CAJ | 학술논문

目的归纳误诊为免疫性血小板减少症(ITP)的再生障碍性贫血(AA)的原因为临床医生鉴别早期AA与ITP提供借鉴,降低AA的误诊率.方法 2001年1月至2011年12月郑州大学第五附属医院血液内科门诊和住院误诊为ITP的AA患者16例,对其临床资料及治疗疗效进行回顾性分析.结果 ①初诊时16例患者中8例出现外周血二系或三系减少；12例行骨髓涂片检查的患者中,3例存在巨核细胞减少.所有患者均接受了糖皮质激素为主的治疗,均无效.②确诊为AA时16例患者中10例存在外周血3系减少,骨髓穿刺检查提示6例患者骨髓增生活跃伴巨核细胞较少或非造血细胞比例增高,10例为典型的AA骨髓象.治疗总有效率为75％.结论临床上对于特别是单纯血小板减少且骨髓巨核细胞减少的患者,做出ITP诊断时需谨慎,治疗过程需动态观察骨髓象变化,必要时及时调整诊断及治疗思路,尽量减少误诊的发生,提高AA的远期疗效并降低病死率.
목적 귀납오진위면역성혈소판감소증(ITP)적재생장애성빈혈(AA)적원인위림상의생감별조기AA여ITP제공차감,강저AA적오진솔.방법 2001년1월지2011년12월정주대학제오부속의원혈액내과문진화주원오진위ITP적AA환자16례,대기림상자료급치료료효진행회고성분석.결과 ①초진시16례환자중8례출현외주혈이계혹삼계감소；12례행골수도편검사적환자중,3례존재거핵세포감소.소유환자균접수료당피질격소위주적치료,균무효.②학진위AA시16례환자중10례존재외주혈3계감소,골수천자검사제시6례환자골수증생활약반거핵세포교소혹비조혈세포비례증고,10례위전형적AA골수상.치료총유효솔위75％.결론 림상상대우특별시단순혈소판감소차골수거핵세포감소적환자,주출ITP진단시수근신,치료과정수동태관찰골수상변화,필요시급시조정진단급치료사로,진량감소오진적발생,제고AA적원기료효병강저병사솔.
Objective To summarize the causes of aplastic anemia (AA) misdignosed as immune thrombocytopenia(ITP),in order to reduce the misdiagnosis rate of aplastic anemia.Methods From January 2001 to December 2011,16 patients with AA misdiagnosed as ITP in department of nephrology and hemotology,the fifth affiliated hospital of Zhengzhou university were retrospectively analyzed,included their clinical data and the therapeutic effects.Results ①According to the clinical data,8 patients had cytopenia involved two or three lineages in peripheral blood.All patients received treatment of glucocorticoid,but the therapeutic effects were inefficient.② The bone marrow smears of 10 patients showed typical picture of AA when AA diagnosis was established.The total efficacy rate were 75 ％ after the treatment of anti thymocyte globulin(ATG),cyclosporin A(CSA) and androgen.Conclusions The diagnosis of aplastic anemia should be considered if the patients were diagnosed as ITP with decreased megkaryocytes and glucocorticoids,we should dynamicly observed the myelogram changes during the course of therapy,timely adjust the diagnosis and treatment,in order to reduce the misdiagnosis,improve the long-term outcome of AA and reduce the mortality.