻 ,对外周血细胞减少而骨髓细胞形态无异常者应警惕SLE可能 ;缺铁可能是狼疮贫血的部分原因 ;肝脾淋巴结肿大可能提示骨髓增生 ;血细胞减少者对激素和细胞毒药物反应良好。     

实用临床诊疗规范--造血系统疾病(一)第三节 再生障碍性贫血

1 概述 再生障碍性贫血简称再障,是一组骨髓造血组织减少、造血功能衰竭,导致周围血全血细胞减少的综合病征.临床上常表现为较严重的贫血、出血和感染.原发性再障中,男性多于女性、青年多于老年.根据疾病变化速度和病情轻重,结合血象和骨髓象,可将再障分为急性型和慢性型.若有致病原因(如药物、化学品、辐射、感染),为继发性.     

以全血细胞减少或高白细胞为主要表现的急性白血病的临床分析

目的 探讨全血细胞减少性急性白血病(PAL)和高白细胞性急性白血病(HAL)临床特点。方法 回顾性分析183例原发急性白血病(AL)的临床资料。结果 PAL38例(20．8％)、HAL42例(23．0％)。23．0％的急性髓细胞白血病(ALL)(尤其56．3％的急性早幼粒细胞白血病)和16．9％的急性淋巴细胞白血病(ALL)表现为PAL，髓外浸润较轻，全血细胞减少明显；73．7％的病例可在外周血发现数量不等的白血病细胞。早期病死率无明显增加，近期和远期疗效与一般类型AL无差别。23．8％的AML(尤其51．2％急性单核细胞白血病)和18．6％的ALL表现为HAL，肿瘤负荷大，髓外浸润重，早期病死率高，不易获得完全缓解，预后恶劣。结论 全血细胞减少或高白细胞是AL患者常见血象表现。了解其特殊血象，有利于指导临床诊断、治疗和判断预后。     

肝炎后再生障碍性贫血

肝炎后再障是在患病毒性肝炎的过程中或以后发生了再生障碍性贫血,亦称肝炎——再生障碍性贫血综合征,临床初发症状与原发性再障相似,有贫血、出血、发热三联症。周围血象呈全血细胞减少,骨髓象增生不良,对一般造血药物治疗无效等。肝炎后再障是再障亚型中的一种。     

Diagnosis of cutaneous lymphomas

Diagnosis of cutaneous lymphoma is based on the clinical picture and the histology. Several, different clinical entities are the members of this group with various clinical and histological features, with different course and prognosis. The clinical picture resembles that of a wide variety of benign, inflammatory dermatosis. The histological characteristics in the early lesions are not pathognomic, therefore immunohistochemistry and gene rearrangement studies are necessary to establish the diagnosis. These processes are evaluated in the article.     

Trombiculiasis, and epidemic of prurigo caused by mites

In four villagers parasitic prurigo caused by the autumnal chigger (Neotrombicula autumnalis) was diagnosed. The clinical picture consisted of intensely itchy, erythematous papules, at sites where clothes fitted tightly or in body folds. Further investigation in the village revealed that in 16 of the 48 homes at least one person in the preceding two months had suffered from prurigo possibly caused by the autumnal chigger. The characteristics of the parasite, the clinical picture, treatment and prevention are discussed.     

Recognizing the faces of hypothyroidism

Physicians may not recognize hypothyroidism if they rely on the stereotypical picture of the disorder. The age of the patient, stage of the disease, and other illnesses or conditions such as pregnancy can change the clinical presentation. The signs and symptoms of hypothyroidism are remarkably diverse. Instead of a single picture, physicians need a mental gallery.     

Female patient with cutaneous anthrax in Belgium]

A 23-year-old Turkish woman was admitted with an infection of the left thumb. The clinical picture was typical for cutaneous anthrax. Microbiological tests confirmed the diagnosis 'infection by Bacillus anthracis'. She recovered when treated with penicillin, although later tests revealed that the bacteria were resistant to this antibiotic. The patient became infected in Belgium as a result of wounding herself on the teeth of an illegally slaughtered sheep, which had possibly become infected in the pasture. Recognising the characteristic clinical picture of cutaneous anthrax is essential for prompt treatment and a favourable prognosis.     

The investigation and control of salmonellosis

The information available about salmonellosis, a controllable disease with a wide distribution, is unsatisfactory for many reasons. Both because of the wide variations in the clinical picture of what is bacteriologically a homogeneous group, and because the methods of control vary considerably with the biochemical and serological type of organism, no country in the world can be said to possess now either a reasonable picture of the occurrence of this disease within its borders or an organization which has brought it under control.     

长期低剂量电离辐射对职业工作者健康影响的研究

长期低剂量电离辐射对职业工作者健康影响的研究表明 :职业工作者人均年剂量当量为 1.10mSv ,累积剂量平均为 14.6 6mSv。在临床症状阳性率、皮肤阳性检出率、晶状体混浊率、异常血象总检出率、微核细胞率、T3、T4 均值方面与对照组相比 ,均有显著性或非常显著性差异 (P <0 .0 5或P <0 .0 1)。在与专业有关的临床症状阳性率、晶状体混浊率、微核细胞率、染色体畸变率均有随放射工龄、累积剂量增加而升高的趋势 ,呈现一定的相关性。提示 ,职业工作者受照剂量在低于国家规定标准年剂量当量限值十分之一以下时 ,仍然存在一定的辐射生物效应。因此 ,应需进一步加强防护。     

Reflections on non-differentiated collagenosis or non-differentiated autoimmune syndrome

The authors review the Non-Differentiated Collagenosis (NDC) described by Gyula Petrányi 29 years ago, and try to establish whether it is still necessary to maintain this clinical picture. Relying on data from special literature and on their own findings, the authors conclude that the maintenance of the NDC terminology is justified by the fact that poly-systemic autoimmune diseases take time to develop and that at certain stages of this development it is almost impossible to make a firm decision as to which clinical picture the process will lead to. The authors discuss the clinical and immunological features of NDC, the implications for the patients and things to be done in order to recognise the NDC disease process. They also emphasize a more frequent occurrence of the features of NDC than is generally stated, and that such patients need regular, competent and devoted medical attention.     

超声诊断临床实习带教体会

在临床实习教学中,强调多学科结合,多媒体及临床实践的应用。运用多种教学方法,注重培养学生归纳分析图像的能力,注重临床实践操作和报告的规范书写等基本功。     

超声诊断临床实习带教体会

在临床实习教学中,强调多学科结合,多媒体及临床实践的应用。运用多种教学方法,注重培养学生归纳分析图像的能力,注重临床实践操作和报告的规范书写等基本功。     

Possible treatment modalities of primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a chronic progressive liver disease with the segmental inflammation, obliterative fibrosis and cholestasis of intra- and extrahepatic biliary ducts which leads to secondary biliary cirrhosis. Its aetiology is unknown. The disease is accompanied with ulcerative colitis in 70-80 percent. Its clinical progress is variable, the average duration of the disease is between the diagnosis and the final stage (liver transplantation) about 18 years. The prevalence of PSC is 1-5/100 000 inhabitants. Mainly it occurs in male patients (70 %), male-female rate is 2:1. The authors summarise the treatment modalities after reviewing the pathogenesis, clinical picture and the diagnostic procedures. The pathomechanism of the basis therapy with ursodeoxycholic acid (UDCA) is discussed in details, especially its effects on the clinical picture and the laboratory data. The authors review the results of the immunosuppressive therapy and the treatments of specific complications in PSC. They underline the importance and opportunities of the early diagnosis of cholangiocarcinoma, which is very frequent in this disease.