恶性肿瘤骨髓转移实验室及临床特点分析

Research on laboratory of malignancy bone marrow metastasis and its clinical features

目的探讨骨髓转移癌患者的骨髓及外周血细胞形态特征及临床特征。方法回顾性分析本院21例确诊的骨髓转移癌患者,分析其骨髓象、外周血象、血液生化指标及临床特点。结果临床上最常见症状为贫血(16/21),其次为骨痛(11/21),再次为发热(5/21),然后为出血(3/21)和消瘦(2/21)。外周血涂片中,3例同时见到幼粒细胞和幼红细胞,4例仅见幼粒细胞,3例仅见幼红细胞。21例患者骨髓象中均可找到单个或成团、成簇出现的转移癌细胞。明确肿瘤原发灶者依次为肺癌5例、胃癌4例、乳腺癌2例、前列腺癌2例、肝癌2例、结直肠癌及鼻咽癌各1例,分布不明者4例。结论出现原因不明的贫血、发热、出血及骨痛且周围血中出现幼红、幼粒细胞时,应考虑骨髓转移癌的可能。骨髓穿刺是简单而有效的确诊手段。

Objective To investigate the clinical and cell morphology features of bone marrow and peripheral blood（ PB） in patients with metastatic carcinoma of bone marrow. Methods A total of 21 diagnosed patients with metastatic carcinoma of bone marrow were researched retrospectively. The bone marrow and peripheral blood and blood biochemical parameters and clinical features were retrospectively analyzed. Results Hematological abnormalities including anemia and thrombocytopenia was the most common symptom（ 16 /21）,and followed by osteodynia（ 11 /21）,fever（ 5 /21）,haemorrhage（ 3 /21） and marasmus（ 2 /21）. In peripheral blood smear,in three cases promyelocytic and erythroblast were found,in four cases only promyelocytic was found,and in three cases only erythroblast was found. Metastatic carcinoma cells could be found as a single or formed group or cluster in the bone marrow smears in all 21 patients. According to the ensured primary tumor,there were five cases of lung cancer,four cases of stomach cancer,two cases of breast cancer,two cases of prostate cancer,two cases of liver cancer,one case of colorectal cancer and one case of nasopharyngeal,and the distribution is unknown in 4 cases. Conclusion The possibility of metastatic carcinoma of bone marrow should be considered,if the symptoms include unexplained anemia,fever,hemorrhage and osteodynia,the presences of immature erythrocyte and immature granulocyte in peripheral blood smear. The bone marrow puncture is a simple and valuable method for the diagnosis of metastatic carcinoma of bone marrow.