免疫相关性血细胞减少症23例临床分析

目的探讨免疫相关性血细胞减少症（IRP/IRH）的发病机制及预后。方法对我院收治的23例患者病例进行分析。结果 23例中并发甲状腺功能亢进、干燥综合征各2例,桥本甲状腺炎、系统性红斑狼疮、糖尿病各1例;网织红细胞正常或增高20例,减低3例;乳酸脱氢酶活性增高14例;外周血单核细胞百分比增高19例,形态异常5例;骨髓单核细胞百分比增高9例,形态异常8例;骨髓增生活跃22例,增生减低1例;白细胞碱性磷酸酶阳性率减低16例,增高3例;单用或联合糖皮质激素、环孢素A及丙种球蛋白为该疾病的主要治疗方法,总有效率为95.6%。结论单核细胞百分比增高及形态异常是IRP/IRH特征的新发现。

Immune-related cytopenia: A report of 23 cases

Objective To study the mechanism and prognosis of immune-related cytopenia.Methods Twenty-three cytopenia patients admitted to our hospital were analyzed.Results Among the 23 cytopenia patients,complications of hyperthyroidism,drying syndrome,thyroiditis,diabetes mellitus,and systemic lupus erythematosus were found in 2,2,1,1,and 1,respectively.Normal or elevated and decreased reticulocytes were detected in 20 and 3 patients,respectively.Elevated lactate dehydrogenase was found in 14 patients.The number of peripheral monocytes was increased in 19 patients with abnormal morphology observed in 5 patients.The number of myeloid monocytes was increased in 9 patients with abnormal morphology observed in 8 patients.Bone marrow proliferation was active in 22 patients with proliferation decreased in 1 patient.The positive rate of leukocyte alkaline phosphatase was low in 16 and high in 3 patients,respectively.Glucocorticoid,cyclosporine A and gamma globulin used alone or in combination are the main drug therapy for the disease with a total effective rate of 95.6%.Conclusion Cytopenia is characterized by increased percentage and abnormal morphology of monocytes.