慢性苯中毒与假性白细胞减少症的相关性研究

目的研究慢性轻度苯中毒(白细胞减少症)患者对肾上腺素试验、泼尼松试验反应及其血象变化特征。方法以43例骨髓象正常的慢性轻度苯中毒(白细胞减少症)患者作为苯中毒组,根据其性别、年龄匹配对照组。分别采集苯中毒组与对照组血样进行肾上腺素试验、泼尼松试验前后的血常规检查,并采用C2检验、t检验分析其试验阳性率、试验前后差值及增加率。结果肾上腺素试验:与对照组相比,苯中毒组肾上腺素试验阳性率(9.3%vs.80%,P0.001)及试验前后白细胞(1.18×109/L vs.2.39×109/L,P0.001)、中性粒细胞(0.43×109/L vs.1.25×109/L,P0.001)、淋巴细胞(0.34×109/L vs.1.02×109/L,P0.001)差值均低;而两组均有淋巴细胞增高现象。泼尼松试验:与对照组相比,苯中毒组泼尼松试验阳性率较低(47.05%vs.86.36%,P0.05),试验前后白细胞(2.04×109/L vs.3.22×109/L,P0.05)、中性粒细胞(2.80×109/L vs.3.66×109/L,P0.05)及淋巴细胞(-0.19×109/L vs.-0.42×109/L,P0.05)差值绝对值低;而两组细胞增加比率相似(57.2%vs.53.9%,P0.05),其中以中性粒细胞增高为主,淋巴细胞呈现负增长。结论苯中毒所致白细胞减少症可能与骨髓造血减少有关,而非白细胞分布异常及贮存池中成熟粒细胞释放障碍。

Study on relativity between chronic benzene poisoning and pseudoleukocytopenia

To study the characteristics of response to epinephrine test, prednisone test reaction and the features of hemogram change in patients with chronic mild benzene poisoning (leukocytopenia). Methods Forty three patients of chronic mild benzene poisoning (leukocytopenia) with normal myelogram were selected as benzene poisoning objects, the controls were 25 normal volunteers without benzene exposure but the gender and age were matched with the benzene poisoning patients. The blood routine examination were made before and after adrenalin test and prednisone test in both two groups. The results were analyzed by C2 teat and t test. Results The results showed that the positive rate of epinephrine test in benzene poisoning group was 9.3% (vs. 80% of control group, P<0.001); the D-value before and after test: leucocyte was 1.18×109/L (vs. 2.39×109/L of control group, P<0.001), neutrophils 0.43×109/L (vs. 1.25×109/L of control group, P<0.001), and lymphocyte was 0.34×109/L (vs.1.02×109/L of control group, P<0.001), which were all lowered compared with control group, meanwhile, both two groups showed some increase of lymphocyte (35.3%, vs.42.4%, P>0.05). The prednisone test showed that compared with control group, the positive rate in benzene poisoning group was lower (47.05% vs. 86.36% of control group, P<0.05), and the absolute D-value were also less: the leucocyte was 2.04×109/L (vs. 3.22×109/L of control group, P<0.05), neutrophil was 2.80×109/L (vs. 3.66×109/L of control group, P<0.05), and lymphocyte was -0.19×109/L (vs. -0.42×109/L of control group, P<0.05). However, the increase rate of two groups was similar (57.2% vs. 53.9%, P>0.05), especially the neutrophils, while the the lymphocytes showed negative growth. Conclusions The results suggested that the leukocytopenia induced by benzene might be related to the reduction of bone marrow hematopoiesis, rather than abnormal distribution of leucocytes and release disorder of mature granulocytes in storage pool of bone marrow.