【摘要】：目的:研究急性白血病病人化療不同階段網(wǎng)織紅細胞參數(shù)變化對骨髓造血功能評價的預測價值。方法:篩選2015年1月-2016年12月間就診于蘭州大學第一醫(yī)院確診為急性白血病的患者32例。所有患者均行化學藥物治療。用自動化血液分析儀Sysmex-XE 5000檢測患者不同化療階段的外周血中的網(wǎng)織紅細胞百分比(RET%)、網(wǎng)織紅細胞絕對值(RET#)、低熒光強度的網(wǎng)織紅細胞(LFR)、中熒光強度的網(wǎng)織紅細胞(MFR)、高熒光強度的網(wǎng)織紅細胞(HFR)、白細胞(WBC)、中性粒細胞絕對值(ANC)以及未成熟網(wǎng)織紅細胞比率(IRF)。結(jié)果:1.對32例病人基本信息、化療方案、骨髓細胞學檢測結(jié)果、骨髓細胞學檢測結(jié)果、血常規(guī)及網(wǎng)織紅細胞計數(shù)結(jié)果等進行收集、整理、分析。急性粒細胞白血病(AML)患者18共人,男性患者10人,女性患者8人,平均年齡35歲,其中診斷為急性粒細胞白血病微分化型(M1)1人,急性粒細胞白血病部分分化型(M2)3人,急性早幼粒細胞白血病(M3)4人,急性粒-單核細胞白血病(M4)4人,急性單核細胞白血病(M5)5人,急性紅白血病(M6)1人;急性淋巴細胞白血病(ALL)患者共14例,男性患者9人,女性患者5人,平均年齡24歲,其中T淋巴細胞白血病3例,B淋巴細胞白血病11例。急性白血病患者共32人,平均年齡為30歲。32例患者均為化療后好轉(zhuǎn)且診斷、治療均按照《血液病診斷及療效標準》。2.32例急性白血病化療患者IRF、MFR、HFR化療后均一直減低,化療第7天降到最低,均在化療第14天出現(xiàn)回升趨勢,化療第21天升高至化療前水平。3.LFR于化療第7天開始升高,化療14天開始降低。4.WBC和RET#于化療第7、14天一直降低,化療第21天出現(xiàn)升高。5.化療后骨髓造血功能開始恢復時,IRF、MFR、HFR較WBC、RET#提前升高,同時LFR開始降低。6.化療后骨髓造血功能開始抑制時,IRF、MFR、HFR較WBC、RET#提前降至最低,同時LFR開始升高。結(jié)論:1.IRF、MFR、HFR、LFR、RET%較WBC是反映骨髓造血功能恢復的更加敏感、特異的指標。2.不同熒光強度的網(wǎng)織紅細胞反映骨髓造血功能情況較網(wǎng)織紅細胞絕對值更加敏感。3.IRF、HFR、MFR化療過程中呈先減后增,LFR呈先增后減,說明未成熟網(wǎng)織紅細胞是骨髓造血功能變化較敏感的指標。
[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.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R733.71

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