Kuwata Kazuhisa, Yamada Shoko, Kinuwaki Etsuo, Naito Makoto, Mitsuya Hiroaki
Konan Hospital, Kyouninkai Inc., Kumamoto, Japan.
Shock. 2006 Apr;25(4):344-50. doi: 10.1097/01.shk.0000209520.82377.41.
Peripheral hemophagocytosis (PHP) is seen in patients with hemophagocytic syndrome (HPS), a clinical status in which activated macrophages play a role in its pathogenesis. The inflammatory state, systemic inflammatory response syndrome (SIRS), is also associated with activated macrophages. However, the link between HPS and SIRS and the clinical implications of PHP remain to be determined. In the present work, we examined the clinical utility and impact of the detection of PHP and the link between HPS and SIRS. We studied the clinical and laboratory profiles of 322 SIRS patients (174 men; mean age, 68 +/- 22 years; range, 16-99 years) who visited an urban hospital specializing in respiratory, cardiovascular, digestive, renal diseases, general surgery, and orthopedics in Japan. Peripheral hemophagocytosis was detected in 40 (23 men; mean age, 81.3 +/- 8.7 years; range, 63-98 years) of 322 patients on 3 +/- 2 days after SIRS diagnosis as determined with a "blunt-edged-smear" method differing from the conventional "feather-edged smear" method. The incidence of advanced SIRS and ensuing death in the SIRS+ PHP- group (37 and 21 of 40, respectively) was significantly greater than in the SIRS+ PHP- group (82 and 17 of 282) (P < 0.01). The duration from SIRS diagnosis to recovery in 19 SIRS+ PHP- surviving patients (26 +/- 18 days) was longer than that in 19 age-matched SIRS+ PHP- surviving patients who initially presented comparable clinical profiles (6 +/- 3 days) (P < 0.001). Bone marrow analysis in all 7 patients having PHP and SIRS showed no HPS initially (<3% hemophagocytes), but all subsequently developed HPS at 7 +/- 1 days after the diagnosis, confirmed by the presence of 9% +/- 13% hemophagocytes in the bone marrow. Electron microscopic and immunohistochemical analyses revealed that PHP was derived from hemophagocytes in the bone marrow. The present data strongly suggest that PHP detection could serve as an early indicator for advanced SIRS and/or HPS and that the use of the blunt-edged method is preferable for PHP detection.
外周噬血细胞现象（PHP）见于噬血细胞综合征（HPS）患者，这是一种临床状态，其中活化巨噬细胞在其发病机制中起作用。炎症状态，即全身炎症反应综合征（SIRS），也与活化巨噬细胞有关。然而，HPS与SIRS之间的联系以及PHP的临床意义仍有待确定。在本研究中，我们检测了PHP检测的临床效用和影响以及HPS与SIRS之间的联系。我们研究了322例SIRS患者（174例男性；平均年龄68±22岁；范围16 - 99岁）的临床和实验室资料，这些患者就诊于日本一家专门治疗呼吸、心血管、消化、肾脏疾病、普通外科和骨科的城市医院。采用不同于传统“羽状涂片”方法的“钝缘涂片”方法，在322例患者中的40例（23例男性；平均年龄81.3±8.7岁；范围63 - 98岁）于SIRS诊断后3±2天检测到外周噬血细胞现象。SIRS + PHP +组（分别为40例中的37例和21例）中严重SIRS及随后死亡的发生率显著高于SIRS + PHP -组（282例中的82例和17例）（P < 0.01）。19例存活的SIRS + PHP +患者从SIRS诊断到恢复的时间（26±18天）长于19例年龄匹配的、最初临床表现相似的存活SIRS + PHP -患者（6±3天）（P < 0.001）。所有7例患有PHP和SIRS的患者骨髓分析最初均未显示HPS（噬血细胞<3%），但随后均在诊断后7±1天发展为HPS，骨髓中噬血细胞的存在证实了这一点，噬血细胞为9%±13%。电子显微镜和免疫组织化学分析显示，PHP源自骨髓中的噬血细胞。目前的数据强烈表明，PHP检测可作为严重SIRS和/或HPS的早期指标，并且钝缘方法更适合用于PHP检测。
