继发性与原发性骨髓纤维化骨髓组织形态学观察及临床意义

Morphology of bone marrow in patients with secondary myelofibrosis and primary myelofibrosis and its clinical significance

目的观察恶性血液病继发骨髓纤维化患者的临床情况和骨髓病理学特征,探讨继发性骨髓纤维化与原发性骨髓纤维化在临床表现及骨髓组织形态的差异。方法对69例继发性骨髓纤维化(SMF)患者分别采用骨髓活检塑料包埋切片HGE(苏木素-吉姆萨-伊红)染色和骨髓涂片Wright染色进行组织与细胞形态学对比观察,并与36例原发性骨髓纤维化纤维化期(PMF-F)患者骨髓组织形态进行回顾性比较分析。结果 69例SMF患者初诊年龄显著低于PMF患者(P<0.05),在初诊时贫血的检出率差异有统计学意义(P<0.05),其他实验室指标包括血红蛋白、白细胞数量、血小板数量没有显著差异。两组病例在骨髓涂片以及骨髓活检的增生程度差异有统计学意义(P<0.05),在骨髓活检网状纤维染色不同级别网状纤维检出率差异有统计学意义(P<0.05)。结论①继发骨髓纤维化的发生年龄小,且多取决于其基础疾病的发生年龄。②继发性骨髓纤维化骨髓涂片和骨髓活检的增生程度与原发性骨髓纤维化相比,增生情况较好,对临床年轻的骨髓纤维化患者及早寻找原发病因,进行鉴别诊断具有重要意义。

Objective To explore the difference of clinical features and morphology between secondary myelofibrosis and primary myelofibrosis.Methods Histopathology analysis of bone marrow by biopsy plastic-embedded sections stained with HGE and by bone marrow smear stained with Wright and clinical features in 69 patients with secondary myelofibrosis（SMF） and 36 patients with primary myelofibrosis（PMF） were reviewed retrospectively.Results The age of SMF patients was significantly lower than that of PMF patients（P〈0.05）.The detection rate of mild anemia was significantly different between SMF and PMF（P〈0.05）.Other laboratory features including hemoglobin,white blood cell count,and platelet count showed no significant difference.The proliferation of bone marrow smear and bone marrow biopsy were significantly different between SMF and PMF（P〈0.05）.And the detection rate of the reticular fiber with Gomori’s stains was also significantly different in bone marrow biopsy between SMF and PMF（P〈0.05）.Conclusion The patients with SMF are younger than PMF patients,depending on the age of their underlying diseases.Compared with PMF,the proliferation of bone marrow smears and bone marrow biopsy is better in SMF,which is important to find the original cause of myelofibrosis in young patients and make the differential daignosis.