【作者】 黄凤飞；

【导师】 袁长吉；

【作者基本信息】 吉林大学 ， 临床医学， 2005， 硕士

【摘要】 全血细胞减少症是指外周血中三种有形成分同时减少,它不是疾病的诊断,而是引起血液有形成分减少的疾病的共同临床表现。因此,全血细胞减少症的鉴别诊断和病因诊断至关重要,对疾病的治疗及预后有重要意义。本文采用计算机病案管理系统检索2002 年~2004 年在我院血液科初次入院病例,入院时至少连续两次血常规检查三系均低于正常值即诊断为全血细胞减少症,据此共收集病例297 例。采用回顾性方法分析全血细胞减少症的临床特点,包括一般资料、临床表现、基础疾病、血细胞减少的程度和均衡性、老年组与成年组疾病分布情况的比较、各疾病的骨髓检查特点、和部分疾病的MCV、MCH、MCHC、RDW 值等。结果表明:(1)全血细胞减少症的临床表现除原发病的表现外,主要是血细胞三系减少所致的贫血、出血、感染症状,血细胞减少的程度不同,症状的轻重不同。(2)能引起全血细胞减少症的病种很多,本组收集病种15 种之多,大致分为四类,即:①造血系统的良性疾病;②造血系统的难治性疾病;③造血系统的恶性疾病;④非造血系统疾病。本组收集297 例病例以造血系统疾病为主,占88.2%,其中又以难治性疾病如再生障碍性贫血、骨髓增生异常综合征为主,占其中的62.2%,且各组病种构成比统计学分析得出,老年组发病低于成年组(P<0.05),与文献报道相符。(3)根据三系血细胞减少的均衡性,可初步进行疾病诊断。本组结果表明,血液病可表现为三系平行性减少或非平行性减少,其中再生障碍性贫血主要为三系平行性减少,而非血液病多为非平行性减少。(4)对部分疾病的MCV、MCH、MCHC、RDW 值更多还原

【Abstract】 Pancytopenia means reduction of three components inperipheralblood and it is common clinical situation of some diseaseswhich can cause reduction of blood formed elements. The diagnosisesof differentiation and etiology of pancytopenia are most important forthe treatment and prognosis judgement. The etiology generallyincludes four categorie: ①Innocuous diseases of hematopoieticsystem; ②Failed diseases of hematopoietic system; ③Maligancydiseases of hematopoietic system; ④Non-diseases of hematopoieticsystem. Recentyears, the definition of immuno-related pancytopeniahas been suggested and separated from AA and MDS, which is veryimportant fordiagnosis and treatment of pancytopenia.Objection Though clinical analysis of 297 cases, this issuestudys the characteristics and common regularity in clinicalmanifestations and laboratory examinations of the diseases which cancaused PCP, which will be very helpful for the doctors to makddiagnosises of differentiation and etiology.Materials and Methods The computer records conservancysystem have been used to retrieve the cases for the first time in theDepartment of Hematology and Oncology in the period of 2002-2004.The patients who had at least twice test blood routine: Hb<100g/L、WBC<4.0×109/L、PLT<100×109/L,and have not received specialtreatment such as radiotherapy and chemotherapy would bediagnosised as PCP, according which we collected 297 cases. Usingthe method of retrospective analysis for the clinical charactersincludingcommon data、primary diseases、the reduction degree ofblood cellsthe comparison of the disease distribution between theelder-group and the adult-group、the characters of bone marrow andMCV、MCH、MCHC、RDW of some diseases. Result & discussion (1) The clinical manifestations of PCPmainly include anemia、bleeding and infection. With the differentreduction degree of blood cells, the severe degree of symptoms isdifferent. ①Anemia: 251 cases have the symptoms of anemia(84.5%). All patients have fatigue of different degree, then dizziness,palpitation, out of breathe and pale. In addition, digestive malfunction,distention and anorexia are also the common symptoms. ②Bleeding:The patients whose PLT is above 50×109/Lhave light or nobleedingsympots and whose PLT is blow the data have differentdegree of bleeding sympots such as petechia, ecchymosis, gumbleeding, blood blister of oral cavity、nasal hemorrhage. Menstruationmay be the only symptoms for some women. If the PLT amount isblow 20×109/L, the patients may have viscero-bleeding such asheatemesis, dark stools, hematuria, vagina bleeding, hemoptysis, butcerebral hemorrhage is rare. ③Infection: If the WBC amount is above30×109/L, the patients generally have no infection symptoms and iftheamount is blow 20×109/L, the patients will be infected. Almost50% of patients run a fever mostly above 38℃. The commoninfectious locus are respiratory tract、digestive tract, urinary tract andmucocutaneous ulceration. (2) There are four categories of etiology:①Innocuous diseases of hematopoietic system such as severe IDA,MegA, ITP; ②Failed diseases of hematopoietic system such as AA,PNH, MDS; ③Maligancy diseases of hematopoietic system such asAL, MM, MH, MF; ④Non-diseases of hematopoietic system such asinfectious diseases, liver or kidney diseases、connective tissuediseases,medicine associated diseases. According the category, diseases ofhematopoietic system are the mainly class (88.2%) and AA, MDS arethe main diseases (62.2%). The statistic analysis of the diseasesdistribution show that the incidence rate of elder-group is lower thanthe adult-group (P<0.05). (3) There is 59 cases (19.9%) in theelder-group and MegA, MDS, AA, AL, MM, cancer and liver diseasesare the main disesases. Because the old people’s digestion ismalfunction and folic acid 、Vitamin B12 can not been intakedefficiently, they easily become MegA patients. Meanwhile, thehematopoietic function become bad, so the incidence of MDS is highin the elder-group. In addition, cancer is common disease in thisgroup. In short, the old PCP patients should be fully examined and bediagnosised and treated early. (4) According to the balance of thereduction of blood cells, primary diagnosis can be made. The resultshow that hematopoietic diseases can be parallel or non-parallelreduction and AA mainly show parallel reduction. Andnon-hematopoietic diseases mainly show non-parallel reduction. (5)Comparing the MCV, MCH, MCHC, RDW of some diseases, we getthe result that AA and AL are normocytic anemia, MegA is macrocyticanemia, MDS isbetween the normocytic and macrocytic anemia. AA更多还原