急性白血病形态学与免疫学分型

目的：分析急性白血病形态学分型(FAB分型)与免疫学分型的相互关系。方珐：选择我院2000～2002年确诊的169例初诊急性白血病进行形态学与单克隆检测免疫学分型比较。结果：106例FAB分型为急性髓细胞白血病(AML)，免疫学特征有M3 HLA-DR(-)，M4、M5有CD14( )特征，及有淋系相关抗原表达；63例FAB分型为急性淋巴细胞白血病(ALL)，免疫学分型有单纯髓系4例，B-ALL18例，T-ALL5例，变异型23例，混合型13例。结论：在AML中(除M0、M7)，不如形态学直观、分型仔细。对于ALL病FAB分型不如免疫学分型，对于M0、M7，只有依靠免疫学分型。FAB分型与免疫学分型两者要相互结合，互相补充，才能更好地反映急性白血病的状况，对临床治疗方案的选择及判断预后有重要意义。     

系统性红斑狼疮患者外周血CD4+CXCR5+滤泡辅助性T细胞样细胞的变化及糖皮质激素对其的影响

Objective To investigate the frequencies of CD4+CXCR5+T cells in the CD4+T cells of peripheral blood of patients with systemic lupus erythematosus (SLE) and the effect of glucocorticoid on it.Methods Frequencies of CD4+CXCR5+T cell were analyzed by flow cytometry in 45 active,20 inactive SLE patients and 20 healthy controls.Differences between groups and the effect of glucocorticoid were analyzed.Meanwhile, the expression of CXCR5 on CDI9+B cells was analyzed. Independent sample t test was used for statistical analysis between twogroups, ANOVA was applied for data analysis between 3 groups,,nonparameterical Spearman's analysis was used for correlation analysis and repeated measurement ANOVA were used to compare the parameters before and after treatment. Results The percentage of CD4+CXCR5+ in CD4+T cells was increased in patients with SLE compared with healthy controls[(16±7)% vs (12±3)%, P＜0.01].It was increased in patients with active SLE [(18±7)%] compared with healthy controls (P＜0.05) but there was no significant difference between inactive SLE[(11±4)%] and healthy controls(P＞0.05). The percentage in patients with LN was higher than that in patients without LN, but without significant difference[(18±7)%vs (14±7)%, P=0.05 ]. The percentage of CD4+CXCR5+T cells was positively correlated with SLEDAI,the titer of ANA and level of ESR but negatively correlated with the level of C3 (P<0.05 for each).No correlation was found between duration and the levels of CRP and immunoglobulin.. The percentage in patients with high anti-dsDNA group was also higher than that of the low group, but no differences were found between anti-Sm antibody positive and negative groups neither between anti-SSA/SSB antibody positive and negative groups(P＞0.05 for each).The expression level of CXCR5 on CD19+B cells in active SLE patients was lower than that of healthy controls[(85±11)% vs (94±3)%, P＜0.05 ]. The percentages of CD4+CXCR5+T cells in 10 untreated active SLE patients were decreased at day 1,day 3 and day 7 after being treated with dexamethasone (20mg/d) when compared with those before the treatment (P＜0.05 for each), but the percentages of CD19+CXCR5+B cells had no significant change (P＞0.05 for each).Conclusion These results demonstrate that the abnormality of CD4+CXCR5+T cells may play an important role in the pathogenesis of SLE.     

CELL——DYN1700血细胞分析仪白细胞分类报警分析

为了探讨血细胞分析仪的WBC分类报警的类型及产生原因，我们采用了仪器自动分析和手工复片对照，结果发现在218例有报警的分类计数中：LYM报警193次（其中RM133次，占68．9％，RO46次占23．9％）；MID28次（主要为R227次占96．4／），GRAN16次（其中R380次占69．0％，R4及RM也较常见）。分类时可有一种WBC报警，也可有两种或两种以上细胞报警，同时一种细胞的报警类型也可有多种。通过WBC分类结果的不同报警信号类型的分析，可指导我们对分类结果是否需要手工复片，两者结合，可提高分类结果的准确性。     

实验诊断学教学改革之思考

实验诊断学是连接基础医学与临床医学的桥梁,是一门将临床医学和实验技术相结合,为疾病的预防、诊断、疗效、预后判断和健康评估提供重要信息的学科。当今,循证医学的理念日益受到认同,“举证倒置”要求临床工作越来越重视客观证据,检验在临床医学中的重要性也与日俱增。但随着检验技术的发展,检验项目越来越多,教学任务也越来越重,其教学弊端也日益突现,教学改革势在必行。     

三日疟1例报告

随着我国疟疾防治工作的不断深入,疟疾发病和流行程度越来越低,三日疟原虫少见。笔者在门诊病人的疟原虫检验中发现了1例三日疟病例,经住院治疗已痊愈,现报告如下。     

过氧化物酶阴性的急性单核细胞白血病2例

例1男,37岁。因牙龈肿痛15天、发热1周、加重5天伴鼻腔出血,于1999年2月12日就诊。血常规RBC 3.18×1012/L,Hb 105 g/L,WBC 141.4×109/L,BPC 33×109/L,血片分类见大量原始细胞,考虑白血病收住我院血液科。体检：神清,轻度贫血貌,上肢皮肤可见散在瘀点,浅表淋巴结未扪及。胸骨压痛(+),肝肋下3 cm,脾肋下3 cm,腹水征(-),双下肢无水肿。外周血分类200个细胞：原始细胞0.895,中性晚幼粒0.01,中性分叶核0.01,淋巴细胞0.085。血片中性粒细胞的碱性磷酸酶(NAP)：27分/20中性分叶核粒细胞。骨髓象示：骨髓增生极度活跃,骨髓片中见大量原始细胞,分类200个有核细胞：原始细胞0.975,淋巴细胞0.25,粒、红两系严重受抑,全片(1 cm×2 cm)可见巨核细胞6个,血小板少,骨髓中原始细胞大小不等,核大,圆形或椭圆形,核染色质细,核仁1～3个,不太清楚,胞质量多,有些细胞可见内外浆,有的可见伪足。其组化特征：过氧化物酶(POX)100%阴性(用骨髓涂片和血片做3次,并做阳性对照);非特异性酯酶染色(NSE)(+～),加氟化钠抑制试验(NaF)100%抑制［用急粒骨髓片做对照：NSE(+),加NaF不抑制］;糖原染色(PAS)弱阳性,有些细胞胞浆边缘阳性颗粒较粗,氯醋酸酯酶染色(CE)阴性。单抗特征：CD3、CD7、CD10、CD22、CD34阴性,CD11b、CD13、CD14、CD33、HLA-DR阳性。     

形态学难以分型的急性白血病12例分析

目的：探讨形态学难以分型的急性白血病和免疫学分型的相关性。方法：选择本院2000～2002年确诊的12例初诊形态学难以分型的急性白血病患进行细胞化学染色与单克隆检测免疫表达比较。结果：6例为M5，1例为B-ALL伴髓系表达，1例为M4，2例为M7，1例为混合型，1例为APL。结论：免疫学分型用于形态学难以分型的急性白血病，具有明显的优越性，尤其对ALL、M7、混合型白血病，可以判断白血病细胞是否来源于髓系。     

疣状胃炎外周血T淋巴细胞亚群变化及其与幽门螺杆菌感染及病理相关性研究

目的：初步检测疣状胃炎外周血中CD3＋、 CD4＋、CD8＋T淋巴细胞的变化,探讨其与幽门螺杆菌（Hp）感染及病理改变的关系。方法：采用流式细胞检测法检测63例疣状胃炎和42例慢性浅表性胃炎外周血CD3＋、CD4＋、CD8＋T细胞变化;同时观察疣状胃炎及慢性浅表性胃炎Hp感染情况及病理改变。结果：疣状胃炎患者Hp感染率明显高于慢性浅表性胃炎（P＜0．05）,且炎症活动重度的疣状胃炎患者其合并Hp感染几率显著高于轻度炎症活动程度（P＜0．01）;疣状胃炎组患者炎症活动程度、不典型增生发生率及肠化发生率均明显高于慢性浅表性胃炎组,差异有统计学意义（P＜0．05）;疣状胃炎患者较慢性浅表性胃炎CD8＋T细胞降低,CD4＋／CD8＋比值升高,差异具有统计学意义（P＜0．05）;疣状胃炎Hp阳性组较Hp阴性组CD3＋、CD4＋、CD8＋T细胞升高,差异有统计学意义（P＜0．05）。结论：疣状胃炎的发生可能与免疫功能紊乱有关,Hp、病毒感染可能是导致免疫紊乱的病因,且疣状胃炎伴有明显的病理异常,有恶变倾向,应重视诊治和随访。