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目的对23例苯中毒病人的周围血及骨髓进行分析,探讨苯中毒骨髓损伤的特征和机制。方法23例住院苯中毒患者,平均离岗及诊断苯中毒时间2.7年;21例为慢性轻度苯中毒,2例为慢性重度苯中毒(苯中毒再生障碍性贫血);男8例,女15例,平均年龄(45.5±7.8)岁。按统一调查表询问职业史、毒物接触史、药物接触史、造血系统疾病史以及肿瘤史;实验室检查包括:血常规、骨髓常规以及骨髓活检、荧光原位杂交技术(FISH)、流式细胞仪和TCR受体基因重排分析。结果(1)23例苯中毒病人中,血常规检查6例正常、系减少1例、一系或二系减少16例(其中14例淋巴细胞数减少)。血中大颗粒淋巴细胞(LGL)百分比增加(平均29.6%,n=22)。(2)23例苯中毒病人骨髓检查均示有一系或二系发育不全,骨髓损害的特征包括:显著的红系病态造血,嗜酸细胞发育不良,中性粒细胞前体细胞中异常的胞浆颗粒,嗜血细胞生成,髓质退化及骨髓增生低下。(3)T细胞受体(TCR)可变区基因重排(14/23),CD4+/CD8+比例减低(0.77±0.48,n=23)。(4)未发现研究对象染色体结构异常。结论与MDS各亚型常见的骨髓表现不同,慢性苯中毒骨髓损伤的特征是:显著的红系病态造血,嗜酸细胞发育不良,中性粒细胞前体细胞中异常的胞浆颗粒,嗜血细胞生成,髓质退化及骨髓增生低下;脱离苯接触若干年后,骨髓的这些损害仍持续存在。
Objective To analyze the blood and bone marrow of 23 patients with benzene poisoning, and to explore the characteristics and mechanism of benzene poisoning bone marrow injury. Methods Twenty-three patients with benzene poisoning were hospitalized on average and were diagnosed with benzene poisoning for 2.7 years. 21 were mild mild benzene poisoning and 2 were severe benzene poisoning (benzene poisoning aplastic anemia). There were 8 males and 15 females For example, the average age (45.5 ± 7.8) years old. According to a unified questionnaire for occupational history, exposure history of poison, history of drug exposure, history of hematopoietic system disease and tumor history; laboratory tests include: blood, bone marrow and bone marrow biopsy, fluorescence in situ hybridization (FISH), flow cytometry Instrument and TCR receptor gene rearrangement analysis. Results (1) Among the 23 cases of benzene poisoning, 6 cases were normal in routine blood test, 1 case was decreased, 16 cases were decreased by one or two lines (including 14 cases with decreased lymphocyte count). The percentage of large granulocyte lymphocytes (LGL) in blood increased (mean 29.6%, n = 22). (2) Bone marrow examination of 23 cases of benzene poisoning patients showed one or two series of hypoplasia, bone marrow damage characteristics include: significant erythroid dysplasia, eosinophilic dysplasia, abnormal cells in neutrophil precursor cells Pulp particles, hemophilia, medulla degeneration and myelodysplasia are low. (3) The gene rearrangement of TCR (14/23) and CD4 + / CD8 + were decreased (0.77 ± 0.48, n = 23). (4) No chromosomal abnormalities were found in the study subjects. Conclusions Compared with the common bone marrow manifestations of each subtype of MDS, the characteristics of chronic benzene poisoning bone marrow injury are: significant erythroid dysplasia, eosinophilic dysplasia, abnormal cytoplasmic granules in neutrophil precursor cells, Formation, medulla degeneration and low myeloproliferation; these exposures to bone marrow persist for several years after exposure to benzene.