骨髓活检在全血细胞减少症中的诊断意义

The significance of bone marrow biopsy in differential diagnosis of patients with pancytopenia

目的探讨骨髓活检在全血细胞减少症中的诊断意义。方法对153例因造血系统疾病所致全血细胞减少的病例,同步做骨髓涂片和活检,进行对比分析。结果再生障碍性贫血(AA)及骨髓增生异常综合征(MDS)在全血细胞减少的病例中所占比例最大,共占66.7%;骨髓涂片增生度明显低于骨髓活检(P<0.01);骨髓涂片对AA的误诊率明显高于活检(分别为30.8%和4.5%),具有极显著性差异(P<0.01),但在MDS则无显著性差异(P>0.05);而骨髓活检对AA和MDS的诊断准确性方面均明显优于涂片(P<0.05和P<0.01)。结论骨髓活检更能真实反映骨髓组织造血的情况,对骨髓增生度的判断优于骨髓涂片;骨髓活检有利于提高AA和MDS的诊断准确率。

Objective To study the significance of bone marrow biopsy in differential diagnosis of patients with pancytopenia. Methods 153 inpatients with pancytopenia caused by hematologic diseases were studied. To compare the difference between bone marrow smear and trephine biopsy, each case was subjected to bone marrow puncture and biopsy simultaneously. Results Of all hematologic diseases causing pancytopenia, aplastic anemia （AA） and myelodysplastic syndrome （MDS） were most popular, accounting for 66. 7 %. The degree of cellularity in bone marrow biopsy for cytologic morphology was higher than that from the smear with the difference being significant （P〈0. 01）. The accuracy of biopsy in diagnosis of AA and MDS was obviously higher than that in smear （P〈0.05 and P〈0.01 ） ; while misdiagnosis rate was lower in diagnosing AA （P〈 0. 01）. Conclusion Bone marrow biopsy is necessary, even important, to the differential diagnosis of pancytopenia. The bone marrow biopsy can increase the accuracy in diagnosis of AA and MDS.