骨髓形态检验在巨幼细胞性贫血与难治性贫血鉴别诊断中的意义

Evaluation of bone marrow morphology test in differential diagnosis of megaloblastic anemia and refractory anemia

目的观察比较巨幼细胞性贫血(megaloblastic anemia,MA)与难治性贫血(refractory anemia,RA)骨髓细胞形态检验差异,总结骨髓形态检验在两者鉴别诊断中的意义。方法选取本院2020年5月-2021年5月收治的贫血患者52例,根据临床诊断29例为MA组,23例为RA组,对比两组患者临床表现、骨髓形态检验和外周血涂片检验结果。结果MA组骨髓形态检验中粒系病态造血、红系病态造血、淋巴样小巨核细胞百分比低于RA组,差异有统计学意义(P<0.05),MA组红系巨幼变细胞的百分比高于RA组,差异有统计学意义(P<0.05),MA组外周血幼稚红细胞百分比、中性粒细胞碱性磷酸酶(NAP)积分均值与RA组相似,差异无统计学意义(P>0.05)。结论RA患者的骨髓形态检验主要特征是粒、红两系的病态造血及淋巴样的小巨核细胞,MA患者的骨髓细胞形态检验主要特征是红系的巨幼改变。因此骨髓形态检验对于MA与RA的鉴别具有重要的临床意义。

Objective To compare the difference of bone marrow morphology test between Megaloblastic anemia(MA)and refractory anemia(RA),and summarize the significance of bone marrow morphologic test in the differential diagnosis of the two.Methods Fifty-two cases of anemia patients admitted to our hospital from May 2020 to May 2021 were selected.According to clinical diagnosis,29 cases were MA group and 23 cases were RA group.Clinical manifestation,the results of bone marrow morphology test and peripheral blood smear test were compared between the two groups.Results In bone marrow morphology test,the percentage of granulocytic disease,erythroid disease,and lymphoid small megakaryocytes in Ma group was significantly lower than that in RA group,these differences were statistically significant(P<0.05).The percentage of erythroid megaloblastic variability cells in MA group was obviously higher than that in RA patients and with statistically significant difference(P<0.05).The percentage of immature red blood cells and Neutrophil alkaline phosphatase(NAP)integral mean were similar between MA group and RA group,without significant difference(P>0.05).Conclusion The main characteristics of bone marrow morphology test in patients with RA are dysplastic hematopoiesis in erythroid cells,granulocytic cells,lymphoid small megakaryocytes,and megaloblastic changes of erythroid is main characteristic in MA group.Therefore,bone marrow morphological test has important clinical significance for the differentiation of MA and RA.