类风湿关节炎合并大颗粒淋巴细胞白血病一例并文献复习

摘要

类风湿关节炎（RA）是常见的慢性自身免疫性疾病，RA 合并大颗粒淋巴细胞白血病（ LGLL）临床罕见，不易早期发现和诊断。本文报道1例 RA 合并 LGLL 患者的诊治经过，并复习相关文献，探讨 RA 与 LGLL 的发生机制及其联系。该例患者 RA 诊断明确，出现血细胞计数减少，经骨髓穿刺、组织活检及 T 细胞受体（TCR）重排诊断为 LGLL。患者经免疫抑制治疗后，血小板计数上升。临床应重视 RA 患者血细胞计数减少现象，及时考虑到并发血液系统疾病的可能，及时安排血液及骨髓系统检查。%Rheumatoid arthritis( RA)is a common chronic autoimmune disease,but RA combined with large granular lymphocytic leukemia(LGLL)is rare clinically,which is difficult to detect and diagnose in early stages. The paper reported the diagnosis and treating process of one case of RA combined with LGLL,reviewed relevant literature,and discussed the occurring mechanism of RA and LGLL and their connections. RA diagnostic result of this patient was clear with a decrease of cytometry;after bone marrow aspiration,biopsy and T cell receptor( TCR)rearrangement,we diagnosed the patient with LGLL. After immunosuppressive therapy,the platelet count of the patient got increased. Therefore,attention should be paid to the decrease of cytometry phenomenon of RA patients,the possibility of concurrent disease of the hematologic system should be timely taken into consideration,and the blood and bone marrow system examination should be arranged in time.