骨髓活检、涂片对儿童血液疾病鉴别诊断的价值分析

Analysis of the Value of Bone Marrow Biopsy and Smear in Differential Diagnosis of Blood Diseases in Children

目的对儿童血液疾病鉴别应用骨髓活检、骨髓涂片的诊断价值进行研究分析。方法方便择取2018年9月—2019年9月间在该院进行治疗的血液学疾病患儿共50例作为研究分析对象,通过双标本同步获取骨髓活检以及骨髓涂片标本,对所有患儿进行骨髓活检以及骨髓涂片,对比两者对骨髓增生以及血液病诊断的差异,同时比较两者联合诊断的价值。结果在增生程度方面,骨髓活检明显高于骨髓涂片,在活跃者方面,骨髓活检活跃23例(88.46%),骨髓涂片活跃19例(73.08%),差异无统计学意义(χ^(2)=1.981,P=0.159);针对再生障碍性贫血以及非典型再生障碍性贫血诊断中,骨髓活检明显优于骨髓涂片,两者相结合明显更优,骨髓活检20例(76.92%)、6例(60.00%),骨髓涂片15例(57.69%)、4例(10.00%),相结合25例(96.15%)、9例(90.00%),差异有统计学意义(P<0.05);在免疫性血小板减少症诊断率方面,骨髓涂片明显高于骨髓活检,骨髓活检3例(37.50%),骨髓涂片5例(62.50%),差异有统计学意义(P<0.05);针对再生障碍性贫血患者治疗后造血功能评估方面,在造血恢复、障碍加重方面,骨髓活检明显优于骨髓涂片,差异有统计学意义(P<0.05),两者相结合,较骨髓涂片明显更优,差异有统计学意义(P<0.05),较骨髓活检差异无统计学意义(P﹥0.05);在对AL维持治疗期血象恢复延迟患儿中判断是否出现早期复发方面,骨髓活检明显优于骨髓涂片,两者结合明显更优,骨髓活检6例(30.00%),骨髓涂片4例(20.00%),相结合10例(50.00%),差异有统计学意义(P<0.05)。结论对不同血液疾病诊断中,骨髓活检以及骨髓涂片均有不同的优缺点,前者在对组织结构观察以及判断增生程度方面更优,后者在对细胞形态学改变观察中更优,通过两种方式结合能够显著提高对小儿血液疾病的诊断正确率,有效降低误诊几率,在临床儿科血液疾病诊断、治疗中具有重要价值。

Objective To study and analyze the diagnostic value of bone marrow biopsy and bone marrow smears in children with blood diseases.Methods A total of 50 children with hematological diseases who were treated in the hospital between September 2018 and September 2019 were conveniently selected as the research and analysis objects.The bone marrow biopsy and bone marrow smear specimens were obtained simultaneously through dual specimens.Perform bone marrow biopsy and bone marrow smear to compare the differences in the diagnosis of bone marrow hyperplasia and blood diseases,and compare the value of the combined diagnosis of the two.Results In terms of hyperplasia,bone marrow biopsy was significantly higher than bone marrow smear.In terms of active patients,23 cases(88.46%)were active on bone marrow biopsy and 19 cases(73.08%)were active on bone marrow smear.The difference was not statistically significant(χ^(2)=1.981,P=0.159);In the diagnosis of aplastic anemia and atypical aplastic anemia,bone marrow biopsy was significantly better than bone marrow smear,and the combination of the two was significantly better.Bone marrow biopsy was found in 20 cases(76.92%)and 6 cases(60.00%),bone marrow smear 15 cases(57.69%),4 cases(10.00%),combined with 25 cases(96.15%),9 cases(90.00%),the difference was statistically significant(P<0.05);in terms of the diagnosis rate of immune thrombocytopenia,bone marrow smears were significantly higher than bone marrow biopsy,bone marrow biopsy 3 cases(37.50%),bone marrow smear 5 cases(62.50%),the difference was statistically significant(P<0.05);for the evaluation of hematopoietic function in patients with aplastic anemia after treatment,bone marrow biopsy was significantly better than bone marrow smears in terms of hematopoietic recovery and aggravation of disorders,and the difference was statistically significant(P<0.05),the combination of the two was significantly better than the bone marrow smear.The difference was statistically significant(P<0.05),and the difference was not statistically significant compared with bone marrow biopsy(P﹥0.05);In judging whether there was early recurrence in children with delayed blood recovery during the maintenance treatment of AL,bone marrow biopsy was significantly better than bone marrow smear,and the combination of the two was significantly better.Bone marrow biopsy was in 6 cases(30.00%),bone marrow smears in 4 cases(20.00%),combined with 10 cases(50.00%),the difference was statistically significant(P<0.05).Conclusion In the diagnosis of different blood diseases,bone marrow biopsy and bone marrow smear have different advantages and disadvantages.The former is better in observing the tissue structure and judging the degree of hyperplasia,while the latter is better in observing the changes in cell morphology.The combination of these methods can significantly improve the accuracy of the diagnosis of pediatric blood diseases,effectively reduce the probability of misdiagnosis,and has important value in the diagnosis and treatment of clinical pediatric blood diseases.