世界卫生组织(WHO)髓系肿瘤新分型的应用与认识(附546例髓系肿瘤回顾与评价)

Applyment and acquaintance of the WHO new classification of hematopoietic tissues neoplasms(Addition 546 cases hematopoietic tissues neoplasms retrace and analysise)

目的 尽早掌握WHO建议的髓系肿瘤分类方案 ,使我院诊断水平与国际接轨。方法 依据 1999年《WHO造血与淋巴组织肿瘤分类方案》 ,对 5 4 6例髓系肿瘤的骨髓细胞形态学进行回顾与重新评价。结果 ①扩大了骨髓增殖性疾病 (MPD)的病种 ,使MPD增加了 6 5例 ,占 39%。②将骨髓增生异常综合征 (MDS)定为血液肿瘤并增减了MDS亚型 ,使MDS减少了 19例 ,占 2 0 %。③降低了白血病诊断阈值 (由 30 %到 2 0 % ) ,有利于早期治疗。④增加了原始细胞小于 2 0 %伴有遗传学改变的特殊类型 ,更贴近于临床指标。结论 新分型对髓系肿瘤的早期诊治、疗效观察及预后判定具有临床指导意义 ,同时它也对从事骨髓细胞形态学工作的实验诊断医生提出了新的任务和课题。

Objective To understand the proposed WHO new classification of hematopoietic tissues neoplasms as soon as possible,so that our diagnosis level is close to interntaional level.Methods According to the WHO classification of neoplastic diseases of hematopoietic and lymphoid tissues,we retrace and analysize 546 cases of hematopoietic tissues neplasms based on examination of the bone marrow.Results ①The categories of MPD are increased by 65 cases(39%);②MDS is classified into the hematopoietic tissues neoplasms and its subtypes are adjusted again.MDS is decreased by 19 cases(20%).③The diagnosis threshold of leukemia is lowered(from 30% to 20%).This helps to treat early.④It increases a special type where myeloblast count is lower than 20% and is companied by genetic change.This is more close to clinical indexes.Conclusion WHO classification have clinical guiding significance for early diagnosis and treatment,therapy observation and prognosis decision.