Smith J G, Smith M A, James I, Blundell E, Maddison P J
Department of Haematology, Royal United Hospital, Bath.
Br J Haematol. 1989 Oct;73(2):148-51. doi: 10.1111/j.1365-2141.1989.tb00244.x.
A 45-year-old Caucasian female with seropositive rheumatoid arthritis was found coincidentally to have a circulating lymphocytosis (6.4 x 10(9)/l) and neutropenia (0.1 x 10(9)/l). Initial presentation was with mouth ulceration and recurrent infections. A spleen scan showed no evidence of splenomegaly and serum titres against EBV, CMV and toxoplasmosis were negative. No anti-neutrophil antibodies were found. Marrow aspiration demonstrated a lymphocytosis of 60% with reduced numbers of granular precursors. Lymphocytes in both blood and bone marrow were CD3, CD8, CD16 and HLA-DR positive. Lymphocyte conditioned medium (LCM) generated from the patient's blood lymphocytes (without phytohaemagglutinin) was found to inhibit allogeneic colony-forming unit, granulocyte-macrophage (CFU-GM) stem cells in semi-solid culture compared with control LCM. This inhibitory activity was abrogated by the cytolytic removal of CD8 cells prior to LCM production and was significantly reduced by co-culture with indomethacin. Culture of the patient's marrow at autostimulatory light density marrow cell concentrations showed poor spontaneous CFU-GM colony formation until marrow CD8 lymphocytes were removed cytolytically. Prednisolone was used therapeutically (40 mg/d) and resulted in the patient's neutrophil count rising from 0.06 x 10(9)/l to 1.1 x 10(9)/l and a fall in the total lymphocyte count to 1.9 x 10(9)/l. Reevaluation of the patient's LCM post steroid therapy showed loss of the previous inhibitory effect. The patient's neutrophil count is maintained on oral azathioprine and indomethacin.
一名血清学阳性的类风湿性关节炎45岁白种女性偶然发现有循环淋巴细胞增多（6.4×10⁹/L）和中性粒细胞减少（0.1×10⁹/L）。最初表现为口腔溃疡和反复感染。脾脏扫描未显示脾肿大证据，针对EB病毒、巨细胞病毒和弓形虫病的血清滴度为阴性。未发现抗中性粒细胞抗体。骨髓穿刺显示淋巴细胞增多60%，颗粒前体细胞数量减少。血液和骨髓中的淋巴细胞CD3、CD8、CD16和HLA - DR均呈阳性。与对照淋巴细胞条件培养基（LCM）相比，由患者血液淋巴细胞（无植物血凝素）产生的LCM在半固体培养中可抑制异基因集落形成单位、粒细胞 - 巨噬细胞（CFU - GM）干细胞。在制备LCM之前通过细胞溶解去除CD8细胞可消除这种抑制活性，与吲哚美辛共培养可使其显著降低。在自刺激低密度骨髓细胞浓度下培养患者骨髓，直到通过细胞溶解去除骨髓CD8淋巴细胞之前，自发CFU - GM集落形成较差。使用泼尼松龙进行治疗（40mg/d），使患者中性粒细胞计数从0.06×10⁹/L升至1.1×10⁹/L，总淋巴细胞计数降至1.9×10⁹/L。类固醇治疗后对患者LCM的重新评估显示先前的抑制作用消失。患者的中性粒细胞计数通过口服硫唑嘌呤和吲哚美辛维持。
