骨髓增生异常综合征骨髓活检评分体系的建立及其临床意义

Design and validation of bone marrow histological scoring system for myelodysplastic syndrome

目的建立骨髓增生异常综合征(MDS)骨髓组织学评分体系,为临床的诊断和动态监测疾病的变化与预后的判断提供参考指标。方法运用HE染色和Gomori网状纤维染色观察149例骨髓组织学改变;用免疫组化的方法标记MPO、CD235、F8、CD42b、CD61和CD34。通过评分方法将MDS骨髓活检多种病变特点数字化,每1例MDS骨髓活检均可得到一个综合性的数字。结果建立了MDS骨髓活检评分体系,该评分体系涵盖了MDS骨髓活检8个方面形态学变化。MDS骨髓活检评分与正常骨髓活检评分比较,当评分≥5时,两者有显著性差异(P<0.001)。MDS骨髓活检评分与MDS发展来的白血病的骨髓活检评分比较,当评分≥9时两者差异非常显著(P<0.001)。结论运用数字评分方法设计了半定量MDS骨髓活检评分体系,适用于常规骨髓病理检查。该体系运用于MDS的骨髓活检诊断,当评分≥5时,结合骨髓涂片及抗原异常表达可作出MDS的诊断;评分增高,提示MDS向白血病发展的危险性增高。当评分≥9时,提示已进入早期白血病阶段。

Objective To design a bone marrow histological scoring system for myelodysplastic syndrome （MDS） in order to provide an objective evaluation of clinical diagnosis, disease development and outcome prediction. Methods HE and Gomori staining were used to observe the morphological alterations in 149 bone marrow biopsies. Immunohistochemical staining for MPO, CD235, F8, CD42b, CD61 and CD34 was performed. The scores of distinct morphological changes of MDS were valued. Results The bone marrow histological scoring system for MDS was established and validated. The scoring system comprised 8 distinct histological features of MDS in bone marrow biopsy. When the score was I〉5, there was significant difference between normal bone marrow biopsy and bone marrow biopsy with MDS （P 〈0. 001 ）. When the score was ≥9, there was significant difference between MDS and AML transformed from MDS （P 〈 0. 001 ）. Conclusion This numerical scoring system is simple and useful in routine bone marrow biopsy. When the score is ≥15, the diagnosis of MDS can be established when cytology of bone marrow smear is combined with the detection of abberant antigen expression. When the score is ≥9, early leukemia is suggested.