血细胞减少或增多患者骨髓穿刺干抽的相关原因分析

Causes of bone marrow dry pumping in patients with hypocytosis or hematocytosis

目的分析血细胞减少或增多患者骨髓穿刺干抽的相关原因。方法选择2012年1月至2017年8月连云港市第二人民医院收治的34例骨髓穿刺干抽的血细胞减少或增多患者，进行骨髓组织学、网状纤维染色以及选择性免疫组织化学染色检查。结果患者以头晕、乏力、脾大、盗汗、出血为主要表现，原发性骨髓纤维化17例（50.0%），慢性粒细胞白血病4例（11.8%），急性髓系白血病2例（5.9%），急性淋巴细胞白血病1例（2.9%），骨髓增生异常综合征2例（5.9%），多发性骨髓瘤2例（5.9%），非霍奇金淋巴瘤骨髓浸润2例（5.9%），真性红细胞增多症1例（2.9%），骨髓转移癌3例（8.8%）。原发性骨髓纤维化患者骨髓增生程度以Ⅱ~Ⅳ级为主，非原发性骨髓纤维化患者以Ⅲ~Ⅴ级为主，两组骨髓增生程度构成差异有统计学意义（χ2=12.900，P=0.004）；原发性骨髓纤维化患者纤维化程度以2~3级为主，非原发性骨髓纤维化患者以1~2级为主，两组骨髓纤维化程度构成差异有统计学意义（χ2=12.692，P=0.003）。结论血液系统肿瘤尤其原发性骨髓纤维化是骨髓穿刺干抽的常见原因。骨髓组织学、网状纤维染色以及选择性免疫组织化学染色对明确病因具有重要意义。

ObjectiveTo analyze some related causes of hypocytosis or hematocytosis with bone marrow dry pumping.MethodsBone marrow histology, reticular fiber staining and selective immunohistochemical staining were performed in 34 bone marrow dry pumping patients with hypocytosis or hematocytosis in the Second People＇s Hospital of Lianyungang from January 2012 to August 2017.ResultsAll the patients showed dizziness, fatigue, splenomegaly, night sweats and bleeding, including primary myelofibrosis （17 cases, 50.0%）, chronic myelocytic leukemia （4 cases, 11.8%）, acute myelocytic leukemia （2 cases, 5.9%）, acute lymphoblastic leukemia （1 case, 2.9%）, myelodysplastic syndrome （2 cases, 5.9%）, multiple myeloma （2 cases, 5.9%）, non-Hodgkin lymphoma with bone marrow infiltration （2 cases, 5.9%）, polycythemia vera （1 case, 2.9%） and bone marrow metastatic tumor （3 cases, 8.8%）. The bone marrow proliferative degree in primary myelofibrosis group was mainly ＂grade Ⅱ＂ to ＂grade Ⅳ＂, and the non primary myelofibrosis group was mainly ＂grade Ⅲ＂ to ＂grade Ⅴ＂, and the differences of proliferative degree component between them were statically significant （χ2= 12.900, P= 0.004）. The fibrosis level in primary myelofibrosis group was mainly ＂grade 2＂ to ＂grade 3＂, and the non primary myelofibrosis group was mainly ＂grade 1＂ to ＂grade 2＂, and the differences of myelofibrosis degree component between them were also statistically significant （χ2= 12.692, P= 0.003）.ConclusionsHematological malignancies, especially primary myelofibrosis, are the common causes of bone marrow ＂dry pumping＂. Bone marrow histology, reticular fiber staining and selective immunohistochemical staining are of great significance in the etiological diagnosis.