实验室检查在多发性骨髓瘤、淋巴瘤骨髓浸润、癌骨髓转移鉴别诊断中的价值

Differential diagnosis value on laboratory analysis in the patients with multiple myeloma,lymphomatosis with bone marrow infiltration and metastatic carcinoma of bone marrow

目的研究多发性骨髓瘤、淋巴瘤骨髓浸润、癌骨髓转移的骨髓形态学和实验室检查特点,提高对这3种疾病的实验室鉴别诊断水平。方法回顾分析多发性骨髓瘤53例、淋巴瘤细胞骨髓浸润24例和骨髓转移癌13例的骨髓形态学特点和实验室相关指标。结果骨髓瘤细胞、淋巴瘤细胞、癌细胞在骨髓涂片中的形态各有其独特的特点,经过仔细观察基本上可加以区别。实验室相关指标中,多发性骨髓瘤球蛋白84.6%升高且77.4%球蛋白大于40g/L,淋巴瘤骨髓浸润、癌骨髓转移球蛋白多为正常或降低。多发性骨髓瘤红细胞沉降率(ESR)96.2%升高且81.1%ESR大于50mm/h,淋巴瘤骨髓浸润和癌骨髓转移ESR多低于50mm/h。对癌骨髓转移较有价值的指标为血清碱性磷酸酶,69.2%癌骨髓转移ALP升高,且均大于200U/L以上,而淋巴瘤骨髓浸润和多发性骨髓瘤较少出现ALP升高。结论加强对骨髓瘤细胞、淋巴瘤细胞、癌细胞的形态学识别能力,提高形态学诊断水平,并结合实验室相关指标综合分析,可避免对多发性骨髓瘤、淋巴瘤骨髓浸润、癌骨髓转移的漏诊和误诊。

Objective To study the the bone marrow morphology and laboratory diagnosis of the patients with multiple myeloma（MM）,lymphomatosis with bone marrow infiltration（LBMI） and metastatic carcinoma of bone marrow（MCBM）.Methods The bone marrow morphologic features and laboratory relative indicators were analysed from patients with MM,LBMI and MCBM.Results The bone marrow morphologic features were different from myeloma cells,lymphoma cells and cancer cells with the bone marrow smears,which can be basically distinguished after careful observation.The globulin of 84.6% patients with MM were higher than normal,77.4% of which were more than 40g/L,but it was normal or lower in patients with LBMI and MCBM;ESR of 96.2% patients with MM were higher,81.1% of which were more than 50 mm/h,but most of LBMI and MCBM were less than 50 mm/h.The serum alkaline phosphatase（ALP） of 69.2% patients with MCBM were increased,which were more than 200 U/L,while only a few patients with MM and LBMI were higher than normal.Conclusion Improving the morphological diagnosis of myeloma cells,lymphoma cells and cancer cells,and combining the comprehensive analysis of related laboratory parameters,could avoid the misdiagnosis and missed diagnosis of there there dieases.