成人脓毒症患者骨髓细胞学特征的研究

目的探讨脓毒症患者骨髓细胞学特征及其临床意义。 方法回顾性分析2015年1月至2020年10月在中山大学孙逸仙纪念医院重症医学科和全科医学科住院，诊断为脓毒症并行骨髓细胞学检查的57例患者的骨髓象特征，分析其与外周血血象、感染指标、临床转归和预后的相关性。 结果脓毒症患者外周血血象表现多样，白细胞计数从极度降低到明显升高不等，多表现为中度贫血、血小板减少、淋巴细胞减少；骨髓象以有核细胞增生活跃或明显活跃为主，占82.5%（47/57），少数患者增生减低；粒红比例升高，多表现为中性杆状粒比例下降，中性分叶粒比例升高，伴部分中性粒胞浆颗粒增粗、增多或可见空泡，部分可见过分叶现象；部分伴有网状吞噬细胞增多，可见噬血现象；多数外周血涂片中性粒细胞碱性磷酸酶（NAP）染色阳性率和积分升高。脓毒症患者骨髓粒系增生情况与外周血粒细胞计数、骨髓巨核细胞计数与外周血血小板计数均存在正相关（r = 0.324、0.574，P均< 0.05）；大肠杆菌感染与脓毒症患者的骨髓增生情况密切相关（χ² = 13.434，P < 0.001）。 结论脓毒症患者多为感染较重阶段，感染发展至脓毒症，骨髓功能在一定程度上呈耗竭状态，部分增生明显低下，其与外周血象、感染具有一定相关性。脓毒症患者血小板减少与骨髓巨核细胞功能直接相关，脓毒症骨髓巨核细胞减少或成熟障碍为脓毒症血小板减少症发病机制之一。此外，大肠杆菌感染的脓毒症患者多表现为骨髓增生减低。

Cytological characteristics of bone marrow in adult patients with sepsis

ObjectiveTo explore the cytological characteristics and clinical significance of bone marrow in patients with sepsis. MethodsThe myelograms of 57 patients that were hospitalized in the Departments of Critical Care Medicine and General Practice in Sun Yat-sen Memorial Hospital, Sun Yat-sen University between January 2015 and October 2020, diagnosed with sepsis, and underwent bone marrow examination were retrospectively analyzed. Besides, the correlations among myelogram and peripheral hemogram, infection, clinical outcome, and prognosis were analyzed. ResultsThe peripheral hemograms of patients with sepsis showed various manifestations, with white blood cell count ranging from extremely low to significantly elevated, mostly presenting as moderate anemia, thrombocytopenia, and lymphopenia. The hyperplasia of nucleated cells in myelogram showed be active or significantly active in 82.5% (47/57) of patients, while a minority of patients showed be hypoplastic. The granulocyte/erythrocyte ratio and neutrophilic segmented granulocyte ratio increased and neutrophilic stab granulocyte ratio decreased, accompanied by some granules thickened, increased or cavitation appeared, and some with lobulated phenomenon. Some of patients were accompanied by increased reticular phagocyte, and the phenomenon of hematophagy was visible. The positive rate and score of neutrophil alkaline phosphatase (NAP) in most peripheral blood smears increased. There were positive correlations between hyperplasia of myeloid granulocytes and peripheral blood granulocyte count, bone marrow megakaryocyte count and peripheral blood platelet count in patients with sepsis (r = 0.324, 0.574; both P < 0.05). In patients with sepsis, there appeared a closely correlation between Escherichia coli infection and myeloid hypoplastic (χ² = 13.434, P < 0.001). ConclusionsMost sepsis patients are in the severe stage of infection. With the development of infection, bone marrow function is in a state of exhaustion to a certain extent and several of them show obviously hypoplasia. Myelogram is correlated with peripheral hemogram and infection. The thrombocytopenia is significantly related to the deficiency of megakaryocyte function in bone marrow and the reduction or dysmaturity of megakaryocyte is one of the pathogenesis of the thrombocytopenia. In addition, patients with Escherichia coli-infected sepsis mostly present with decreased myelodysplasia.