文献复习:
患者 68 岁老年男性,因咳嗽、咳痰伴发热半月入院。体温最高 38.5 ℃。社区诊所曾予头孢呋辛、阿奇霉素输液治疗一周,热退但仍有咳嗽,遂收入我院。
仔细分析血常规发现淋巴细胞计数 0.79 × 109/L(正常值 1.1~3.2 × 109/L),于是查淋巴细胞免疫:CD4+ 198 个/μl,CD4/CD8 比值 0.40(正常值 0.71-2.78),CD19+ 0.1%(正常值 4.0 ~ 17.0%),提示 CD4+ 明显减少,伴 CD4/CD8 比值倒置,CD19+ 明显降低(说明 B 细胞缺乏)。
继续查体液免疫 IgG、IgA 与 IgM 明显偏低(表 1)。
需要注意的是,GS 患者接种减毒活疫苗属于禁忌。
诊治思路:
患者为老年男性,胸腺瘤切除术后反复肺炎,查体液免疫及 T、B 淋巴细胞免疫均存在缺陷,可确诊 Good 综合征。仔细询问病史及查体,本患者无重症肌无力表现。
总结:
参考文献
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