胸骨穿刺对髂骨增生低下骨髓增生异常综合征诊断意义探讨

Discussion on the significance of sternal puncture in diagnosis of myelodysplastic syndrome patients with hypoplasia through iliac puncture

目的:探讨胸骨骨穿对于骨髓增生异常综合征(MDS)的诊断意义。方法:分析我院31例经胸骨骨穿诊断的MDS,对同期的髂骨和胸骨骨髓像进行对比研究。结果:31例经胸骨诊断为MDS的患者髂骨穿刺及髂骨活检表现为增生低下,按WHO分型均为MDS-RCMD;31例髂骨骨髓增生低下患者粒系、红系少见病态造血,粒系仅6.5%(2例)出现巨幼样变,12.9%(4例)患者出现核浆发育失衡,红系仅6.5%(2例)患者出现巨幼样改变,巨核细胞少见,仅3.2%(1例)患者见到4个巨核细胞,未见到病态巨核细胞;相反,同期的胸骨骨髓均表现为增生活跃或明显活跃,三系病态造血明显,在粒系病态造血表现中54.8%(17例)出现双核粒,71.0%(22例)出现了巨幼样粒细胞,93.5%(29例)出现了核浆发育失衡粒细胞,22.6%(7例)出现了假性派胡细胞;红系病态造血表现中,35.5%(11例)患者出现三核红细胞,77.4%(24例)患者出现巨幼样红细胞;87.1%(27例)患者巨核系统出现病态造血,其中小巨核、单圆核、双圆核、三圆核巨核出现的比例分别为19.4%(6例)、77.4%(24例)、35.5%(11例)、35.5%(11例)。结论:部分MDS患者表现为髂骨增生低下,髂骨穿刺发现病态造血的概率低,胸骨穿刺能有效地发现具有重要意义的病态造血表现,为诊断提供明确的依据,是诊断此类MDS的重要方法。

Objective：To explore the significance of sternal puncture in the diagnosis of MDS. Method：We analyzed 31 MDS cases which were all diagnosed by sternal puncture and compared the morphology of bone marrow cells obtained from ilium and sternum at the same time. Result：These MDS patients were all diagnosed hypoplastic through bone marrow aspiration and bone marrow biopsy at ilium,and finally diagnosed as RCMD according to WHO classification after sternal puncture;there was little dysplasia in granulopoiesis and erythropoiesis anmong these 31 cases with low hyperplasia through iliac puncture bone marrow aspirates.Only 6.5%（2 cases） patients had Megaloblastoid changes and 12.9%（4 cases）patients had nuclear-cytoplasm asynchrony in granulopoiesis;Only 6.5%（2 cases） patients had Megaloblastoid changes in erythropoiesis;Only 3.2%（1 case） patients had four megakaryocytes,other patients did not have megakaryocytes and the four megakaryocytes were normal;On the other hand,in the same period,all patients＇bone marrows were active or more active though sternal puncture,and the dysplasia was obvious.The number and incidence of multinuclearity,megaloblastoid,nuclear-cytoplasm asynchrony in granulopoiesis was 17（54.8%）,22（71%）,29（93.5%）;In erythropoiesis,the number and incidence of multinuclearity,megaloblastoid was 11（35.5%）,24（77.4%）;In megakaryocytic series,87.1%（27 cases） patients had dysplasia.The number and incidence of micromegakaryocytes,round nucleus,binucleated megakaryocyte,megakaryocyte with round separated nuclei was 6 cases（19.4%）,24 cases（77.4%）,11 cases（35.5%）,11 cases（35.5%）. Conclusion：Some MDS patients show hypoplastic through iliac puncture bone marrow aspirates,the chance of fouding dysplasia is very low.However we can effectively found significant pathological hematopoietic performance through sternal puncture,and the significant dysplasia is very important for the diagnosis of MDS.As a result,sternal puncture is a major method for diagnosis of such MDS.