苯中毒患者骨髓象56例临床分析

目的 通过对56例苯中毒患者骨髓象进行分析,探讨苯对造血系统损害的骨髓象的特点.方法 按GBZ 68-2008<职业性苯中毒诊断标准>将苯中毒患者分为轻度中毒组、中度中毒组、再生障碍性贫血及全血细胞减少症组(再障组)、白血病组,均进行骨穿、涂片、以瑞氏-姬姆萨染色的骨髓片计数100个有核细胞,进行分类并观察细胞形态.结果 骨髓增生程度和巨核细胞增殖按轻度中毒、中度中毒、再障依次递减.轻度、中度中毒患者的原始和幼稚细胞增殖有受抑制的趋势,出现中毒相关的细胞形态异常.与其余各组及正常参考值比较,再障组的骨髓细胞占有核细胞百分率(早幼粒0.17%、中幼粒3.11%,早幼红0.06%、中幼红3.16%)降低,差异有统计学意义(P＜0.01,P＜0.05).白血病表现为粒系、红系幼稚细胞单克隆性增殖伴成熟障碍,巨核细胞增殖分化受明显抑制,与其余各组及正常参考值比较,白血病组的骨髓细胞占有核细胞百分率(原幼粒21.25%、早幼粒4.88%)升高、差异有统计学意义(P＜0.01).再障组、白血病组的粒细胞、红细胞出现细胞形态异常和核畸形比例增高,以白血病组尤为明显.结论 慢性苯中毒轻度、中度病例的骨髓象可见骨髓原始和幼稚细胞增殖已出现受抑制的趋势,且出现部分细胞形态异常.重度中毒骨髓象表现出与临床分型相对应的异常改变.

Abstract：

Objective To explore the bone marrow feature of hemopoietic system injured by benzene through analyzing 56 benzolism cases. Methods The 56 benzolism cases were divided into mild poisoning group, midrange poisoning group, aplastic anemia group, pancytopenia group and leukemia group. All cases progressed bone marrow aspiration and smear, and counted hundred karyocytes by Wright-Giemsa tinct bone marrow smear to classification and observe the cells' feature. Results The megakaryocytes and the extent of bone marrow hyperplasia were decreased by turns of mild poisoning group, midrange poisoning group and aplastic anemia group. The archaeocytes and juvenile cells proliferation in mild poisoning group and midrange poisoning group were inhibited and occured cell paramorphia which related to intoxication. Comparing with the other groups and mormal reference value, the pancytopenia group' s percentage of bone marrow cells in karyotes was significantly decreased (P＜0.01. P＜0.05) and the leukemia group's pecentage of bone marrow cells in karyotes was significantly increased (P＜0.01). The proportion of cell paramorphia and nucleus malformation of granulocytes and red blood cells in pancytopenia group and leukemia group were increased, expecially in leukemia group. Conclusion We saw the inhibition of archaeocytes and juvenile cells proliferation and somecell paramorphia appearances in mild poisoning and midrange poisoning cases of chronic benzolism. The abnormality changes which can be seen in bone marrow of severe benzolism cases were corresponding with the clinical classification.

Analysis on bone marrow feature of 56 clinic cases of benzene poisoning

Objective To explore the bone marrow feature of hemopoietic system injured by benzene through analyzing 56 benzolism cases. Methods The 56 benzolism cases were divided into mild poisoning group, midrange poisoning group, aplastic anemia group, pancytopenia group and leukemia group. All cases progressed bone marrow aspiration and smear, and counted hundred karyocytes by Wright-Giemsa tinct bone marrow smear to classification and observe the cells' feature. Results The megakaryocytes and the extent of bone marrow hyperplasia were decreased by turns of mild poisoning group, midrange poisoning group and aplastic anemia group. The archaeocytes and juvenile cells proliferation in mild poisoning group and midrange poisoning group were inhibited and occured cell paramorphia which related to intoxication. Comparing with the other groups and mormal reference value, the pancytopenia group' s percentage of bone marrow cells in karyotes was significantly decreased (P＜0.01. P＜0.05) and the leukemia group's pecentage of bone marrow cells in karyotes was significantly increased (P＜0.01). The proportion of cell paramorphia and nucleus malformation of granulocytes and red blood cells in pancytopenia group and leukemia group were increased, expecially in leukemia group. Conclusion We saw the inhibition of archaeocytes and juvenile cells proliferation and somecell paramorphia appearances in mild poisoning and midrange poisoning cases of chronic benzolism. The abnormality changes which can be seen in bone marrow of severe benzolism cases were corresponding with the clinical classification.