继发于恶性肿瘤骨髓纤维化症47例临床资料分析

Clinical Analysis of 47 Cases of Myelofibrosis Secondary to Malignant Tumors and Literature Review

目的探讨继发性骨髓纤维化(secondarymyelofibrosis,SMF)患者的临床及骨髓病理学特点。方法对1995年～2004年同济医院确诊的47例继发性骨髓纤维化患者的临床表现、血片和骨髓象的细胞学表现及骨髓活检进行了回顾性研究,同时对不同疾病SMF程度与巨核细胞数的关系作了相关分析。结果骨髓转移癌常伴有SMF,易致骨髓穿刺干抽或稀释。急性淋巴细胞性白血病(ALL)或多发性骨髓瘤(MM)常伴SMF,骨髓象不易确诊,骨髓活检常能提供确诊的依据。各原发疾病之间MF程度没有统计学差异,而且MF程度与巨核细胞数没有明显相关性。结论当骨髓穿刺表现为“干抽”或疑为稀释、增生低下时,要考虑可能合并SMF,则应做骨髓活检,有助于对骨髓转移癌、ALL、MM、恶性淋巴瘤等疾病的诊断。

Objective To investigate the characteristic of the clinical features and the bone marrow pathology of secondary myelofibrosis. Methods Fourty-seven patients with secondary myelofibrosis in Tongji Hospital since 1995 to 2004 were analyzed retrospectively.And the relationship between myelofibrosis degree and megakaryocyte count is analyzed.Results Metastatic carcinoma is often associated with SMF and the examination of bone marrow is often dry tap or dilution.ALL or MM often associated with SMF,but by cellular examination of bone marrow can＇t be diagnosed.ln analysis no significant difference of the mygakaryocytes＇ count and association of myelofibrosis with it was found.Conclusions When cellular examination of bone marrow is dry tap or dilution, there is SMF perhaps.Then bone marrow biopsy is useful to diagnosis.