论文部分内容阅读
1例78岁男性特发性肺间质纤维化患者,应用泼尼松、硫唑嘌呤及雷公藤总苷联合治疗。给予硫唑嘌呤150 mg/d,共用19个月,总量93 g。2年后,患者出现发热、呼吸困难。入院查血常规:WBC 0.83×109/L,N 0.06,L 0.86,M 0.18~0.39,PLT 74×109/L,Hb 121 g/L;骨髓涂片:有核细胞增生活跃,分类不明细胞占50%,该类细胞呈深灰色,中等偏大,有伪足,胞浆中充满紫红色细小颗粒,未见Auer小体;骨髓活检:增生低下,三系细胞减少;血细胞染色:过氧化物酶呈阴性或弱阳性,碱性磷酸酶90%阳性。入院76 d复查骨髓象:有核细胞增生明显活跃,幼稚单核细胞占56%,三系细胞增生受抑。皮下注射阿糖胞苷200 mg/d,连用2 d。效果不佳,于入院后128 d死亡。
A 78-year-old man with idiopathic pulmonary fibrosis, prednisone, azathioprine and Tripterygium glycosides combined treatment. Azathioprine given 150 mg / d, sharing 19 months, a total of 93 g. Two years later, the patient developed fever and had difficulty breathing. The routine blood tests for admission were: WBC 0.83 × 109 / L, N 0.06, L 0.86, M 0.18-0.39, PLT 74 × 109 / L, Hb 121 g / L; bone marrow smear: active nucleated cells proliferated, 50%, these cells were dark gray, medium-sized large, pseudopodia, cytoplasm filled with purple granules, no Auer bodies; bone marrow biopsy: hyperplasia, decreased three lines; blood cell staining: peroxides Negative or negative enzyme, alkaline phosphatase 90% positive. On the 76th day after admission, bone marrow was examined. The nucleated cells proliferated obviously, naive mononuclear cells accounted for 56%, and the three-cell hyperplasia was suppressed. Subcutaneous injection of cytarabine 200 mg / d, once every 2 d. Ineffective, died 128 days after admission.