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目的了解高铁负荷对免疫相关性全血细胞减少症(IRP)骨髓造血功能的影响。方法抽取天津医科大学总医院2009年7月至2010年2月收治的46例IRP患者骨髓4～5mL,进行红细胞集落生成单位、爆式红细胞集落生成单位、粒细胞-单核细胞集落生成单位骨髓祖细胞培养,并将其按血清铁蛋白高低分成2组,比较2组骨髓祖细胞培养情况、血象、骨髓象、输血情况及疗效。结果高铁组IRP患者3类集落数[(43.33±17.74)/105BMMNC、(1.50±2.20)/105BMMNC、(11.06±5.83)/105BMMNC]均显著低于铁正常组[(77.43±40.64)/105BMMNC、(9.57±7.99)/105BMMNC、(21.25±11.41)/105BMMNC](P<0.01);高铁组外周血红蛋白、红细胞[(65.0±18.67)g/L、(1.97±0.55)×109/L]、骨髓粒系、红系所占比例[(29.69±9.57)%、(18.44±17.18)%]以及骨髓增生程度、治疗后总有效率(44.4%)均显著低于铁正常组[(84.25±27.56)g/L、(2.41±0.77)×109/L、(42.30±15.76)%、(34.14±19.64)%、75.0%](P<0.05),而红细胞和血小板输注量(P<0.05)明显高于铁正常组。结论高铁负荷可能降低IRP患者骨髓造血功能,临床上应动态监测血清铁蛋白。
Objective To investigate the effect of high-speed rail load on the hematopoietic function of immune related pancytopenia (IRP). Methods The bone marrow of 46 patients with IRP from July 2009 to February 2010 in Tianjin Medical University General Hospital was treated with 4 ~ 5mL bone marrow, erythrocyte colony forming unit, blast-type erythrocyte colony forming unit, granulocyte-mononuclear cell colony forming unit Progenitor cells were cultured and divided into two groups according to the level of serum ferritin. The culture conditions, blood images, bone marrow, blood transfusion and therapeutic effects were compared between the two groups. Results The numbers of 3 types of colonies [(43.33 ± 17.74) / 105 BMMNC, (1.50 ± 2.20) / 105 BMMNC, (11.06 ± 5.83) / 105 BMMNC) in IRP group were significantly lower than those in IR group [(77.43 ± 40.64) / 105 BMMNC, (9.57 ± 7.99) / 105BMMNC, (21.25 ± 11.41) / 105BMMNC] (P <0.01). The levels of peripheral hemoglobin, erythrocytes in the high-iron group were (65.0 ± 18.67) g / (29.69 ± 9.57)%, (18.44 ± 17.18)%], the degree of myeloproliferation and the total effective rate (44.4%) after treatment were significantly lower than those in normal iron group [(84.25 ± 27.56) (2.41 ± 0.77) × 109 / L, (42.30 ± 15.76)%, (34.14 ± 19.64)%, 75.0%] (P <0.05), while the red blood cells and platelet transfusion volume Higher than normal iron group. Conclusion The high-iron load may reduce the hematopoietic function of bone marrow in patients with IRP. Serum ferritin should be dynamically monitored in clinic.