骨髓涂片联合活组织检查浆细胞数量对浆细胞骨髓瘤的诊断价值

Evaluation of bone marrow aspirate and biopsy in the diagnosis of plasma cell myeloma

目的探讨骨髓涂片(bone marrow aspirate,BMA)与活组织检查(bone marrow biopsy,BMB)浆细胞数量对浆细胞骨髓瘤的诊断价值。方法回顾性选择2015年10月至2019年1月在复旦大学附属中山医院收治的217例骨髓瘤患者,分析BMA与BMB的浆细胞数量分布关系、骨髓浆细胞数量与患者年龄及血液学指标的关系,并采用SPSS曲线估计制作2种方法的浆细胞数量散点图与拟合曲线,得到回归方程。结果BMA浆细胞≥10%的190例患者中,BMB浆细胞<10%与≥10%患者分别占1.6%(3/190)和98.4%(187/190);而BMA浆细胞>60%时,所有患者BMB浆细胞≥10%(21/21)。提示对于浆细胞≥10%患者,2种方法评估浆细胞数量的一致性较高。相反,BMA浆细胞<10%的27例样本中,BMB浆细胞<10%与≥10%患者分别占11.1%(3/27)和88.9%(24/27)。此时2种方法对浆细胞骨髓瘤的诊断一致性欠佳。BMA浆细胞≥10%组β_(2)-微球蛋白含量较浆细胞<10%组显著升高(P<0.05),而2组血清钙、肌酐、尿素及白蛋白结果差异无统计学意义。拟合非线性曲线的方程为y=11.13·x^(0.39)(R^(2)=0.17)。结论采用BMA或BMB的浆细胞数量作为评判PCM标准可能会导致漏诊,联合BMA与BMB能提高浆细胞肿瘤诊断的准确性。同时对仅做BMA或BMB的患者,可用方程初步估算浆细胞数量,判断疾病疗效或预后。

Objective To explore the value of bone marrow aspirate(BMA)and bone marrow biopsy(BMB)in the diagnosis of plasma cells myeloma(PCM).Methods The distribution of plasma cells in BMA and BMB of 217 PCM patients was analyzed retrospectively in Zhongshan Hospital,Fudan University from October 2015 to January 2019.The relationship between BMA plasma cell numbers and patients’age and hematological results were also evaluated.The scatter diagram and fitting curve of plasma cells in two methods were made by SPSS,and the regression equation was obtained.Results Among 190 patients with BMA plasma cells≥10%,those with BMB plasma cells<10%and plasma cells≥10%accounted for 1.6%(3/190)and 98.4%(187/190),respectively.When BMA plasma cells>60%,BMB plasma cells≥10%in all patients.It was indicated that the two methods had high consistency in evaluating plasma cells in patients with plasma cells≥10%.In contrast,among 27 patients with BMA plasma cells<10%,those with BMB plasma cells<10%and plasma cells≥10%accounted for 11.1%(3/27)and 88.9%(24/27),respectively.It was inconsistent for two methods in diagnosis of PCM.β_(2)-microglobulin in group with plasma cells≥10%was higher than that in plasma cells<10%group(P<0.05),but there was no significant difference in calcium,creatinine,urea and albumin between the two groups.Equation was y=11.13·x^(0.39)(R^(2)=0.17).Conclusion The combination of BMA and BMB may improve the accuracy of PCM diagnosis.Meanwhile,plasma cells can be preliminarily estimated by equation in order to judge curative effect or prognosis for patients only with BMA or BMB.