45例血细胞减少的系统性红斑狼疮骨髓细胞学表现及治疗反应

目的:了解血细胞减少的系统性红斑狼疮(SLE)骨髓细胞学变化、临床意义及其对药物治疗的反应。方法:对45例外周血细胞减少的SLE病人进行骨髓细胞检查及4例骨髓活检,并与血象等其它临床资料综合分析,及观察激素和细胞毒药物治疗后血象的变化。结果:SLE骨髓表现从增生明显活跃到增生受抑,以至再生障碍。最具意义的是增生受抑,但较外周血轻,且未见细胞形态异常。受抑发生率依次为巨核细胞/血小板抑制(46.7%),红系(42.2%)和粒系(15.6%)。3例呈再生障碍骨髓象。网状吞噬细胞(9例)及浆细胞(6例)增多,6例铁染色减少。15例肝脾淋巴结肿大者均呈增生性骨髓象。4例骨髓活检未见骨髓纤维化。治疗后血细胞减少均得以改善(P<0.001)。结论:SLE骨髓损害主要为骨髓各系受抑,少数再生障碍,骨髓受累程度较外周血轻;缺铁可能是狼疮贫血的部分原因;肝脾淋巴结肿大可能提示骨髓增生;对外周血细胞减少而骨髓细胞形态无异常者应警惕SLE可能。血细胞减少者对激素和细胞毒药物反应良好。

Bone Marrow Findings in 45 Cases Systemic Lupus Erythematosus Patients with Cytopenias and Reaction to Chemical Therapeutics

Objective:To learn the features and significances of bone marrow in lupus patients with pancytopenia and observe effect of chemical therapy. Methods:Bone marrow aspiration in 45 cases and bone marrow biopsies in 4 cases were employed. The findings combining with other clinical data such as peripheral blood pictures were analyzed and reaction to steroids and cytotoxine drugs on peripheral blood were explored. Results:Bone marrow findings in SLE were various,including obvious proliferation, hyperplasia and hypoplasia. The most valuable finding was hypoplasia that was less damage on marrow than peripheral blood pictures,however,cellular morphologic abnormalities were absent. The prevalence rate of hypoplasia was sequemially megalocaryocyte/platelet(46.7%), erythrocytic series(42.2%) and granulocytic series(5.6%). Aplasias were found in 3 cases. The other findings included phagocytes,plasmacytosis and decrease of iron staining. All of 15 cases with hepatosplenomegaly and enlargement of lymph nodes show hyper cellular marrow. No myelofibrosis in this group was seen. Pancytopenias were significantly responded to chemical therapeutics(P < 0.001). Conclusion:The main injury on bone marrow in SLE was hypocellular in all hemocytopoisis series,so far as aplasia. Insufficiency of iron can be partial causes of lupus anemia. The degree of hypocellularity on bone marrow was less than on peripheral blood. Hepatosplenomegaly and enlargement of lymph nodes suggested hyperphsia of hemocytopoisis. The diagnosis of SLE should be considered in case of presenting pancytopenia with normal marrow cellular morphology in order to avoid misdiagnosis. Steroids and cytotoxine drugs were of benefit to the cases with pancytopenias