细胞形态学联合血液指标鉴别诊断骨髓增生异常综合征与巨幼细胞性贫血

Differential Diagnosis in Myelodysplastic Syndromes and Megaloblastic Anemia

目的根据2016年WHO分型新标准,从临床特点、常用的血液指标以及细胞形态学对骨髓增生异常综合征(MDS)和巨幼细胞性贫血(MA)进行分析及鉴别。方法回顾性分析本院26例MDS和28例MA患者的血常规数据、血清铁蛋白(SF)、乳酸脱氢酶(LDH)、维生素B12(B12)检测结果 ,用独立t检验比较两组之间有无统计学差异。对26例MDS及15例MA患者的骨髓及血细胞形态进行分析,用χ~2检验比较两组之间有无统计学差异。结果 MDS组和MA组的RBC、MCV差异具有显著性意义,而Hb、RDW差异不具有显著性意义;MDS组和MA组的LDH、B12差异具有显著性意义,而SF差异不具有显著性意义。在外周血细胞形态中MDS组和MA组的原始细胞、巨红细胞差异具有显著性意义;在骨髓细胞形态中MDS组和MA组的原始细胞(≥5%)、核浆发育不平衡、(类)巨幼变幼红细胞、环形铁粒幼细胞、小巨核细胞、单圆核巨核细胞差异具有显著性意义;MDS组和MA组在骨髓细胞形态三系病态造血比例超出10%上差异不具有显著性意义。结论联合外周血及骨髓细胞形态学、血液指标,有利于鉴别MDS和MA。

To investigate the clinical manifestation,blood index and morphology on differential diagnosis in myelodysplastic syndromes and megaloblastic anemia according to the 2016 revision of WHO classification.Methods Blood indexes of CBC and SF,LDH,VitB12 were retrospectively analyzed on 26 patients with myelodysplastic syndromes and 28 with megaloblastic anemia.Morphology of bone marrow and peripheral blood was retrospectively analyzed on 26 patients with myelodysplastic syndromes and 15 with megaloblastic anemia.Results Between 26 patients with myelodysplastic syndromes and 28 with megaloblastic anemia,there were significance differences of the levels of RBC,MCV,LDH,VitB12 and no significance differences of the levels of Hb,RDW,SF.Between 26 patients with myelodysplastic syndromes and 15 with megaloblastic anemia,there were significance differences of the levels of blast,megalocyte in peripheral blood and of blast(≥5%),imbalance of nuclear and plasma,megaloblast,ring sideroblast,micromegakaryocyte,single round nuclear megakaryocyte in bone marrow.There were no significance differences of dysplasia(>10%).Conclusion Differential diagnosis in myelodysplastic syndromes and megaloblastic anemia could be analyzed by combination with morphology and blood index.