骨髓增生异常综合征与巨幼细胞性贫血的实验室特点分析

Laboratory characteristics of myelodysplastic syndrome and megaloblastic anemia

目的探讨骨髓增生异常综合征(MDS)与巨幼细胞性贫血(MA)患者血液学指标及细胞形态学上的差异。方法选择2015年7月至2020年6月安徽医科大学附属合肥医院(合肥市第二人民医院)17例初诊MDS患者(MDS组)和18例MA患者(MA组),比较两组患者的血常规、生化检查及骨髓涂片的结果。结果两组患者的白细胞计数、血小板计数、血红蛋白、平均红细胞体积及总胆红素、间接胆红素进行比较,差异无统计学意义(P>0.05)。MA组患者乳酸脱氢酶高于MDS组,MDS组患者血清铁蛋白高于MA组,两组差异有统计学意义(P<0.05)。MDS组9例(52.94%)患者发生红系巨幼变,3例(17.64%)发生粒系巨幼变,14例(82.35%)红系出现其他病态造血,13例(76.47%)粒系出现其他的病态造血,8例(47.06%)患者出现淋巴样小巨核,13例(76.47%)患者的原始细胞增多,与MA组相比,差异有统计学意义(P<0.05)。结论联合血液学指标及骨髓细胞学检查,有利于鉴别诊断骨髓增生异常综合征与巨幼细胞性贫血。

Objective To investigate the differences in hematological indexes and cell morphology between myelodysplastic syndrome(MDS)and megaloblatic anemia(MA)patients.Methods From July 2015 to June 2020,17 newly diagnosed MDS patients and 18 MA patients were selected.The results of blood routine test,biochemical examination and bone marrow smear were compared between the two groups.Results Among 17 patients with myelodysplastic syndrome and 18 with megaloblatic anemia,there were no significance differences in the levels of white blood cell count,platelet count,hemoglobin,mean corpuscular volume,total bilirubin and indirect billirubin.The levels of serum lactate dehydrogenase in MA group was significantly higher than those in MDS group,but the level of serum SF was significantly lower than that in MDS group(P<0.05).In the bone marrow of MA group,megaloblastic changes of middle late erythroblastic were predominant in erythroid cells,while in MDS group,there were also H-J corpuscle,binucleate phenotypes and multinucleate cells in addition to middle late erythrocytic megaloblasty.Both MA and MDS showed different degrees of morbid hematopoiesis,including imbalance of nucleocytoplasmic development,nuclear swelling and cytoplasmic granule reduction.The rates of primitive cell(76.47%)and lymphoid micromegakaryocyte(47.06%)increasing in MDS were significantly higher than in MA(P<0.05).Conclusions The combination of hematological indexes with bone marrow cytology is conducive to the different ialdiagnosis of myelodysplastic syndrome and megaloblastic anemia.