異型淋巴細胞增多兩例并文獻復(fù)習(xí)

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摘要：為探討異型淋巴細胞的鑒別診斷，減少誤診率，分析2例細胞形態(tài)提示異型淋巴細胞的病歷資料，其中1例診斷傳染性單核細胞增多癥，1例診斷侵襲性NK細胞白血病。本文旨在強調(diào)僅憑細胞形態(tài)學(xué)判讀的異型淋巴細胞可能有誤，需結(jié)合患者的臨床癥狀、體征、影像學(xué)檢查、細胞免疫表型、疾病轉(zhuǎn)歸等綜合診斷。

關(guān)鍵詞：白血?。涣馨图毎?；異型；NK細胞；單核細胞

中圖分類號： R552 文獻標(biāo)志碼： B 文章編號：1000-503X（2023）06-1005-06

DOI：10.3881/j.issn.1000-503X.15301

Atypical Lymphocytosis：Report of Two Cases and Literature Review

SHAN Yaxin1，LI Jing1，YANG Xiang2，LI Lin2，HUANG Zoufang2

1The First Clinical Medical College of Gannan Medical University，Ganzhou，Jiangxi 341000，China

2The Endemic Disease（Thalassemia）Clinical Research Center of Jiangxi Province，Department of Hematology，F(xiàn)irst Affiliated Hospital of Gannan Medical University，Ganzhou，Jiangxi 341000，China

Corresponding author：HUANG Zoufang Tel：13879727439，E-mail：[email protected]

ABSTRACT：To improve the diagnosis of atypical lymphocytes and reduce the misdiagnosis rate，we analyzed the medical records of 2 cases with cell morphology suggestive of atypical lymphocytes.One case was diagnosed with infectious mononucleosis and the other with aggressive NK cell leukemia.The purpose of this paper is to emphasize that the diagnosis of atypical lymphocytes based only on morphological interpretation of cells may be incorrect，which should be combined with clinical symptoms，signs，imaging examination，cell immunophenotype，and disease outcome.

Key words：leukemia；lymphocyte；atypical；NK cells；mononuclear cell

Acta Acad Med Sin，2023，45（6）：1005-1010

異型淋巴細胞是病毒感染、免疫反應(yīng)等誘因引起的淋巴細胞形態(tài)改變，主要見于傳染性單核細胞增多癥（infectious mononucleosis，IM），也可見于淋巴瘤、風(fēng)疹、病毒性肝炎、冠狀病毒感染、登革熱等疾病，其本質(zhì)多為T淋巴細胞，通常T淋巴細胞>5%時具有病理生理意義，有時T淋巴細胞甚至可高達20%或更高，根據(jù)異型淋巴細胞的形態(tài)學(xué)特點將其分為3型：Ⅰ型為泡沫型，Ⅱ型為不規(guī)則型，Ⅲ型為幼稚型[1]。（剩余9400字）