Reversible bone marrow dysplasia in patients with systemic lupus erythematosus
Reversible bone marrow dysplasia in patients with systemic lupus erythematosus
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DOI：
10.2169/internalmedicine.47.0607
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发表时间：
2008-01-01
影响因子：
1.2
通讯作者：
Harigae, Hideo
中科院分区：
文献类型：
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作者：
Oka, Yumiko;Kameoka, Junichi;Harigae, Hideo
目的系统性红斑狼疮（SLE）患者骨髓发育不良的报道已有报道。然而，报告主要限于红系谱系的描述;没有后续研究报告，发育不良的临床意义是未知的。方法回顾性分析17例因血细胞减少（WBC <1，500/μ l，或Hb <10.5g/dl，或血小板计数<10 × 10（4）/μ l）而进行骨髓穿刺的SLE患者的骨髓穿刺涂片。在17名患者中，4名患者在随访期间进行了重复骨髓抽吸。结果17例SLE患者中，12例有发育异常，包括：红系细胞多核（三核或三核以上）5例，巨母细胞样改变4例，假Pelger异常6例，环形核髓系细胞2例，核分离巨核细胞4例，小巨核细胞5例。在4例进行了随访骨髓穿刺的患者中，这些发育不良与疾病活动相关;一些异常随着SLE的缓解而消失。弥漫增生性肾小球肾炎（3例）和脑狼疮/神经精神性狼疮（4例）仅见于发育不良的SLE患者。结论SLE患者骨髓细胞均可发生发育不良，且在病程中发育不良是可逆的。发育不良的存在似乎与疾病的严重程度有关。
Objective Several reports of bone marrow dysplasia in patients with systemic lupus erythematosus (SLE) have been published. However, the reports are restricted primarily to descriptions of the erythroid lineage; no follow-up studies have been reported, and the clinical significance of the dysplasias is unknown. Therefore, in the present study, the dysplasias noted in bone marrow aspirates obtained from SLE patients were characterized.Patients and Methods The smears of bone marrow aspirates obtained from 17 SLE patients who had bone marrow aspiration due to cytopenia (WBC < 1,500/mu l, or Hb < 10.5 g/dl, or platelet count < 10x10(4)/mu l) were examined retrospectively. Of the 17 patients, 4 had a repeat bone marrow aspiration during follow-up. Clinical and laboratory data were obtained from the medical records.Results Of the 17 SLE patients, 12 had dysplasias, including: erythroid cell multinuclearity (trinuclear or more) (5 patients), megaloblastoid changes (4), pseudo-Pelger abnormalities (6), annular nuclear myeloid cells (2), separated nuclear megakaryocytes (4), and micromegakaryocytes (5). In the 4 patients who had follow-up bone marrow aspiration, these dysplasias were correlated with disease activity; some abnormalities disappeared with remission of SLE. Diffuse proliferative glomerulonephritis (3 patients) and cerebral lupus/neuropsychiatric lupus (4 patients) were seen only in patients with dysplasia.Conclusion This study found that bone marrow dysplasia can be observed in all lineage cells of SLE patients, and that the dysplasia is reversible during the course of the disease. The presence of dysplasias appears to be associated with disease severity.