重症SARS患者危险因素分析

目的　通过对重症SARS患者相关危险因素的分析 ,指导临床医生及时、准确判断病情。方法 采用回顾性方法对比总结40例重症患者与43例普通型患者临床资料。结果 普通型患者年龄构成比小于40岁占98.2% ,50岁以上均为重症患者。重症患者高热持续时间长 ,平均7.7d ,激素干预3d体温仍不降或下降后复升者占36.4%;合并腹泻的比例高 (占45.0%) ,持续时间平均6d。重症、普通型患者淋巴细胞记数 (L cell<1.0×10⁹/L)的比例分别占91.7%、38.0% ,且15d内进行性下降的比例重症患者为41.2%。T细胞亚群中CD₄、CD₃明显下降在重症患者中所占比例 (81.3%、52.9%)较普通型高 (50.0%、22.2%)。结论 重症SARS的相关危险因素为 (1)年龄大于50岁;(2)持续高热 ,应用激素3d体温不降或复升;(3)持续腹泻超过6d;(4)淋巴细胞计数2周内进行性下降;(5)血清酶系统升高大于正常值2倍。     

新型冠状病毒肺炎患者早期外周血白细胞分类特点

探讨新型冠状病毒肺炎(COVID-19)患者早期外周血白细胞分类特点。对2020年1月22日—2月17日上海市第六人民医院及其金山分院收治的10例COVID-19患者及同期收治的30例其他病毒导致的病毒性肺炎(非COVID-19)患者血白细胞分类进行分析。10例COVID-19患者白细胞计数为4.95(3.90,6.03)×10^9/L,白细胞减少2例(2/10);淋巴细胞绝对值为1.20(0.98,1.50)×10^9/L,减少2例(2/10);嗜酸性粒细胞绝对值0.01(0.01,0.01)×10^9/L,减少7例(7/10)。与COVID-19组相比,30例非COVID-19患者白细胞计数8.20(6.78,9.03)×10^9/L(P<0.001);淋巴细胞绝对值1.75(1.20,2.53)×10^9/L(P=0.036),16.7%患者淋巴细胞减少;嗜酸性粒细胞绝对值0.02(0.01,0.03)×10^9/L(P=0.005),16.7%患者嗜酸性粒细胞减少。COVID-19组的白细胞、淋巴细胞及嗜酸性粒细胞数值显著低于,非COVID-19组。     

白血病皮肤浸润1例

<正>1病例资料患者男性,62岁。因咽痛5 d、发热1 d于2013年12月13日就诊于我院,查血常规:白细胞计数(WBC)2.09×10~9/L,中性粒细胞绝对值(NE)0.08×10~9/L,红细胞(RBC)2.82×10~(12)/L,血红蛋白(HGB)91 g/L,血小板(PLT)75×10~9/L;行骨髓象:(1)骨髓有核细胞增生明显活跃;(2)粒细胞系:增生     

白细胞减少症的药物治疗

白细胞减少症是一种由化学、物理、生物等因素及不明原因引起的外周血中白细胞计数持续低于4×10^9/L的临床综合征。中性粒细胞低于0.5×10^9/L称粒细胞缺乏症,病死。     

急性心肌梗死斑块破裂光学相干断层成像特征与外周血白细胞计数的关系

目的研究急性心肌梗死斑块破裂光学相干断层成像(OCT)特征与外周血白细胞计数的关系。方法连续入选阜外医院因急性心肌梗死(AMI)行急诊经皮冠状动脉介入治疗(PCI)并在血栓抽吸后行OCT证实斑块破裂的33例患者。搜集患者人口学资料、危险因素、既往病史、冠状动脉造影资料、OCT影像特征和围术期实验室检查结果。结果 33例患者中,纤维帽厚度65μm患者淋巴细胞计数、单核细胞计数和嗜碱性粒细胞计数[(2.31±0.86)×10~9/L比(1.57±0.80)×10~9/L;(0.57±0.08)×10~9/L比(0.44±0.14)×10~9/L;(0.05±0.03)×10~9/L比(0.03±0.02)×10~9/L]明显高于纤维帽厚度≤65μm患者,差异均有统计学意义(均P0.05)。有胆固醇结晶组嗜酸性粒细胞计数低于无胆固醇结晶患者[(0.04±0.06)×10~9/L比(0.10±0.09)×109/L,P=0.028];前者的中性粒细胞/淋巴细胞比值显著高于后者[(8.35±6.13)比(4.97±2.01),P=0.020]。具有白血栓的患者淋巴细胞计数高于无白血栓组(P=0.038)。钙化斑块患者单核细胞计数明显高于无钙化斑块患者(P0.05)。有巨噬细胞浸润患者血小板/淋巴细胞比值明显升高[(165.72±85.93)比(113.47±19.13),P0.05)]。OCT特征数量的增加,白细胞计数、中性粒细胞计数、单核细胞计数水平逐渐升高,但仅单核细胞计数水平的升高差异有统计学意义(P=0.014)。结论外周血白细胞计数水平可能与AMI患者斑块破裂的OCT特征有关,提示炎症水平与斑块破裂有关。     

北京首批重症急性呼吸综合征患者临床特征及预后分析

目的　探讨重症急性呼吸综合征 (SARS)临床特征 ,分析其预后影响因素。方法　以北京地区首批 34例SARS患者为研究对象 ,观察其临床特征及辅助检查 ,并对 1例死亡患者尸检。结果　患者年龄平均 (33 4± 13 4 )岁 ;潜伏期 2～ 14d ,中位数 4d。发热 (10 0 % )、心悸 (91 7% )、肌痛(79 2 % )、头痛 (70 8% )、腹泻 (73 9% )、咳嗽 (5 8 3% )为主要临床表现。初诊时白细胞计数平均 (4 6± 1 4 )× 10 9/L ,淋巴细胞平均 0 2 7± 0 11,淋巴细胞绝对计数 (1 2 3± 0 4 6 )× 10 9/L ,6 8 4 %病例低于正常。ALT、乳酸脱氢酶、血沉水平升高者分别占 76 2 %、2 8 6 %、4 7 8% ,血清铁、血清白蛋白水平降低者分别为 6 3 2 %、38 1%。 32例有胸部X线检查异常 ,2例CT扫描发现异常。尸检 :肺脏和淋巴组织受累明显。多因素分析显示 ,不良预后独立影响因素是高龄。结论　发热、淋巴细胞和血清铁降低及胸部影像学检查可早期诊断SARS ;年龄为该病预后的独立预测因素。     

重症脑型恶性疟一例

患者男,24岁,因间歇发热6 d于2009年8月18日入院.患者6 d前突然发热,达39℃.次日赴广州中医药大学第一附属医院急诊,体温为39.7℃,伴畏寒、乏力、头痛及全身酸痛,数小时后汗出热退.后每日下午或夜间发热.入院前3 d,WBC 5.7×109/L、中性粒细胞(N)0.904,淋巴细胞(L)0.67,单核细胞0.023,嗜酸性粒细胞0.004,RBC 4.74×1012/L,Hb 145 g/L,PLT 45×109/L、血小板比积(PCT)0.05;外周血未找到疟原虫.追问病史,患者2009年1月曾赴非洲加纳,4、6月在加纳诊断为疟疾,经复方蒿甲醚治疗后痊愈,8月回国.入院时体温39.5℃,脉搏120次/min,BP 90/60 mm Hg(1 mm Hg=0.133 kPa).     

口服牛黄解毒片致HAART中的AIDS病人白细胞下降1例

1 临床资料 某男,25岁。2009年3月确诊为艾滋病,2011年2月10日检测CD4＋T淋巴细胞计数137个／μL,血白细胞4．1×10^9／L,中性粒细胞2．0×10^9/L.     

淋巴细胞计数联合HBV-DNA定量检测在早期诊断重症肝炎及判断预后中的意义

目的　探讨淋巴细胞计数联合HBV -DNA定量检测在预示重症肝炎趋势、诊断早期重症肝炎及判断预后中的意义。方法　选择初诊慢性乙型肝炎 (中度 ) 65例 ,根据病情最终演变情况分成慢性乙型病毒性肝炎 (重度 )组和重症肝炎组 ,观察两组淋巴细胞计数和HBV -DNA负荷量变化情况。结果　慢性乙型病毒性肝炎 (重度 )组患者中仅有 4例患者血淋巴细胞计数在病情演变中出现低于正常值情况 ,但患者血HBV -DNA负荷量较高。重症肝炎组中 17例患者在病情演变为重症肝炎前血淋巴细胞计数出现低于正常值情况 ,仅 1例患者始终正常 ,但患者HBV -DNA负荷量均为阴性。重症肝炎组和慢性乙型肝炎 (重度 )组淋巴细胞计数平均值分别为 0 .8± 0 .12× 10 9/L和 1.3± 0 .34× 10 9/L ,两组比较有显著差异 (P <0 .0 5 )。 18例重症肝炎患者在淋巴细胞减少平均 7.7± 2 .1天后出现明显重症肝炎临床症状和体征。结论　淋巴细胞计数联合HBV -DNA定量检测有助于预测慢性乙型病毒性肝炎 (中度 )的发展趋势、在早期诊断重症肝炎中有重要意义     

系统性免疫炎症指数与胃癌根治术后患者预后的相关性研究

目的:基于外周血中性粒细胞、淋巴细胞和血小板计数计算系统性免疫炎症指数(SII),探讨其预测胃癌根治术后患者预后的临床价值。方法:回顾性分析2012年1月1日至2015年1月1日于河北医科大学第四医院外三科行根治性手术治疗的2 273例胃癌患者资料,根据公式[SII＝中性粒细胞计数(×10 9/L)×血小板...     

北京市重症急性呼吸综合征患者的临床免疫学特点

目的探索北京市所有重症急性呼吸综合征(SARS)患者的临床免疫学特点及其规律.方法对2003年3～7月期间在北京非典型肺炎定点医院住院的所有SARS患者病历进行完整录入、数据处理、回顾性统计分析.结果 2003年3～7月期间资料完整的确诊SARS患者1291例,其白细胞总数、淋巴细胞、CD3、CD4、CD8淋巴细胞亚群绝对值均在发病早期同时下降,总阳性率分别为56.91%、88.26%、47.96%、45.56%及41.10%;其CD3、CD4、CD8在前3天中位数分别为425×106/L、223×106/L、170×106/L,达病程的最低值;第2周分别为536×106/L、267×106/L、224×106/L,至第4周恢复正常(P<0.05);其数值出现随病程发展逐渐升高的正相关趋势.将连续4周检测的同一组患者,分别与相邻时间段的同一组患者和所有非同组患者的各免疫学指标进行比较分析,3组中CD3、CD4、CD8表达仍然是第1～3天最低,除连续检测组第3周CD3的中位数(954×106/L)偏高外,其他3组间差异无显著性(P<0.05),各数据与病程呈平行升高趋势.C反应蛋白早期升高,血沉,补体C3、C4均在正常范围内.结论 SARS患者的发病早期白细胞、淋巴细胞、淋巴细胞亚群CD3、CD4、CD8均同时明显减少,淋巴细胞、淋巴细胞亚群CD3、CD4、CD8随病程发展呈上升恢复趋势.特别是第1周内,CD3、CD4、CD8同时减低,是SARS的免疫学特征之一,有助于早期诊断.     

Haematological parameters in severe acute respiratory syndrome

Clinical presentation of severe acute respiratory syndrome (SARS) is non-specific and isolation of all suspected patients is difficult because of the limited availability of isolation facilities. We studied changes in haematological parameters in SARS patients using median values analysed according to the day of symptom onset. White cell (WCC), absolute neutrophil, absolute lymphocyte (ALC) and platelet counts followed a v-shaped trend with the nadir at day 6 or 7 after symptom onset except for ALC in the ICU group that had not reached the nadir by day 12. None of our patients had a platelet count < 80 x 10(9)/l and WCC < 2 x 10(9)/l in the first 5 days of symptoms and these parameters may allow early stratification of febrile patients into likely and unlikely SARS cases to allow effective utilization of isolation facilities. On multivariate analysis, age is the only independent predictor for ICU admission.     

Effects of severe acute respiratory syndrome (SARS) coronavirus infection on peripheral blood lymphocytes and their subsets.

INTRODUCTION: Severe acute respiratory syndrome (SARS) caused large outbreaks of atypical pneumonia in 2003, with the largest localized outbreak occurring in Beijing, China. Lymphopenia was prominent amongst the laboratory abnormalities reported in acute SARS. METHODS: The effect of SARS on peripheral blood lymphocytes and their subsets was examined in 271 SARS coronavirus-infected individuals. RESULTS: There was a significant decrease in the CD45+, CD3+, CD4+, CD8+, CD19+ and CD16+/56+ cell counts over the five weeks of the SARS illness although CD4+/CD8+ ratios did not change significantly. The lymphopenia was prolonged, reaching a nadir during days 7-9 in the second week of illness before returning towards normal after five weeks, with the lowest mean CD4+ cell count of 317 cellsx10(6)/L at day 7, and CD8+ cell count of 239 cellsx10(6)/L at day 8. Patients with more severe clinical illness, or patients who died, had significantly more profound CD4+ and CD8+ lymphopenia. DISCUSSION: Lymphopenia is a prominent part of SARS-CoV infection and lymphocyte counts may be useful in predicting the severity and clinical outcomes. Possible reasons for the SARS-associated lymphopenia may be direct infection of lymphocytes by SARS-CoV, lymphocyte sequestration in the lung or cytokine-mediated lymphocyte trafficking. There may also be immune-mediated lymphocyte destruction, bone marrow or thymus suppression, or apoptosis.     

严重急性呼吸综合征患者外周血B细胞亚群及CD40表达变化的意义

目的　探讨严重急性呼吸综合征 (SARS)患者外周血B1细胞、B细胞数量及CD4 0 表达在病程中的变化规律及其与疾病严重程度的关系。方法　用三色流式细胞技术对 162例SARS临床诊断病例外周血B1细胞 (CD+ 19CD+ 5 )数、B细胞 (CD+ 19)数及B细胞CD40 的平均荧光强度 (CD4 0 MF)进行检测并与 3 0例肺炎支原体感染组患者及 3 0名健康对照者外周血B1细胞数、B细胞数及CD40 MF作比较。结果　SARS临床诊断病例B细胞总数为 ( 2 92± 181)× 10 6 /L ,显著高于健康对照组的 ( 2 0 0± 65)× 10 6/L(F =6 17,P <0 0 5) ,但显著低于肺炎支原体感染患者的 ( 3 59± 168)× 10 6 /L(F =6 2 8,P <0 0 5) ;在病程的 11～ 2 0天B1细胞数为 ( 2 4± 14 )× 10 6 /L ,显著低于健康对照组的 ( 3 9± 2 0 )× 10 6 /L(F =4 2 3 ,P <0 0 5) ;病程的前 10天CD4 0 MF为 ( 9 8± 1 6) ,显著低于健康对照组的 ( 12 6± 4 4) (F =5 13 ,P <0 0 5)。SARS重症组与轻症组B细胞数分别为 ( 3 4 7± 156)× 10 6/L及 ( 2 68± 2 11)× 10 6/L ,两者比较差异具有非常显著性 (F =7 11,P <0 0 1)。结论　 ( 1)SARS患者外周血B细胞、B1细胞的数量及CD40 MF的表达均受到不同程度影响 ,其中B细胞数量与SARS病情严重程度相关。 ( 2 )B细胞、B     

对结核性胸膜炎患者使用分支杆菌类免疫刺激剂的商榷性研究

目的　为观察在结核性胸膜炎患者使用分支杆菌类免疫增强剂的实际疗效并探讨其使用是否具合理性。方法　观察结核性胸膜炎患者分别经单纯抗结核 +胸穿抽液 (对照组 )和抗结核 +斯奇康 +胸穿抽液 (实验组 )的胸液平均消退时间和胸液淋巴细胞密度的动态改变 ,同时采用原位DNA末端标记技术观察两组患者胸液淋巴细胞凋亡时程的动态改变。结果　对照组和实验组的胸液消退时间分别为 (2 1 .2± 5 .4)d和 (2 8.7± 7.1 )d ,两组相比P <0 .0 5。两组患者胸液淋巴细胞密度于用药满 1周、2周、3周时分别为 1 .6× 1 0 9/L与 2 .1× 1 0 9/L(P <0 .0 1 )、0 .83× 1 0 9/L与 1 .52× 1 0 9/L(P <0 .0 1 )、0 .55× 1 0 9/L与 1 .1 6× 1 0 9(P <0 .0 1 )。两组患者胸液淋巴细胞半数凋亡时间于用药满 1周、2周、3周时分别为 94与 1 2 4h(P <0 .0 1 )、84与 1 2 3h(P <0 .0 1 )、79与 1 2 0h(P <0 .0 1 )。结论　分支杆菌类免疫刺激剂可持续活化淋巴细胞 ,延长胸液淋巴细胞凋亡时程 ,从而减缓结核性胸液的消退进程。故该类制剂不宜用于结核性胸膜炎的辅助治疗。     

78例传染性非典型肺炎病例临床分析

目的　分析传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)患者的临床特点 ,并对其诊断标准和治疗方法进行探讨。方法　对广州呼吸疾病研究所 2 0 0 2年 12月 2 2日至 2 0 0 3年 3月 31日收治的 78例SARS患者的临床、实验室、影像学资料进行回顾性分析。结果78例SARS患者 :男 4 2例 ,女 36例 ;年龄 2 0～ 75岁 ,平均 (37 5± 11 6 )岁 ;医务人员 4 4例 (5 6 % )。临床症状包括 :发热 (10 0 % )、咽痛 (17% )、咳嗽 (88% )、气促 (80 % )、畏寒 (5 9% )、肌肉酸痛 (41% )。血常规 :白细胞 (WBC) <4 0× 10 9/L 12例 (15 % ) ,WBC(4 0～ 10 0 )× 10 9/L 4 9例 (6 3% ) ,WBC >10 0× 10 9/L 17例 (2 2 % ) ,平均为 (7 6± 5 0 )× 10 9/L ;中性粒细胞为 0 75± 0 14 ,淋巴细胞 0 18±0 11。胸部X线和CT显示肺部斑片状阴影 ,短期内病灶增多 ,累计单侧 2 3例 (30 % )、双侧 5 2例(6 7% )。分析医护人员被感染途径 ,提示本病具有较强的飞沫近距离传染特性。出现急性肺损伤(ALI) 37例 (47% ) ,其中发展为急性呼吸窘迫综合征 (ARDS) 2 1例。 7例死亡患者均为ARDS合并有多器官功能衰竭综合征 (MODS)。结论　流行病接触史、发热、X线肺炎征及白细胞计数正常或减少是诊断本病的临床依据。     

Antilymphocyte globulin, cyclosporin, and granulocyte colony- stimulating factor in patients with acquired severe aplastic anemia (SAA): a pilot study of the EBMT SAA Working Party

Patients with severe aplastic anemia (SAA) and a neutrophil (PMN) count of less than 0.5 x 10(9)/L are exposed to a high risk of early mortality when treated with antilymphocyte globulin (ALG) and steroids, with the major problem being infectious complications. The addition of human recombinant granulocyte colony-stimulating factor (rhG-CSF) to ALG may reduce early mortality by improving neutrophil counts in the short term. To test the feasibility of this approach, the SAA Working Party of the European Group for Blood and Marrow Transplantation (EBMT) designed a pilot study that included rhG-CSF (5 micrograms/kg/d, days 1 through 90), horse ALG (HALG; 15 mg/kg/d, days 1 through 5), methylprednisolone (2 mg/kg/d, days 1 through 5, then tapering the dose), and cyclosporin A (CyA; 5 mg/kg/d orally, days 1 through 180). Patients with newly diagnosed acquired SAA (untreated) and with neutrophil counts of < or = 0.5 x 10(9)/L were eligible. Forty consecutive patients entered this study and are evaluable with a minimum follow up of 120 days: the median age was 16 years (range, 2 to 72 years), the interval from diagnosis to treatment was 24 days, and the median PMN count was 0.19 x 10(9)/L. Twenty-one patients had hemorrhages, and 19 were infected at the time of treatment. Overall, treatment was well tolerated: the median maximum PMN count during rhG- CSF administration was 12 x 10(9)/L (range, 0.4 x 10(9)/L to 44 x 10(9)/L). There were three early deaths (8%) due to infection. Four patients (10%) showed no recovery, whereas 33 patients (82%) had trilineage hematologic reconstitution and became transfusion- independent at a median interval of 115 days from treatment. Median follow up for surviving patients is 428 days (range, 122 to 1,005). Actuarial survival is 92%: 86% and 100% for patients with PMN counts less than 0.2 x 10(9)/L or between 0.2 x 10(9)/L and 0.5 x 10(9)/L, respectively. This study suggests that the addition of rhG-CSF to ALG and CyA is well tolerated, is associated with a low risk of mortality, and offers a good chance of hematologic response. This protocol would appear to be an interesting alternative treatment for SAA patients with a low PMN count who lack an HLA-identical sibling.     

Definition of myeloid engraftment after allogeneic hematopoietic stem cell transplantation

Neutrophil counts continued to rise after reaching 0.5x10(9)/L in 78 allograft recipients receiving granulocyte colony-stimulating factor (G-CSF) post-transplant. This was confirmed in 44 subsequent patients not receiving G-CSF. This suggests that the first day of neutrophils >or=0.5x10(9)/L can be considered a valid definition of myeloid recovery after allogeneic transplantation.     

Autoimmune Neutropenia With Cyclic Oscillation of Neutrophil Count After Steroid Administration

A 16-year-old female patient was evaluated for pancytopenia. She had a white blood cell count of 1.6 x 10(9)/L with 0.02 neutrophils and a platelet count of 19 x 10(9)/L. In the bone marrow, mature granulocytes were markedly decreased in number, but no atypical cells were present. Antineutrophil antibody was demonstrated by flow cytometry, and the level of platelet-associated immunoglobulin G was increased. A diagnosis of autoimmune neutropenia and thrombocytopenia was made. Interestingly, neutrophil and platelet counts fluctuated cyclically after the initiation of prednisolone therapy. The neutrophil count fluctuated between 0.1 x 10(9)/L and 7 x 10(9)/L, and the platelet count fluctuated between 19 x 10(9)/L and 175 x 10(9)/L, in 4-week cycles. Following splenectomy, neutrophil and platelet counts normalized. We believe the immune mechanism of recurrent neutropenia in this patient differs from that in other patients with cyclic neutropenia reported with stem cell disorders.