18例骨髓坏死患者的临床特征及实验室检查结果分析

Analysis of clinical features and laboratory examination results of 18 patients with bone marrow necrosis

目的分析骨髓坏死(BMN)的临床特征及实验室检查结果,加强临床对该类疾病的认识。方法选取2017年1月至2021年1月于复旦大学附属中山医院行骨髓涂片细胞形态学检查提示为BMN的患者18例为研究对象,对其临床特征及相关实验室检查结果进行分析。结果 18例患者原发疾病主要为恶性肿瘤(83.3%)。临床症状以发热、骨痛、乏力最常见。排除3例无法取得活检组织的患者,骨髓病理活检提示BMN患者8例(53.3%),坏死分级:Ⅱ级2例(25.0%),Ⅲ级6例(75.0%);骨髓纤维化患者11例(73.3%),骨髓纤维化半定量分级:MF-1级5例(45.5%),MF-2级3例(27.3%),MF-3级3例(27.3%)。实验室检查结果:外周血涂片可见幼稚粒细胞、幼稚红细胞,贫血、血小板计数减低、白细胞计数减低,乳酸脱氢酶、碱性磷酸酶、纤维蛋白原、D-二聚体、C反应蛋白、红细胞沉降率、网织红细胞百分比、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、铁蛋白、尿酸、白细胞介素-2受体、白细胞介素-6升高较常见。结论 BMN病因多种多样,建议临床对疑似患者及时进行骨髓细胞形态学、骨髓病理活检以辅助确诊BMN,从而做到早诊断、早治疗,改善患者预后,提高生存率。

Objective To analyze the clinical features and laboratory examination results of bone marrow necrosis(BMN) to strengthen clinical understanding of this type of disease.Methods Eighteen patients with BMN who underwent bone marrow smear cell morphology examination at Zhongshan Hospital, Fudan University from January 2017 to January 2021 were selected as the research objects.Analyzed the clinical features and laboratory examination results of the research objects.Results The primary disease of 18 patients was mainly malignant tumor(83.3%).The most common clinical symptoms were fever, bone pain and fatigue.Excluding 3 patients who could not get biopsy tissue, bone marrow pathological biopsy revealed 8 patients(53.3%) with BMN,necrosis grading included 2 cases(25.0%) of grade Ⅱ,6 cases(75.0%) of grade Ⅲ.A total of 11 cases(73.3%) with myelofibrosis, semi-quantitative classification of myelofibrosis included MF-1 grade 5 cases(45.5%),MF-2 grade 3 cases(27.3%),MF-3 grade 3 cases(27.3%).Laboratory examination results showed that peripheral blood smears found fine grains and young red blood cells, anemia, decreased platelet count, decreased white blood cell count, elevated lactate dehydrogenase, alkaline phosphatase, fibrinogen, D-dimer, C-reactive protein, erythrocyte sedimentation rate, percentage of reticulocytes, alanine aminotransferase, aspartate aminotransferase, ferritin, uric acid, interleukin-2 receptor, and interleukin-6 were more common.Conclusion BMN has a variety of causes.Therefore, it is recommended that bone marrow cell morphology and bone marrow pathological biopsy be performed on suspected patient in time to assist in the diagnosis of BMN,so as to achieve early diagnosis and early treatment, improve patient prognosis, and increase survival rate.