网织红细胞参数在急性白血病化疗中的应用研究

发布时间：2019-04-10 13:34

【摘要】：目的:研究急性白血病病人化疗不同阶段网织红细胞参数变化对骨髓造血功能评价的预测价值。方法:筛选2015年1月-2016年12月间就诊于兰州大学第一医院确诊为急性白血病的患者32例。所有患者均行化学药物治疗。用自动化血液分析仪Sysmex-XE 5000检测患者不同化疗阶段的外周血中的网织红细胞百分比(RET%)、网织红细胞绝对值(RET#)、低荧光强度的网织红细胞(LFR)、中荧光强度的网织红细胞(MFR)、高荧光强度的网织红细胞(HFR)、白细胞(WBC)、中性粒细胞绝对值(ANC)以及未成熟网织红细胞比率(IRF)。结果:1.对32例病人基本信息、化疗方案、骨髓细胞学检测结果、骨髓细胞学检测结果、血常规及网织红细胞计数结果等进行收集、整理、分析。急性粒细胞白血病(AML)患者18共人,男性患者10人,女性患者8人,平均年龄35岁,其中诊断为急性粒细胞白血病微分化型(M1)1人,急性粒细胞白血病部分分化型(M2)3人,急性早幼粒细胞白血病(M3)4人,急性粒-单核细胞白血病(M4)4人,急性单核细胞白血病(M5)5人,急性红白血病(M6)1人;急性淋巴细胞白血病(ALL)患者共14例,男性患者9人,女性患者5人,平均年龄24岁,其中T淋巴细胞白血病3例,B淋巴细胞白血病11例。急性白血病患者共32人,平均年龄为30岁。32例患者均为化疗后好转且诊断、治疗均按照《血液病诊断及疗效标准》。2.32例急性白血病化疗患者IRF、MFR、HFR化疗后均一直减低,化疗第7天降到最低,均在化疗第14天出现回升趋势,化疗第21天升高至化疗前水平。3.LFR于化疗第7天开始升高,化疗14天开始降低。4.WBC和RET#于化疗第7、14天一直降低,化疗第21天出现升高。5.化疗后骨髓造血功能开始恢复时,IRF、MFR、HFR较WBC、RET#提前升高,同时LFR开始降低。6.化疗后骨髓造血功能开始抑制时,IRF、MFR、HFR较WBC、RET#提前降至最低,同时LFR开始升高。结论:1.IRF、MFR、HFR、LFR、RET%较WBC是反映骨髓造血功能恢复的更加敏感、特异的指标。2.不同荧光强度的网织红细胞反映骨髓造血功能情况较网织红细胞绝对值更加敏感。3.IRF、HFR、MFR化疗过程中呈先减后增,LFR呈先增后减,说明未成熟网织红细胞是骨髓造血功能变化较敏感的指标。
[Abstract]:Objective: to study the predictive value of reticulocyte parameters on bone marrow hematopoiesis function in patients with acute leukemia at different stages of chemotherapy. Methods: 32 patients with acute leukemia diagnosed in the first Hospital of Lanzhou University from January 2015 to December 2016 were selected. All patients were treated with chemotherapy. Reticulocyte percentage (RET%), reticulocyte absolute value (RET#) and low fluorescence intensity reticulocyte (LFR), were measured by automated hematology analyzer Sysmex-XE 5000 in peripheral blood of patients with different chemotherapy stages. Medium fluorescence intensity reticulocyte (MFR), high fluorescence intensity reticulocyte (HFR), leukocyte (WBC), neutrophil absolute value (ANC) and immature reticulocyte ratio (IRF). Results: 1. The basic information, chemotherapy regimen, bone marrow cytology, blood routine and reticulocyte count were collected, sorted and analyzed in 32 patients. There were 18 patients with acute myelogenous leukemia (AML), including 10 males and 8 females, with an average age of 35 years. One of them was diagnosed as acute myeloid leukemia (M1) differential type (M1). There were 3 patients with partial differentiation of acute myeloid leukemia (M2), 4 patients with acute promyelocytic leukemia (M3), 4 patients with acute myelo-monocytic leukemia (M4) and 5 patients with acute monocytic leukemia (M5). 1 case of acute erythroleukemia (M6); There were 14 patients with acute lymphoblastic leukemia (ALL), including 9 males and 5 females, with an average age of 24 years, including 3 cases of T-lymphocyte leukemia and 11 cases of B-lymphocyte leukemia. The mean age of 32 patients with acute leukemia was 30 years old. All 32 patients were improved after chemotherapy and were diagnosed according to the criteria of diagnosis and curative effect of hematological disease. 2.32 patients with acute leukemia treated with chemotherapy were treated with IRF,MFR, in accordance with the criteria of diagnosis and curative effect of hematological disease. After chemotherapy, HFR decreased all the time, decreased to the lowest level on the 7th day of chemotherapy, and showed a rising trend on the 14th day of chemotherapy, and increased to the pre-chemotherapy level on the 21st day of chemotherapy. 3. LFR began to increase on the 7th day of chemotherapy. On the 14th day of chemotherapy, WBC and RET# began to decrease. 4. WBC and WBC decreased continuously on the 7th and 14th day of chemotherapy, and increased on the 21st day of chemotherapy. When the hematopoiesis function of bone marrow began to recover after chemotherapy, IRF,MFR,HFR increased earlier than WBC,RET#, and LFR began to decrease. 6. 5%. When the hematopoiesis function of bone marrow began to be inhibited after chemotherapy, IRF,MFR,HFR decreased to the lowest level earlier than WBC,RET#, and LFR began to increase. IRF, MF, HFR, LFR, RE% are more sensitive and specific markers to reflect the recovery of hematopoietic function of bone marrow than WBC. 2. The reticulocyte with different fluorescence intensity was more sensitive than absolute value of reticulocyte in reflecting hematopoietic function of bone marrow. 3. In the course of chemotherapy with IRF, HFR,MFR decreased first and then increased, and LFR increased first and then decreased. These results suggest that immature reticulocyte is a sensitive indicator of bone marrow hematopoiesis.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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