病态造血特征对骨髓增生异常综合征分型诊断价值的探讨

Diagnostic Value of Dysplasia Characteristics in Typing of Myelodysplastic Syndrome

本研究探讨细胞病态造血特点对于骨髓增生异常综合征(MDS)诊断的实用价值。通过细胞形态学、细胞组织化学染色、骨髓病理学检查,分析64例WHO-MDS患者病态造血特点,评估其对于疾病判断的灵敏度、特异性等指标的意义。结果表明,外周血出现原始细胞、巨核细胞,骨髓粒系Auer小体、假性Pelger-Huёr畸形,幼红细胞空泡,微小巨核对于WHO-MDS诊断灵敏度虽然不高,分别为34.4%,3.1%,3.1%,75.0%,6.3%,42.4%,但其诊断特异性均为100%。幼红细胞奇数核、核畸形、核碎裂、核出芽、环形铁粒幼细胞,及单圆核、多圆核巨核细胞对于WHO-MDS诊断也有一定参考价值。通过骨髓病理学检查,同样发现WHO-MDS患者三系出现病态造血,并且4例RCMD患者,12例RAEB患者检出幼稚前体细胞异常定位(ALIP)。超过半数WHO-MDS患者有轻至中度网硬蛋白纤维增生。结论:细胞形态学是诊断WHO-MDS的重要基础和关键,多种检测方法联合应用可以提高MDS早期诊断的准确性。

This study was purposed to investigate the diagnostic value of hematopoietic cell dysplasia in myelodys plastic syndrome （MDS）. Sixtyfour cases of WHOMDS were detected by cytomorphology, cytohistochemical staining and bone marrow biopsy. The characteristics of hematopoietic cell dysplasia were analyzed, and its sensitivity and speci ficity were evaluated for WHOMDS diagnosis. The results showed that though myeloblast, megakaryocyes presented in peripheral blood and granular Auer body, abnormal granular pseudo PelgerHu^r, vacuole of erythroid, micromegakaryo cyes appeared in bone marrow for diagnosis sensitivity were not very high, and respectively were 34.4% ,3.1%, 3.1%, 75.0% ,6.3% ,42.4%, the specificity of these characteristics was 100%. Moreover, erythroid odd nucleus, nuclear de formity, fragmentation, nuclear budding, ring sideroblasts, single and more round nuclear megakaryocyte had better ref erence value for WHOMDS diagnosis. By bone marrow biopsy, the dysplasia and abnormal localization of immature precursor （ALIP） also were found in patients with WHOMDS. More than half patients with WHOMDS had mild to moderate increase in reticulin fibres. It is concluded that the cytomorphology assay is the base and key for the diagnosis of WHOMDS. Diagnostic accuracy can be improved by combinative use of a variety of detection methods.