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患者男,21岁,因头晕、乏力、间歇牙龈出血20天于1992年5月4日入院.体检:精神软,贫血貌,皮肤、巩膜无黄染,两侧颌下、腋下及腹股沟各可扪及1～2颗黄豆至蚕豆大小淋巴结,活动,无触痛.心肺听诊正常,腹平软,肝肋下1cm,脾肋下2cm,边钝,无触痛,两下肢无浮肿.神经系统正常.血象:Hb58g/L,WBC1.6×10~9/L,P 0.10,L 0.78,M 0.12,血小板计数66×10~9/L.我院及上海瑞金医院血液科骨穿均示红系增生活跃,中晚幼细胞呈巨幼变,原粒Ⅰ+Ⅱ为13.5%.诊断为骨髓异常增生综合征(MDS).入院后经小剂量阿糖胞苷(10mg/M~2,每12小时皮下注射)治疗21天及输血对症处理后,患者头晕乏力症状减轻,牙龈出血控制.血Hb74g/L,WBC 3.6×10~9/L,N 0.60,L 0.40,血小板数124×10~9/L.骨穿:原粒Ⅰ+Ⅱ为3%.但患者出现两下肢进行性软弱无力,体检:两下肢肌力减退,各为Ⅳ级,两下肢肌张力降
Male, 21 years old, was admitted for hospitalization on May 4, 1992 due to dizziness, weakness and intermittent gingival bleeding. Physical examination: mental softness, anemia appearance, skin, sclera without yellow dye, bilateral submandibular, armpit and groin Palpable 1 to 2 beans to the size of broad bean lymph nodes, activities, no tenderness. Cardiopulmonary auscultation normal, abdominal soft, liver ribs 1cm, Spleen ribs 2cm, blunt, no tenderness, no swelling of both lower extremities. The system is normal.Huixue: Hb58g / L, WBC 1.6 × 10 ~ 9 / L, P 0.10, L 0.78, M 0.12, platelet count 66 × 10 ~ 9 / The erythroid hyperplasia was active, and the young and middle-aged cells showed megaloblastic and juvenile myeloablative, the protoplasm Ⅰ + Ⅱ was 13.5% .The diagnosis of myelodysplastic syndrome (MDS) was confirmed by low dose of cytarabine (10mg / M ~ 2, Subcutaneous injection every 12 hours) for 21 days and blood transfusion symptomatic treatment, patients with dizziness and fatigue symptoms, bleeding control of gingival bleeding Hb74g / L, WBC 3.6 × 10 ~ 9 / L, N 0.60, L 0.40, platelet count 124 × 10 ~ 9 / L. bone wear: the original particle Ⅰ + Ⅱ 3%, but patients with weakness in both lower limbs, physical examination: lower extremity muscle strength, each grade Ⅳ, lower extremity muscle tension