实验室检测指标结合细胞形态学分析在MA与MDS鉴别诊断中的价值

Laboratory Assays Combined with Cytomorphometric Analysis in MA with MDS Value in the Differential Diagnosis

目的:研究分析实验室检测指标以及外周血、骨髓细胞形态,以鉴别诊断巨幼细胞性贫血(MA)与骨髓增生异常综合征(MDS)。方法:选取2020年10月—2022年6月南方医科大学顺德医院收治的21例MDS与17例MA患者作为研究对象,检测其血常规及维生素B12(Vit B12),制作外周血涂片和骨髓涂片,观察细胞形态特征。结果:MA与MDS的全血细胞减少,红细胞(RBC)总数、血红蛋白(Hb)、红细胞平均体积(MCV)比较,差异无统计学意义(P>0.05),而Vit B12、MCV>100 f L比较,差异均有统计学意义(χ^(2)=30.762、3.979,P<0.05)。进行外周血细胞形态分析,嗜多色性红细胞、卡波环、中心淡染区扩大、原始粒细胞、双核粒细胞、粒细胞巨变、假Pelger-Huёt畸形、中性粒细胞核分叶多比较,差异均有统计学意义(χ^(2)=14.491、14.568、10.238、12.533、14.568、7.495、4.661,P<0.05),大血小板、畸形血小板比较,差异无统计学意义(P>0.05)。骨髓细胞形态分析,红系双核、奇数核、巨原红、巨早幼红、巨中幼红、大RBC、成熟红细胞大小不均,粒系原始粒细胞(≥5%)、巨中幼粒、巨晚幼粒、巨杆状核、假Pelger-Huёt畸形、核浆发育不平衡、中性粒细胞核分叶多(>5叶)、颗粒减少或无颗粒,巨核系巨核核分叶多、小巨核、双圆巨核、多圆巨核、微小巨核比较,差异均有统计学意义(χ^(2)=8.314、4.259、7.112、20.761、18.087、9.401、15.641、21.478、9.547、8.197、5.768、3.619、4.259、4.661,P<0.05)。红系核畸形、多核、巨晚幼红,粒系晚幼粒、棒槌小体、环状核,巨核系大血小板、畸形血小板比较,差异无统计学意义(P>0.05)。结论:MA与MDS血象均有不同程度的全血细胞减少,MA红细胞形态以大细胞(MCV>100 f L)为主,而Vit B12显著降低,结合血清Vit B12测定有助于两者的鉴别。MA病态造血主要体现三系的巨幼变;MDS则有一些克隆性证据,表现在红系有双核、奇数核,粒系可见原始粒细胞、双核粒细胞、假Pelger-Huёt畸形,巨核系可见小巨核、微小巨核、双圆巨核、多圆巨核细胞等。

Objective:To analyze the laboratory test indexes,and peripheral blood and bone marrow cells to differential diagnose megaloblocytic anemia(MA)and myelodysplastic syndrome(MDS).Methods:From October 2020 to June 2022,21 MDS and 17 MA patients were studied,tested for blood routine and VitB12,made peripheral blood smear and bone marrow smear,and observed cell morphological characteristics.Results:Pancytopenia,RBC,Hb and MCV between MA and MDS(P>0.05),while VitB12 and MCV were>100 fL(P<0.05).Peripheral blood cell morphology analysis showed that there were differences in polychromatic erythrocytes,carbring,central light area expansion,primitive granulocytes,binuclear granulocytes,granulocytes,false Pelger-Huёt malformation and neutrophil nuclear segmentation,with statistically significant difference(χ^(2)=14.491,14.568,10.238,12.533,14.568,7.495,4.661;P<0.05).There were no statistically significant difference in large platelets and abnormal platelets(P>0.05).Bone marrow cell morphology analysis showed Erythroid binucleus,odd nuclei,macroprotoluene,macroprotoluene,macromesoprotoluene,macroerythroid,macrored cells,and mature red blood cells were of uneven size,granulocyte(≥5%),macromesopluene,macrolatepluene,macrorod nucleus,pseudopelger-huet deformity,unbalanced karyoplasmic development,many neutrophil nuclear lobes(>5 lobes),reduced or no granules,megakaryonuclear lobulated,small megakaryon,double round megakaryon,multi-round megakaryon,small megakaryon,and the differences were statistically significant(χ^(2)=8.314,4.259,7.112,20.761,18.087,9.401,15.641,21.478,9.547,8.197,5.768,3.619,4.259,4.661;P>0.05).Conclusion:Both MA and MDS blood images have different degrees of pancytopenia.MA red blood cell morphology is dominated by large cells(MCV>100 fL),and VitB12 is significantly reduced,combined with serum VitB12 determination to facilitate the identification of the two.MA pathological hematopoiesis mainly reflects the giant age of three lines.MDS has some clonal evidence,manifested in the erythroid dikaryres,primitive granulocytes,double nuclear granulocytes,false Pelger-Huet malformation,micro megakaryus,micro megakaryus,and multiround megakaryocytes,etc.