慢性淋巴细胞白血病涂片与切片诊断价值的比较

The comparison of diagnostic value of bone marrow section and smear in chronic lymphocytic leukemia

目的:比较骨髓活检与涂片两种方法诊断慢性淋巴细胞白血病(CLL)的价值。方法:同步观察32例慢性淋巴细胞白血病患者骨髓涂片和活检切片,并与20例反应性淋巴细胞增多症患者作比较。观察骨髓增生程度、细胞形态学分类(髓内增生的优势细胞系)及组织病理学分类、纤维组织增生程度。结果:CLL组患者骨髓造血组织在切片中的增生度高于涂片,两者差异有统计学意义(P<0.05);与反应性淋巴细胞增多症比较差异亦有统计学意义(P<0.05)。CLL组中根据瘤细胞的形态学差异,分为典型CLL、伴幼淋巴细胞CLL和大小细胞混合型CLL;按照组织病理学又分为结节型、间质型、弥漫型;4例涂片未能作明确诊断,切片比涂片敏感性高。CLL组网硬蛋白纤维积分为1+及以上占12.5%,反应性淋巴细胞增多症均为阴性或弱阳性反应,差异有统计学意义(均为P<0.05)。结论:切片除了在淋巴细胞形态上能够反映疾病的类型,还能在组织病理上反映浸润的模式与程度,常能提供附加的预后信息。在做传统的骨髓涂片检测时,应同时做骨髓活检,可以提供更准确丰富的诊断依据及信息。

Objective：To compare two methods of bone marrow biopsy and smear diagnosis of chronic lymphocytic leukemia（CLL）.Methods：The simultaneous observation of 32 patients with chronic lymphocytic leukemia bone marrow smear and biopsy sections was performed.compare with reactive lymphocytosis syndrome in 20 patients for comparison.Results：CLL patients in sections of bone marrow hematopoietic tissue proliferation was better than smear,（P 0.05） ;and reactive lymphocytosis syndrome differences were also statistically significant（P 0.05）.CLLnetwork myelofibrosis points was 1 ＋ and above in 12.5%,reactive lymphocytosis syndrome were negative or weak positive reaction,（P 0.05）.Conclusion：In addition to cell morphology section to reflect the type of the disease,but also reflected in the histopathological pattern and extent of invasion,often can provide additional prognostic information.