骨髓形态学结合外周血片检查对全血细胞减少性疾病的诊断意义

Diagnostic significance of bone marrow morphology combined with peripheral blood smear examination in pancytopenia

目的探讨骨髓形态学结合外周血片检查对全血涂细胞减少性疾病的诊断意义。方法选取2010年1月~2017年6月我院收治的135例血细胞减少性疾病患者,根据血细胞减少类型分为A组(n=60,非全血细胞减少)和B组(n=75,全血细胞减少)。两组患者均进行外周血常规检查和骨髓形态学检查,统计两组患者的血小板(PLT)值、红细胞(RBC)值、白细胞(WBC)值、血红蛋白(Hb)值、平均血红蛋白浓度(MCHC)值、红细胞参数[红细胞平均体积(MCV)、红细胞平均血红蛋白量(MCH)]、血涂片检测结果,分析骨髓形态学结合外周血片检查在全细胞减少性疾病中的诊断价值。结果 A组患者的PLT值、RBC值、WBC值、Hb水平,均高于B组(P<0.05);A组中转移性肿瘤5例,骨髓增生异常综合征7例,脾功能亢进19例,巨幼红细胞性贫血29例。B组再生障碍性贫血44例,急性白血病31例。两组骨髓象形态学均伴有不同程度改变,A组脾功能亢进血片结果,均低于转移性肿瘤、骨髓增生异常综合征(P<0.05);B组再生障碍性贫血血片结果,均低于急性白血病,差异均有统计学意义(P<0.05);A组与B组不同疾病之间MCH量及MCV比较差异无统计学意义(P>0.05)。结论将骨髓形态学结合外周血片检查用于全血细胞减少性疾病效果理想,能提高临床诊断确诊率,值得推广应用。

Objective To investigate the significance of bone marrow morphology combined with peripheral blood smear examination in the diagnosis of pancytopenia.Methods A total of 135 patients with hematopoietic diseases who were admitted to our hospital from January 2010 to June 2017 were selected.According to the type of hemocytopenia,the patients were divided into group A （n=60,non-pancytopenia） and group B （n=75,paneytopenia）.Two groups of patients were all given routine examination of peripheral blood and bone marrow morphological examination.The levels of platelet （PLT）,erythrocyte （RBC）,leukocyte （WBC）,hemoglobin （Hb）,average hemoglobin concentration（MCHC）,erythrocyte parametersaverage volume of red blood cells（MCV）,and blood smear test results were statistically collected in both groups, and the diagnostic value of bone marrow morphology combined with peripheral blood smear examination in pancytopenia was analyzed.Results The levels of PLT,RBC,WBC cell and Hb in group A were all higher than those in group B （P〈0.05）.There were 5 cases of metastatic tumors in group A,7 cases of myelodysplastic syndromes,19 cases of splenic hyperthyroidism,and 29 cases of megaloblastic anemia.There were 44 cases of aplastie anemia in group B,and 31 cases of acute leukemia.The bone marrow morphology were accompanied by varying degrees of changes in both groups.The results of blood smear of hypersplenism in group A were significantly lower than those of metastatic tumor and myelodysplastic syndrome （P〈0.05）;the results of blood smear of aplastic anemia in group B were lower than those of a- cute leukemia （P〈0.05）;there were no statistically significant differences in the MCH hemoglobin and MCV between different diseases in group A and group B （P〉0.05）.Conclusion Bone marrow morphology combined with peripheral blood smear examination used for pancytopenia has an ideal effect,which can improve the clinical diagnosis rate and is worthy to be popularized and applied.