内科

目的观察25例系统性红斑狼疮患者自体外周血造血干细胞移植前后的粒细胞形态变化。方法采用环磷酰胺和重组人粒细胞集落刺激因子（rhGM-CSF）动员后获得的外周血造血干细胞，经马利兰、环磷酰胺、抗人淋巴细胞球蛋白、甲基强的松龙预处理后，回输自体外周血干细胞，用rhGM-CSF刺激恢复造血，注射rhGM-CSF前后采集静脉血制备血涂片，pH 6.4～6.8条件下瑞特-姬姆萨混合染色后在油镜下观察中性粒细胞形态，同时进行中性粒细胞碱性磷酸酶（NAP）染色，pH 5.4条件下姬氏染色观察中毒颗粒。结果应用rhGM-CSF治疗前1 d中性粒细胞形态无明显异常，中毒颗粒、NAP积分值均在正常范围；应用rhGM-CSF治疗后中毒颗粒、NAP积分明显增高，96%的中性粒细胞胞体偏大，胞浆内见“中毒”性颗粒、空泡数量增加。结论系统性红斑狼疮患者应用rhGM-CSF可引起外周血中性粒细胞出现明显的形态学改变。

ObjectiveTo observe the changes of neutrophils in patients with systemic lupus erythematosus before and after autologous hematopoietic stem cell transplantation.MethodsUsing cyclophosphamide and recombined human granulocyte colony stimulating factor (rhGM-CSF) to obtain hematopoietic stem cells,after pretreatment of busulfan,cyclophosphamide,anti-lymphocyte cytoglobin and Methylprednisolone,the autologous hematopoietic stem cells were Transfusion to the patients,then rhGM-CSF was used stimulating recovery hematopoiesis.After injecting rhGM-CSF,blood smear was made,using the venous blood,dyed with Wright and Gimsa under PH6.4～6.8 conditions,then observed using oil immersion lens,at the same time NAP of neutrophile granulocyte was dyed by Cgiemsa and observed under PH5.4 conditions.ResultsNeutrophils′ shape have not obvious changes using rhGM-CSF before the first day,and poisoning particles,NAP scores still in normal stage;After using rhGM-CSF poisoning particles,NAP scores rise clearly,96% neutrophils become bigger,the “poisoning” particles and empty bubbles increased.ConclusionsSLE patients neutrophils′ shape changed obviously after using rhGM-CSF.