骨髓活检在诊断及鉴别诊断真性红细胞增多症中的价值

The value of diagnosis and differential diagnosis of bone marrow biopsy for polycythaemia vera

目的:探讨骨髓活检在真性红细胞增多症(PV)诊断与鉴别诊断中的价值。方法:同步观察真性红细胞增多症37例患者骨髓涂片和活检切片。并与继发性红细胞增多症20例患者作比较,以正常人20例作对照。观察骨髓增生程度、增生优势细胞系、网硬蛋白积分。结果:PV组患者骨髓造血组织在切片中的增生度明显高于涂片,两者差异有统计学意义(P<0.05);与继发性红细胞增多症及正常对照组比较差异亦有统计学意义(P<0.05)。PV组切片中增生优势细胞系分为累及三系的增生,累及二系(红系和粒系、红系和巨核系)的增生,仅累及红系单系的增生;继发性红细胞增多症组仅显示红系相对增生。PV组网硬蛋白纤维积分为1+及以上占83.8%,继发性红细胞增多症组及正常对照组均未见1+或1+以上,分别比较差异有统计学意义(均为P<0.05)。结论:骨髓活检能准确反应骨髓组织的增生程度、增生优势细胞系、纤维增生程度,对PV的诊断及鉴别诊断有较高价值。

Objective：To explore the diagnosis and differential diagnosis value of bone marrow biopsy for patients with polycythaemia vera （PV）. Methods ： The bone marrow hyperplasia degree, proliferative advantage of cell lines and reticulin points were compared respectively in the plastic embedded bone marrow sections and the bone marrow smears of 37 cases of PV ,20 cases of secondary polyeythemia and 20 cases of normal control group. Results：In PV group, the proliferating degree in sections was higher than in smears. The difference was statistically significant （ P 〈 0.05 ） ; compared with secondary polycytbemia and normal control group, the differences were also significant （P 〈 0.05 ）. PV group of slices proliferative advantage of cells were divided into involving three lines proliferation, involving two lines （ red lines and granulocyte ; erythroid and megakaryocyte ） proliferation, involving only a single line of the proliferation of erythroid ; secondary polyeythemia group showed only the relative erythroid hyperplasia. Fibers points of one plus sign（ ＋ ） and above of PV group reticulin account for 83.8%. Secondary polycythemia and normal control group were no more than one plus sign（ ＋ ） or one plus sign（ ＋ ） ,the difference was statistically significant （both P 〈0.05）. Conclusion：The bone marrow biopsy can accurately reflect the degree of bone marrow hyperplasia, proliferation advantage of cell lines, degree of fibrosis of PV with higher value diagnosis and differential diagnosis.