慢性苯中毒患者34例骨髓象的临床观察

目的　通过对慢性苯中毒患者骨髓象分析,了解其临床类型特点。方法　按诊断标准对患者进行分组诊断,３４ 例患者均进行骨髓穿刺,选取材、涂片、染色好的骨髓片计数有核细胞２００ 个,进行分类并观察细胞形态。结果　除２ 例再生障碍性贫血（ 简称再障） 患者外,其他患者均表现骨髓增生活跃或明显活跃,但各组患者粒红比值均数低于正常值均数。骨髓增生异常综合征（ Ｍ Ｄ Ｓ） 患者骨髓中原粒和早幼粒细胞百分率高于正常,分别为５ ．０８ 和７ ．８５（ 正常参考值分别为０ ．６４ 和１ ．５９） ,粒细胞和红细胞有细胞形态异常和核畸形。结论　慢性苯中毒可以导致 Ｍ Ｄ Ｓ,慢性重度苯中毒患者 Ｍ Ｄ Ｓ 发病率高于再障,应考虑将骨髓象检查列为苯中毒诊断的必要项目。     

慢性轻度苯中毒骨髓象探讨

慢性轻度苯中毒骨髓象探讨单宝荣吴学霖赵学文本文对４５例确诊为职业性慢性轻度苯中毒（下称苯中毒）患者作了骨髓穿刺检查，对骨髓细胞进行认真分析，以探讨苯中毒的骨髓分类及形态的特点，有助于提高苯中毒诊断的准确率。１材料与方法４５例确诊为苯中毒患者，从事苯作...     

慢性苯中毒与脾功亢进患者的骨髓象比较

本文集收确诊为慢性轻度苯中毒患者33例及经同位素检查确诊的脾功亢进患者23例的完整骨髓象资料进行分析比较。结果发现慢性苯中毒患者的骨髓增生程度较脾亢者低,并有增生受抑的表现。脾亢者红系统增生最为显著,粒系增生相对减低,粒红比例显著低于苯中毒者,苯中毒者粒系受损更重,骨髓象可见细胞老化及中毒颗粒等形态异常,脾亢患者则表现为红系统形态异常。     

37例慢性苯中毒患者骨髓象分析

目的：对慢性苯中毒患者骨髓象进行分析，探讨骨髓象分类及形态特点，以便提高苯中毒诊断的准确率。方法：对患者进行骨髓穿刺，选取材、涂片、染色好的骨髓片计数有核细胞200个，对其进行分类并观察细胞形态，最后按诊断标准进行分组。结果：随着轻、中、重分组变化，骨髓增生度及粒红比值减低的比例逐渐增加，骨髓异常改变的比例也逐渐增加。结论：长期接触苯及化合物可导致骨髓造血异常，骨髓象检查是苯中毒诊断的必要项目。     

苯诱导小鼠骨髓与外周血微核率的观察

骨髓嗜多染细胞微核试验已成为致突变试验中一种常用的筛检方法,本实验目的旨在通过观察苯对小鼠骨髓嗜多染细胞(PCE)和外周血正染红细胞(NCE)微核率的影响与相互关系,探讨运用微量外周血方法对长期苯接触进行监测。材料与方法1．受试物:纯苯,市售分析纯。溶媒为市售精制玉米油。2．实验动物:中山医科大学动物房提供健康昆明种小鼠200只。体重15~22g。雌雄各半。按体重随机分组。每组10只动物。3．剂量设计:实验设一个空白对照组,一个自身对照组(纯苯0.5ml/kg),以及对照组(色拉油0.1ml/10g体重)1~6组、低剂量组(纯苯0.5mg/kg)1~6组,高剂量组(纯苯1.0ml/kg)1~6组。     

苯致继发性骨髓增生异常综合征1例

苯致继发性骨髓增生异常综合征１例席时重患者女，６５岁，在橡胶厂从事布胶鞋刷胶浆２９年（１９５０～１９７９年）。厂房矮小，无通气设备。每月工作２５天，每天８小时。胶浆由含苯１２０＃汽油和橡胶制成。车间苯浓度为４２．０～１５１．５ｍｇ／ｍ３，甲苯为１４～...     

苯致骨髓增生异常综合征1例报告

介绍一患者接触苯类化合物24年,70年代初开始出现WBC减少、贫血,最后诊断为苯中毒,期间经历30年。表明该企业70～90年代职业病防治工作存在很大漏洞,当地化工职防机构的监督管理也有疏漏。本病例再次提示,苯中毒患者如不及时诊断治疗,病情会持续发展;职业病医师要及时掌握和运用新的诊断标准,使病人尽早得到准确的治疗。     

13例铅中毒患者骨髓象分析

本文报告了13例慢性职业性铅中毒患者的骨髓象。主要改变为有核细胞活跃增生,粒:红下降,红细胞大小不均(4例)、畸形(3例)、靶形(2例)、Hb分布不匀(1例)等。铁末染色示7例细胞内、外铁均降低,成熟红细胞发白区扩大。     

苯致急性单核细胞白血病骨髓象的临床分析

患者男 ,2 8岁 ,喷漆工人。因“头痛、头晕、睡眠差、周身乏力伴发热半年”于 2 0 0 2年 5月 7日入院。患者自 2 0 0 1年 11月开始出现头痛、头晕、睡眠差、周身乏力、皮下易有出血点 ,伴低热 ,自服“止痛药”可暂时缓解 ,仍坚持工作。因突发抽搐伴失语、呕吐急送我院就诊。门诊进行颅脑CT及脑电图检查未见明显异常 ,血常规示Hb 80g/L ,RBC 2 .0 4× 10 12 /L ,WBC1.8× 10 9/L ,PLT 4 2× 10 9/L ,门诊以职业性慢性苯中毒观察收入院。患者既往体健 ,1992年接毒作业工人健康体检时 ,血常规均正常 ,否认既往肝炎史、特殊用药史及放射…     

氯氮平治疗患者骨髓象研究

51例精神病人应用常规剂量氯氮平6周后，22例（43．14％）骨髓象增生明显活跃，29例（56．86％）无变化，未见骨髓抑制。作认为氯氮平对部分病人早期骨髓象可能有刺激增生作用。     

Malignancies due to occupational exposure to benzene

There is no doubt about the leukemogenic effect of benzene in man. The evidence is as follows: (1) The incidence of leukemia in shoeworkers exposed to benzene in a period of 8 years in Istanbul was 13.6/100,000, which is significantly higher than that for leukemia in the general population. (2) Following the phase-out of benzene in Istanbul, the number of leukemic workers decreased and none were reported in the subsequent 3 years. (3) The development of leukemia in pancytopenic patients with benzene exposure was observed in 13 out of 51 patients. (4) The differences in the distribution of the types of leukemia in individuals exposed and in nonexposed groups were as follows: acute leukemia 96.1% in the former group, and 46% in the latter group. The high percentages of acute erythroleukemia and preleukemia were other interesting findings in the exposed group. (5) Two cases of leukemia were observed in a 6-year period at a tire cord manufacturing plant with 550 workers. At one location in the plant the concentration of benzene measured by gas chromatography was nearly 110 ppm. Additionally, we have studied 12 cases of malignant lymphoma, four cases of multiple myeloma, and six cases of lung cancer, all of whom were chronically exposed to benzene. The possible role of benzene in the etiology of these malignancies is discussed.     

苯中毒致再生障碍性贫血患者周围血象及骨髓象特点分析

目的 分析职业性慢性苯中毒致再生障碍性贫血患者周围血及骨髓细胞形态学,了解苯对造血系统的损害.方法 采用髂前或髂后部位抽取患者骨髓,综合分析25例住院苯中毒致再生障碍性贫血患者的周围血及骨髓细胞形态学特征.结果 本研究25例住院苯中毒致再生障碍性贫血患者,粒、红、巨3系细胞主要病理变化为:粒系可见中毒颗粒、空泡变性等;大多数患者红系可见病态造血,成熟红细胞形态大小不一;巨核细胞减少或无,偶见小巨核.周围血象可见至少1系或2系发育不良.结论 长期接触苯及苯的同系物,可导致人体骨髓造血功能异常;周围血常规可作为过筛检查.     

Chromosome analysis from peripheral blood lymphocytes of workers after an acute exposure to benzene.

A spillage of about 1200 gallons of benzene occurred during the loading of a ship, and 10 workers on a single shift were exposed to benzene. Shortly afterwards, an assay of the urine of these individuals showed that substantial amounts of phenol were being excreted. About three months after the incident samples of venous blood were taken from 10 individuals exposed to benzene and 11 men on a comparable shift who acted as controls. The lymphocytes were stimulated to divide in short term cultures. For each subject, 200 cells at metaphase were examined for chromosome damage using 48 h cultures, and sister chromatid exchanges (SCE) were analysed from about 30 cells in their second division, using 72 h cultures. The most frequent types of aberrations in all the individuals were chromatid gaps, with occasional breaks of chromatids and chromosomes. There were few exchanges within or between the arms of chromatids or chromosomes. More cells in the control than in the exposed group showed damage, an effect that was especially noticeable for chromatid gaps. All values, however, were considered to be within a normal range. There were slightly more SCE in some of the exposed individuals than in the controls and there was a trend towards a positive association between the frequency of SCE recorded for each individual and the maximum value for the excretion of phenol in the urine on the day after the incident. There is no evidence to indicate that benzene induced any type of lasting chromosome damage in the lymphocytes of the 10 exposed workers when cells were examined about three months after the incident.     

Analysis of TCR Vgamma gene diversity from peripheral blood in patients with chronic benzene poisoning

OBJECTIVE: To observe the TCR Vgamma gene repertoire diversity in the peripheral blood mononuclear cells of the patients with the chronic benzene poisoning. METHODS: Complementarity determining region 3 (CDR3) of TCR Vgamma subfamily genes were amplified in 10 patients with the chronic benzene poisoning using RT-PCR. The PCR products were further analyzed by genescan to evaluate clonality of T cells. 8 healthy persons served as control. RESULTS: All Vgamma subfamilies were detected in the 8 healthy donors. (1.30 +/- 0.48) Vgamma subfamilies were detected in 10 patients. The number of detectable Vgamma subfamilies present in the patients with the chronic benzene poisoning was significantly lower than in the control group (P < 0.01). The most frequently used Vgamma genes in clonally expanded T-cells were VgammaII. CONCLUSION: Skewed distribution and clonal expansion of TCR Vgamma subfamily T cells could be found in the patients with the chronic benzene poisoning. This is the first report of clonal expansion TCR Vgamma T cells in patients with chronic benzene poisoning. The bias pattern of TCR Valpha T cells may be due to the immune cytotoxicity from benzene.     

慢性苯中毒35例临床分析

目的了解不同严重程度苯中毒病人在工龄及恢复时间方面的情况。方法对某厂发生的35例慢性苯中毒住院病人资料进行分析。结果35例中毒病人中13例(37.14%)轻度中毒,6例(17.14%)中度中毒,16例(45.72%)重度中毒,包括3例再生障碍性贫血,病情严重程度与工龄无统计学意义(P>0.05);经治疗后全部康复,病情严重程度与恢复时间差异有显著性(P<0.05),轻度中毒恢复较快。结论这些现象提示存在对苯的个体易感性。加强含苯溶剂的管理以及检测与个体易感性相关的生物标志物,对工人健康防护将有很大的价值。     

职业性慢性放射性皮肤损伤病例分析

对我院近20年来诊治的22例职业性慢性放射性皮肤损伤病例进行总结分析。结果显示,22例均为男性,放射诊断医师2人,骨科医师20人,放射作业工龄6～46年,估算手部累积吸收剂量为39.1～233.7 Gy,确诊为慢性放射性皮肤损伤Ⅰ度1例,Ⅱ度6例,Ⅲ度15例,皮肤损伤Ⅲ度合并放射性皮肤癌5例。提示慢性放射性皮肤损伤有一定的潜伏期,存在剂量-效应关系。长期不愈的放射性溃疡或角质增生物是皮肤癌变的基础。     

慢性苯中毒患者外周血T细胞TCR Vγ基因多样性分析

目的 了解慢性苯中毒患者外周血T细胞的TCR Vγ基因谱系多样性和克隆性增殖特点.方法 利用反转录-聚合酶链反应(RT-PCR)方法扩增10例慢性苯中毒患者外周血单个核细胞中3个TCR Vγ基因,PCR产物进一步经荧光标记和基因扫描分析T细胞克隆性,并与8例健康人进行比较.结果 8例健康人外周血T细胞检测到所有Vγ亚家族,10例慢性苯中毒患者平均表达(1.30±0.48)个Vγ亚家族,较健康人明显减少,差异有统计学意义(P＜0.01).慢性苯中毒患者出现克隆性增殖改变比较集中在VγⅡ亚家族.结论 慢性苯中毒患者外周血出现TCR Vγ亚家族倾斜性分布和克隆性增殖T细胞,这可能是苯中毒后所引起的机体特异性免疫反应.     

利用相似接触组研究低浓度苯接触对工人血液指标的影响

目的　研究不同相似接触组 (SEG)工人的血液指标与苯的接触剂量的关系。方法　研究对象为某鞋厂成型车间的制鞋工人 ,采用观察法和采样法相结合的方法划分SEG ,个体采样泵采集每个SEG中 5个工人呼吸带处接触水平 ,体检收集工人的血样、职业史 ,多元回归分析苯的接触水平对血常规的影响。结果　根据SEG的定义及该车间的实际情况 ,划分为 5个SEG ,除年龄有差异外 ,各SEG工人的工龄、吸烟、饮酒、血常规、主诉症状方面差异无显著性 (P >0 .0 5 ) ;多元回归分析发现 ,外周血白细胞计数随空气中苯浓度的增加而减少 ,两者之间呈负相关 (r=- 0 .36 ,P <0 .0 5 ) ;接苯工龄与红细胞计数也存在负相关 (r =- 0 .2 9,P <0 .0 5 ) ;而红细胞和血小板的计数与苯接触之间没有发现类似的相关关系 (P >0 .0 5 )。结论　SEG研究发现 ,苯的接触剂量与白细胞计数之间存在剂量 -反应关系 ,今后应该通过增加样本量 ,进一步研究低浓度的苯接触对工人外周血液指标的影响。