骨髓细胞形态、细胞化学染色及骨髓活检切片联合检测在低原始细胞骨髓增生异常综合征与溶血性贫血鉴别诊断中的价值

Significance of Morphological Examination,Cytochemical Staining Combined with Bone Marrow Biopsy in Differential Diagnosis of Myelodysplastic Syndrome with Low Blasts and Hemolytic Anemia

目的:探讨骨髓细胞形态、细胞化学染色和骨髓活检切片联合检测低原始细胞骨髓增生异常综合症(myelodysplastic syndrome,MDS)与溶血性贫hemolytic anemia,HA)鉴别诊断中的价值。方法:回顾性分析解放军总医院2009年9月到20巧年3月确诊的低原始细胞(<5%)MDS患者85例,HA患者61例的临床数据,比较两组一般临床特征、细胞遗传学和分子遗传学参数、骨髓细胞计数以及形态特征、细胞化学染色参数及骨髓活检特征的差异。结果:MDS组与HA组患者的一般临床特征相比较,其差异无统计学意义(P>0.05);而MDS组巨核病态造血发生率、环核铁粒幼红细胞阳性率和阳性水平、幼红细胞糖原阳性率和阳性水平、骨髓活检中MDS幼稚前体细胞异常定位及巨核病态造血发生率均明显高于HA组,其差异均具有统计学意义(P<0.05)。联合检测可识别90.6%的低原始细胞MDS。结论:骨髓细胞形态、细胞化学染色及骨髓活检切片联合检测能及时、准确地鉴别诊断低原始细胞MDS与HA。

Objective:To explore the value of morphological examination,cytochemical staining combined with bone marrow biopsy in the differential diagnosis between myelodysplastic syndrome(MDS) with low blasts and hemolytic anemia(HA).Methods:The clinical data of 85 cases of myelodysplastic syndrome with low blasts(<5%) and61 patients with hemolytic anemia in Chinese PLA's Gerneral hospital from September 2009 to March 2015 were retrospectively analysed.The clinical characteristics,cytogenetic and molecular features,bone marrow cell count and morphology features,cytochemical staining results and bone marrow biopsy features of above-methioned patients were compared.Results:There was no significant difference(P > 0.05) in clinical data between MDS group and HA group.Megakaryocytic dysplasia-positive rate,and ring sideroblasts positive rate,and PAS positive rate were significantly higher in MDS group than those that in HA group(P <0.05).Abnormal localization of immature precursors(ALIP) and megakaryocytic dysplasia positive rate in bone marrow biopsy were significantly higher in MDS group than those that in HA group(P <0.05),90.6%of MDS with low blasts patients were identifiable by combined detections.Conclusion:Combining detection of morphology,cytochemistry staining and bone marrow biopsy has been confirmed to be more useful for differential diagnosis between MDS with low blasts and HA.