骨髓活检小巨核细胞酶标染色对骨髓增生异常综合征的诊断价值

The diagnostic value to meylodysplastic syndrome by using enzyme labeling of micromegakaryocytes in bone marrow biopsy

目的利用骨髓活检切片进行小巨核细胞酶标染色以检测骨髓增生异常综合征(MDS)患者小巨核细胞的情况,从而判断骨髓活检小巨核细胞酶标染色对MDS的诊断价值。方法分别对我院52例初诊为MDS患者的骨髓涂片及骨髓活检切片进行巨核细胞特异性抗体(CD41a)标记碱性磷酸酶抗碱性磷酸酶(APAAP)方法染色并与骨髓涂片常规瑞特染色方法对比镜检小巨核细胞的情况。结果 52例MDS患者骨髓涂片瑞特染色法中有18例检出小巨核细胞,阳性率为34.6%,0例检出淋巴样小巨核细胞,阳性率为0;骨髓涂片联合APAAP法中有30例检出小巨核细胞,阳性率为57.7%,22例检出淋巴样小巨核细胞,阳性率为42.3%;骨髓活检切片联合APAAP法有48例检出小巨核细胞,阳性率为92.3%,47例检出淋巴样小巨核细胞,阳性率为90.4%。三种方法检出小巨核细胞阳性率相比差异有统计学意义(P<0.05)。三种方法检出淋巴样小巨核细胞阳性率相比,差异有统计学意义(P<0.05)。其中骨髓活检切片酶标染色法检出小巨核细胞阳性率和淋巴样小巨核细胞阳性率最高。结论利用骨髓活检切片进行小巨核细胞酶标染色能更准确检出小巨核细胞和淋巴样小巨核细胞,并能直观显示巨核病态造血分布情况,为MDS早期诊断提供可靠依据。

Objective Using of bone marrow biopsy of small megakaryocytes with enzyme labeling staining to detect myelodysplastic syndrome（MDS） patients＇ micromegakaryocytes（SMK） condition,so as to judge the diagnoise value of bone marrow biopsy of small megakaryocytes enzyme staining in patients with MDS.Methods To detect small megakaryocytes condition on 52 cases in our hospital diagnosed as MDS patients with bone marrow smear and bone marrow biopsy of megakaryocyte specific antibodies（CD41a） labeled with alkaline phosphatase antialkaline phosphatase（APAAP） method for staining of bone marrow smear and with conventional staining method.Results 18 cases of 52 cases of MDS patients＇ bone marrow with smear staining method detect of micromegakaryocytes,the pnositive rate was 34.6%,0 cases with lymphoid small megakaryocytes,the positive rate was 0.30 cases of 52 cases using bone marrow smear combined with APAAP method detect of micromegakaryocytes,the positive rate was 57.7%,22 cases with lymphoid small megakaryocytes,the positive rate was 42.3%.48 cases of 52 cases using bone marrow biopsy combined with APAAP method detect of micromegakaryocytes,the positive rate was 92.3%,47 cases with lymphoid small megakaryocytes,the positive rate was 90.4%.Compared the three methods for detection of micromegakaryocytes＇ positive rate wiith Chi square test,there was a statistically significant difference between them（P0.05）.Compared the three methods for detection of lymphoid micromegakaryocyte positive＇s rate with Chi square test,P 0.05,there was a statistically significant difference between the three methods（P 0.05）.We can see,bone marrow biopsy enzyme staining method for detection of micromegakaryocytes positive＇s rate and lymphoid micromegakaryocyte positive＇s rate is the highest.Conclusion Using of bone marrow biopsy for small megakaryocytes enzyme labeling staining can detect of micromegakaryocytes and lymphoid small megakaryocytes much more accurated,and can visually display the megakaryocyte morbid hematopoietic distribution,and provides reliable basis for early diagnosis of MDS.