3374例血液病患者骨髓细胞形态及活检同步检测的比较分析

The Comparative analysis of bone marrow cell morphology and biopsy in 3374 patients with hematologic diseases

目的探讨骨髓细胞形态与骨髓活检病理同步检测在血液病诊断与鉴别诊断中的价值。方法采用骨髓抽吸-活检双标本取材术,获取骨髓涂片、活检标本,对我院3374例血液病患者的血涂片、骨髓涂片与活检切片的细胞形态及病理变化进行比较研究。结果骨髓活检的增生度明显高于涂片(P<0.05);骨髓活检对急性白血病(AL)、慢性粒细胞白血病(CML)、慢性淋巴细胞白血病(CLL)、多发性骨髓瘤(MM)、骨髓转移癌(MCBM)、淋巴瘤、骨髓纤维化(MF)、骨髓增生异常综合征(MDS)、再生障碍性贫血(AA)诊断的阳性率高于涂片(P<0.05);骨髓涂片对特发性血小板减少性紫癜(ITP)、骨髓感染诊断的阳性率明显高于活检(P<0.05)。MDS粒系病态造血的检出率骨髓活检高于涂片;红系及巨核系病态造血的检出率骨髓涂片高于活检。骨髓活检观察粒系幼稚前体细胞异常定位(ALIP)、巨核细胞异常分布、基质病理改变具有明显优势。结论骨髓细胞形态与骨髓活检病理检查相结合可以明显提高血液病的诊断率、减少漏诊,对血液病的诊断与鉴别诊断具有非常重要的意义。

Objective To investigate the value of bone marrow biopsy in diagnosis and differential diagnosis of hematological diseases. Methods Using bone marrow aspiration - biopsy double specimens surgery to obtain bone marrow specimen and biopsy specimens, and the cell morphology and pathological changes of blood smears, bone marrow smear and biopsy specimens of 3374 hematological diseases patients were done with comparative study. Results The hyperplasia of bone marrow biopsy was significantly higher than that of smear（P〈0.05） ;Bone marrow biopsy for a- cute leukemia （AL）, chronic myeloid leukemia （CML）, chronic lymphocytic leukemia （CLL）, multiple myeloma （MM） ,lymphoma, bone marrow fibrosis （MF）, bone marrow hyperplasia （MDS）, and MCBM （AA） were diagnosed with a higher positive rate （P-0.05） ;The positive rate of bone marrow smear on idiopathic thrombocytopenic purpura （ITP） and bone marrow infection was significantly higher than that of biopsy （P〈0.05）. The detection rate of bone marrow biopsy in the patients with MDS was higher than that of smear;The detection rate of pathological hematopoie- sis in the red line and the giant nuclear system was higher than that of bone marrow biopsy. The abnormal localization of immature precursor cells （ALIP） was observed by bone marrow biopsy,and the abnormal segments of the giant cells were observed. The pathological changes of the immature precursor cells （ALIP）,the abnormal segment of the giant cells, and the matrix pathological changes were significantly superior. Conclusion The bone marrow cell morphology and bone marrow biopsy combined with pathological examination can improve the diagnosis rate and reduce the missed diagnosis, It has very important significance for the diagnosis and differential diagnosis of hematological diseases.