Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Department of Hematology, Roskilde University Hospital, Roskilde, Denmark.
J Intern Med. 2016 Jun;279(6):566-75. doi: 10.1111/joim.12467. Epub 2016 Jan 21.
Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L(-1) , may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood.
Using a primary care resource, comprising more than 370 000 individuals, we assessed the association with a number of previously recognized conditions as well as all-cause mortality in the 4 years following the identification of neutropenia. By matching laboratory data with Danish nationwide health registers, risk estimates were assessed.
Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84-2.91), 2.80 (2.20-3.57) and 4.77 (3.22-7.07) for subnormal (≥1.5-1.8 G L(-1) ), mild (≥1.0-1.5 G L(-1) ) and moderate-severe (≥0.0-1.0 G L(-1) ) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35-4.45), 8.69 (6.58-11.47) and 46.03 (33.98-62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively.
Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented here support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.
中性粒细胞减少症定义为绝对血液中性粒细胞计数（ANC）<1.5 G L(-1)，可能伴随多种疾病。然而，常规全血细胞计数中检测到的中性粒细胞减少症的临床意义尚不清楚。
我们使用初级保健资源，包含超过 37 万人，评估了与多种先前公认的疾病的关联，以及在确定中性粒细胞减少症后的 4 年内的全因死亡率。通过将实验室数据与丹麦全国健康登记册相匹配，评估风险估计。
中性粒细胞减少症约见于所有个体的 1%，并与病毒感染、血液恶性肿瘤（而非自身免疫性疾病或实体癌）和死亡率呈剂量依赖性相关。中性粒细胞减少症与 HIV、急性白血病和骨髓增生异常综合征尤其相关。病毒感染的优势比（95%置信区间（CI））分别为亚正常（≥1.5-1.8 G L(-1)）、轻度（≥1.0-1.5 G L(-1)）和中度-重度（≥0.0-1.0 G L(-1)）中性粒细胞减少症个体的 2.32（1.84-2.91）、2.80（2.20-3.57）和 4.77（3.22-7.07）（均 P < 0.001）。同样，血液恶性肿瘤的优势比（95%CI）分别为中性粒细胞减少症相同水平的 3.23（2.35-4.45）、8.69（6.58-11.47）和 46.03（33.98-62.35）（均 P < 0.001）。因此，ANC 越低，这些疾病的可能性越大。观察到的严重中性粒细胞减少症的相对风险估计与血液恶性肿瘤和任何原因导致的死亡率分别为 40%和>50%的绝对风险相对应。
中性粒细胞减少症是一个危险信号，需要仔细随访。这里提出的风险估计支持在观察到中性粒细胞减少症时，将注意力集中在病毒疾病和血液恶性肿瘤上。
