骨髓活检195例临床应用分析

Clinical Value of Bone Marrow Biopsy: an Analysis of 195 Cases

目的探讨骨髓活检在血液病诊断中的临床应用价值。方法对195例疑诊血液病患者行常规髂后上棘骨髓穿刺活检,石蜡包埋,苏木精-伊红(HE)、Gomori染色,骨髓纤维化患者增加Masson三色染色,肿瘤患者行相关免疫组织化学(免疫组化)染色。结果 195例中明确诊断为正常骨髓象13例,再生障碍性贫血(aplastic anemia,AA)65例,慢性特发性骨髓纤维化(chronic idiopathic myelofibrosis,CIMF)26例,骨髓增生异常综合征(myelodysplastic syndrome,MDS)23例,各类淋巴细胞性肿瘤22例,慢性粒细胞白血病(chronic myelogenous leukemia,CML)18例,骨髓浆细胞瘤15例,原发性血小板增多症(essential thrombocythemia,ET)7例,感染引起的骨髓增生4例,转移性癌2例。结论骨髓活检对诊断AA、CIMF具有很好的临床应用价值,对MDS、ET和其他增殖性病变需结合临床表现、医技检查及骨髓涂片细胞学检查。免疫组化检查对各类肿瘤的诊断、鉴别诊断及分类具有重要意义。

Objective To evaluate clinical application value of bone marrow biopsy in diagnosis of hematologic diseases. Methods 195 cases with suspected diagnosis of hematologic diseases underwent bone marrow biopsy on posterior superior iliac spine; paraffin embedding, HE, Gomori staining. In addition, Masson staining was used in myelofibrosis patients, and the relevant immunohistochemical staining was used in neoplastic patients. Results Among the 195 cases, there were 13 cases of normal human myelogram, 65 cases of aplastic anemia（AA）, 26 cases of chronic idiopathic myelofibrosis（ CIMF）, and 23 cases of myelodysplastic（ MDS）, 22 cases of various lymphocytoma, 18 cases of chronic myelogenous leukemia（CML）, 15 cases of medullary plasrnacytoma, 7 eases of essential thrombocythemia（ET）, 4 cases of myelosis caused by infection, and 2 cases of metastatic carcinoma. Conclusion Bone marrow biopsy is valuable in diagnosis of AA and CIMF with important clinical application value, and should be combined with clinical manifestations, assistant examinations, and bone marrow smear in diagnosing MDS, ET and other hyperplasia. Immnohistochemical staining is significant in neoplastic diagnosis, differential diagnosis and categorization.