骨髓组织印片在急性白血病化疗后形态学评估中的价值

Application of bone marrow imprints in diagnosis of acute leukemia after chemotherapy

目的探讨骨髓组织印片在急性白血病化疗后形态学评估中的实用价值。方法收集126例次急性白血病患者化疗后同步进行骨髓涂片、组织印片和切片检查结果,比较骨髓涂片、组织印片和切片在有核细胞量、缓解度、诊断符合率性能指标中的差异。结果组织印片与骨髓涂片在有核细胞量分级分布差异有统计学意义(P=O.000),而组织印片与切片无统计学差异(P=0.997)。组织印片与骨髓涂片在显示缓解度分布有统计学差异(P=0.003),而组织印片与切片无统计学差异(P=0.955)。以切片显示缓解度为标准:切片完全缓解(CR)组中,组织印片与涂片符合率无统计学差异(98.6%、100%,P=1.000);切片部分缓解(PR)组中,组织印片与骨髓涂片符合率有统计学差异(88.4%、46.5%,P=0.000);切片未缓解(NR)组中,组织印片与骨髓涂片符合率有统计学差异(84.6%、38 5%,P=0.041);组织印片在灵敏度、特异度、阳性预测值、阳性似然比、Youden指数等性能指标总体上优于骨髓涂片。结论骨髓组织印片兼有涂片和切片的特征,组织印片联合骨髓涂片互补性检查,对急性白血病化疗后骨髓造血评估具有明显优势。

Objective To evaluate the application of bone marrow imprints in diagnosis of acute leukemia after chemotherapy. Methods Bone marrow aspiration, bone marrow imprints and bone marrow biopsy of 126 patients with acute leukemia after chemotherapy were collected. The amount of nucleated cells, the degree of remission, diagnostic accordance rate was compared among three methods. Results The grading distribution of nucleated cells in bone marrow imprints was significantly different to bone marrow aspiration （Х^2=29.452, P=0.000）, but close to that of bone marrow biopsy （Х^2 =0.589, P=0.997）. The degree of bone marrow remission shown on bone marrow imprints was significantly different to that on bone marrow aspiration （Х^2=11.389, P=0.003）, and close to that on bone marrow biopsy （Х^2=0.092, P=0.955）. With the results of bone marrow biopsy as gold standard, the diagnostic accordance rates in complete remission （CR） for bone marrow aspiration and bone marrow imprints were 98.6% and 100.0%, respectively （Fisher＇s exact probability P=1.000） ;the accordance rates in partial remission （PR） for bone marrow aspiration and bone marrow imprints were significantly different （88.4%, 46.5%, Х^2 =17.158, P=0.000）; the accordance rates in non-remission （NR） for bone marrow aspiration and bone marrow imprints were significantly different （84.6%, 38.5%, Х^2 =5.850, 17=0.041）. The overall sensitivity, specificity, positive predictive value, positive likelihood ratio, Youden index of bone marrow imprints were better than those of bone marrow aspiration. Conclusion Bone marrow imprints with characteristics of both bone marrow aspiration and bone marrow biopsy, have advantages for assessment of bone marrow hematopoietic in acute leukemia after chemotherapy.