骨髓活检与涂片联检对153例全血细胞减少诊断价值的临床意义

Diagnostic value of bone marrow biopsy and marrow smear in 153 patients with pancytopenia

目的探讨骨髓活检切片与骨髓涂片同步观察对全血细胞减少症诊断的临床意义。方法对153例全血细胞减少症患者,采用骨髓穿刺涂片、骨髓活检同步取材,涂片用瑞氏染色,骨髓活检采用塑料包埋、苏木精-姬姆萨-酸性品红染色,同时观察其骨髓涂片和骨髓活检切片。结果 153例中男67例,女86例,年龄3～83岁。血液系统疾病138例(90.2%),非血液系统疾病15例。骨髓活检切片诊断符合率87.58%,高于骨髓涂片71.90%。骨髓活检切片总误诊率为4.58%低于骨髓涂片25.36%。骨髓活检增生程度的判断优于骨髓涂片。结论骨髓活检更能客观地反映骨髓组织的真实情况,特别是在恶性血液系统疾病所致全血细胞减少的诊断、鉴别诊断等方面的价值更优于涂片。骨髓活检与涂片二者联合检测能有效提高全血细胞减少症的诊断准确性。

Objective To investigate the clinical significance of simultaneously detection of bone marrow biopsy and bone mar- row smear in the diagnosis of pancytopenia. Methods We took the bone marrow biopsy and aspiration simultaneously in 153 clini- cal paneytopenia cases. For sections, plastic embedding and Hematein-Giemsa-Fuchsime（HGF） staining were done. For smears, Wright staining was done. Then they were observed under miscopy. Results Age of the 153 clinical cases （67 males and 86 females） ranged from 3 to 83 years. 138 cases of hematological diseases,accounting for 90.2%. The other 15 cases were diagnosed of non-hematologic diseases. The accuracy rate of sections （87.58 %） was higher than that of smears（71.9%）. Total misdiagnostic rate of sections （4.58%） was lower than that of smears （25.36%）. As for the evaluation of bone marrow hyperplasia degree,see tion was also superior to smears. Conclusion Bone marrow biopsy and section method is more objective than smear method for re- vealing the true condition of the bone marrow,especially in the diagnoses and differential diagnoses of malignant paneytopenia. The combination of these two methods will increase the accuracy rate for the diagnosis of pancytopenia.