骨髓组织印片评估有核细胞量的价值

Application of bone marrow biopsy imprint in evaluating cellularity

目的:研究骨髓印片评估有核细胞量的价值。方法:272例经骨髓活检术获取的组织块置于载玻片上轻轻滚动制成印片,W right-G iem sa染色,按有核细胞评判标准与骨髓涂片同步检查。结果:有核细胞明显减少和极度减少,明显增多和极度增多的4个级别,骨髓印片明显高于骨髓涂片(P<0.05),而印片与切片比较无明显差异(P>0.05)。以骨髓切片细胞量变化为标准,切片减少组中印片和涂片的符合率(84.4%和97.9%)较高;细胞量正常和增加组中印片的符合率(84.4%和93.2%)高于涂片(60%和64%),两组比较有显著性差异(P<0.01);灵敏度、特异性、Y ouden index、阳性预示值和阳性似然比,印片优于涂片。以切片诊断为金标准,印片诊断再生障碍性贫血和造血减低阳性率为37.1%,假阳性率为7.3%,比涂片(阳性率66.9%、假阳性率29.8%)低,(P<0.01);诊断指标的性能印片优于涂片,其中印片诊断为脾功能亢进和骨髓增殖性疾病(除感染和少数骨髓增殖性疾病外)涂片为假阴性结论。结论:骨髓印片在评估有核细胞量优于骨髓涂片,印片和涂片简便快速联检可提高骨髓细胞学的诊断水平。

Objective： To study the value of bone marrow biopsy imprint in evaluating cellularity. Methods： The bone marrow tissues were obtained by trephine biopsy from 272 patients,and then put on the slides to make the imprints. The imprints was stained by Wright-Giemsa method, and the bone marrow smears and imprints were examined simultaneously according to the bone marrow cellularity criteria. Results： In bone marrow cellularity ,four grades （distinct decrease, extreme decrease, distinct increase, and extreme increase） were significantly higher in bone marrow imprints than those in bone marrow smears （P〈0.05）,but there was no significantly differences between bone marrow imprints and sections （P 〉 0. 05）. Using bone marrow sections as standard,in cellularily decreasing samples ,the consistent rate of bone marrow imprints and smears were both high （84.4% and 97.9%）, in the group of the normal and increased cellularity,the consistent rate of the bone marrow imprints （84.4% and 97. 7%） was significantly higher than that in smears （60% and 64%,P〈0.01）. The sensitivity,specificity, Youden index,positive predictive value and positive likelihood rate of bone marrow imprints were all higher than those of the smears. Using the bone marrow sections as gold standard ,in 124 cases with decreased cellularity in smears, the positive diagnosis rate for aplastic anemia and dyshaematopoiesis based on bone marrow imprints was 37. 1% with a false positive rate of 7.3%, which was lower than that of the bone marrow smears （false positive rate of 29.8%,P〈0.01）. Conelusions z To evaluate bone marrow cellularity, bone marrow imprint is better than bone marrow smear. The combination of the two examinations can make the diagnosis more convenient and quicker.