巨核细胞胞核形态在3种骨髓增殖性肿瘤鉴别诊断中的价值

The value of nuclear morphology of megakaryocytes in the differential diagnosis of primary thrombocytosis,polycytosis and early primary myelofibrosis

目的探讨骨髓涂片中巨核细胞胞核形态在原发性血小板增多症(ET)、真性红细胞增多症(PV)及早期原发性骨髓纤维化(PMF)鉴别诊断中的价值。方法回顾性分析2009年1月至2018年9月的113例3种骨髓增殖性肿瘤(MPN)的骨髓涂片,将其分为ET组、PV组及早期PMF组,计算出各组中的3型巨核细胞胞核形态(高分叶型、低分叶型及核固缩型巨核细胞)所占的比例,并比较各型在疾病组中的差异,同时界定特定疾病中的临界百分比,计算出各疾病组的诊断效率。结果ET组高分叶型巨核细胞检出率最高[(31.12±9.34)%],分别与PV组、早期PMF组比较,差异均有统计学意义(P<0.05);PV组低分叶型巨核细胞检出率最高[(30.84±5.97)%],分别与ET组、早期PMF组比较,差异均有统计学意义(P<0.05);早期PMF组核固缩型巨核细胞检出率最高[(18.62±2.38)%],分别与ET组、PV组比较,差异均有统计学意义(P<0.05)。高分叶型巨核细胞在ET组的临界百分比为21.8%;低分叶型巨核细胞在PV组的临界百分比为24.9%;核固缩型巨核细胞在早期PMF组的临界百分比为16.2%。高分叶型巨核细胞占ET的百分比大于21.8%时,诊断效率(即准确度)为90.1%;低分叶型巨核细胞占PV的百分比大于24.9%时,诊断效率为87.9%;核固缩型巨核细胞占早期PMF的百分比大于16.2%时,诊断效率为97.2%。结论高分叶型巨核细胞的形态及其百分比增高在3种MPN中对ET有具有鉴别诊断价值;低分叶型巨核细胞的形态及其百分比增高在3种MPN中对PV有具有鉴别诊断价值;核固缩型巨核细胞的形态及百分比增高在3种MPN中对早期PMF有具有鉴别诊断价值。当鉴别3种MPN疾病有困难时,可使用巨核细胞胞核形态来提供辅助诊断信息,上述方法方便、直观、高效、易于推广,具有较高的实用价值。

Objective To explore the value of megakaryocytes in bone marrow smears in the differential diagnosis of primary thrombocytosis(ET),polycytosis(PV)and early primary myelofibrosis(PMF).Methods A retrospective analysis of 113 cases of three kinds of bone marrow hyperplastic tumor(MPN)of bone marrow smear from January 2009 to September 2018 was performed.All cases were divided into ET group,PV group and early PMF.The proportion of megakaryocyte nuclei form(high leaf type,leaf type and low nuclear pyknosis megakaryocyte)was calculated and compared the differences of each model.The critical percentage of specific diseases was defined at the same time.The diagnosis efficiency was calculated for each disease.Results The highest detection rate of high-resolution foliar megakaryocytes was found in ET group[(31.12±9.34)%],and the difference was statistically significant compared with that in PV group and early PMF group(P<0.05).PV group had the highest detection rate of low-foliated megakaryocytes[(30.84±5.97)%],which was statistically significant compared with ET group and early PMF group(P<0.05).The early PMF group had the highest detection rate of megakaryocytes[(18.62±2.38)%],which was statistically significant compared with ET group and PV group(P<0.05).The critical percentage of high-lobulated megakaryocytes in ET group,PV group,and early PMF group was 21.8%,24.9%,16.2%,respectively.When the percentage of high-lobulated megakaryocytes to ET was greater than 21.8%,the diagnostic efficiency(accuracy)was 90.1%.When the percentage of low-lobulated megakaryocytes to PV was greater than 24.9%,the diagnostic efficiency was 87.9%.When the percentage of nuclear-pyknosised megakaryocytes accounted for more than 16.2%of early PMF,the diagnostic efficiency was 97.2%.Conclusion The morphology and percentage increase of hyperlobular megakaryocytes have differential diagnostic value for ET in 3 types of MPN.The increase of the morphology and percentage of low-lobulated megakaryocytes has the value of differential diagnosis for PV in 3 types of MPN.The increase of the morphology and percentage of nuclear-pyknosised megakaryocytes in 3 types of MPN has the value of differential diagnosis of early PMF.When it is difficult to distinguish three kinds of MPN diseases,the nuclear morphology of megakaryocytes can be used to provide diagnostic information,which is convenient,intuitive,efficient,easy to popularize,and has high practical value.