骨髓增生异常综合征与巨幼细胞性贫血、再生障碍性贫血的细胞形态学对比分析
|
摘要
目的探讨骨髓增生异常综合征与巨幼细胞性贫血、再生障碍性贫血在细胞形态学上的区别。方法通过外周血细胞计数、外周血镜检分类、骨髓涂片、骨髓铁染色等检验方法,重点分析骨髓增生异常综合征和巨幼细胞性贫血、再生障碍性贫血在红细胞系、粒细胞系以及巨核细胞系细胞形态上的共性与差异。结果在所分析的病例中,外周血三系均出现一系或多系的降低。骨髓涂片中,骨髓增生异常综合征与巨幼细胞性贫血在细胞核畸变上难以区分,在红细胞系、粒细胞系巨幼(样)变方面差异有统计学意义(P<0.05)。骨髓增生异常综合征与再生障碍性贫血在细胞核畸变方面差异有统计学意义(P<0.05)。淋巴样小巨核细胞是骨髓增生异常综合征与其他2种疾病的重要区别。结论骨髓增生异常综合征与巨幼细胞性贫血、再生障碍性贫血在细胞形态学上既有相似又有不同之处。这些不同点有助于这3种疾病的鉴别与诊断。
Objective To investigate the cell morphological differences of myelodysplastic syndrome with megaloblastic anemia and aplastic anemia. Methods Peripheral blood cell counts, microscopic classification of peripheral blood, bone marrow routine inspection, bone marrow iron stain experiment and other methods were applied to analyze the similarities and differences of myelodysplastic syndrome, megaloblastic anemia and aplastic anemia in erythroid, granulocytic and megakaryocytic cell morphology. Results In cases analysis, peripheral blood cell reduction(s) were observed, i.e. peripheral blood hemoglobin, white blood cell and red blood cell. In bone marrow smear, myelodysplastic syndrome and megaloblastic anemia were difficult to differentiate in nuclear aberration, and the differences in megaloblastic changes of erythroid and granulocytic cell were statistically significant(P<0.05). There was statistical significance on the difference in nuclear aberrations of myelodysplastic syndrome and aplastic anemia(P<0.05). Lymphoid micro megakaryocytes were an important difference between myelodysplastic syndrome and the other two diseases. Conclusion Cell morphology of myelodysplastic syndrome, megaloblastic anemia and aplastic anemia is similar and different. These differences contribute to the identification and diagnosis of the three diseases.
Objective To investigate the cell morphological differences of myelodysplastic syndrome with megaloblastic anemia and aplastic anemia. Methods Peripheral blood cell counts, microscopic classification of peripheral blood, bone marrow routine inspection, bone marrow iron stain experiment and other methods were applied to analyze the similarities and differences of myelodysplastic syndrome, megaloblastic anemia and aplastic anemia in erythroid, granulocytic and megakaryocytic cell morphology. Results In cases analysis, peripheral blood cell reduction(s) were observed, i.e. peripheral blood hemoglobin, white blood cell and red blood cell. In bone marrow smear, myelodysplastic syndrome and megaloblastic anemia were difficult to differentiate in nuclear aberration, and the differences in megaloblastic changes of erythroid and granulocytic cell were statistically significant(P<0.05). There was statistical significance on the difference in nuclear aberrations of myelodysplastic syndrome and aplastic anemia(P<0.05). Lymphoid micro megakaryocytes were an important difference between myelodysplastic syndrome and the other two diseases. Conclusion Cell morphology of myelodysplastic syndrome, megaloblastic anemia and aplastic anemia is similar and different. These differences contribute to the identification and diagnosis of the three diseases.
引文
[1] Swerdlow SH, Campo E, Harris NL. 造血与淋巴组织肿瘤WHO分类[M]. 4版. 北京: 诊断病理学杂志, 2008: 111-119.
[2] 何苗, 赵强, 韩燕霞, 等. 难治性贫血与巨幼细胞贫血、再生障碍性贫血的细胞形态学对比分析[J]. 现代肿瘤医学, 2016, 24(11): 1808-1812.
[3] 陈方平. 临床检验血液学[M]. 北京: 高等教育出版社, 2006: 150.
[4] 李玲, 江明, 程红, 等. 病态造血细胞与细胞遗传学改变对骨髓增生异常综合征诊断及分型的意义[J]. 白血病·淋巴瘤, 2012, 21(7): 40-411.
[5] 朱小平. 骨髓增生异常综合征与巨幼细胞性贫血诊治区别[J]. 国际检验医学杂志, 2016, 37(8): 1107-1108.
[6] Rosangela I, Federica Q, Matteo Giovanni DP. Importance of classical morphology in the diagnosis of myelodysplastic syndrome[J]. Mediterr J Hematol Infect Dis, 2015, 7(1): e2015035.
[7] Mufti GJ, Bennett JM, Goasguen J, et al. Diagnosis and classification of myelodysplastic syndrome: International Working Group on Morphology of myelodysplastic syndrome (IWGM-MDS) consensus proposals for the definition and enumeration of myeloblasts and ring sideroblasts[J]. Haematologica, 2008, 93(11): 1712-1717.
[8] 田旭, 闫振宇. 低增生性骨髓增生异常综合征与再生障碍性贫血鉴别诊断的研究进展[J]. 白血病·淋巴瘤, 2015, 24(10): 638-640.
[9] 陈雷. 特异性病态造血在骨髓增生异常综合征诊断中的应用价值[J]. 现代医用影像学, 2016, 25(6): 1035-1039.
[10] 侯仕荣. 骨髓小巨核细胞对骨髓增生异常综合征的诊断价值[J]. 医药卫生: 全文版, 2016(6): 167-167.
[11] 付佩一, 徐方明, 胡玫. 骨髓增生异常综合症分型及与巨幼细胞性贫血的鉴别[J]. 微量元素与健康研究, 2016, 33(6): 91-92.
[12] 浦节, 陈真, 石军, 等. 骨髓活检组织病理在骨髓增生异常综合征诊断中的价值[J]. 重庆医学, 2014, 43(3): 257-259.
[13] 李芳, 白洁, 朴文花. 骨髓涂片联合骨髓活检对骨髓增生异常综合征的诊断价值探讨[J]. 中国实验诊断学, 2011, 15(3): 508-510.
[14] 孙嘉峰, 黄艳, 杨佳, 等. 骨髓涂片及骨髓活检在骨髓增生异常综合征诊断中的意义[J]. 山西医科大学学报, 2011, 42(11): 912-914.
[15] 杨再林, 张勇, 徐双年, 等. 骨髓活检与涂片联检对诊断骨髓增生异常综合征的临床意义[J]. 临床与实验病理学杂志, 2011, 27(12): 1329-1332.
[2] 何苗, 赵强, 韩燕霞, 等. 难治性贫血与巨幼细胞贫血、再生障碍性贫血的细胞形态学对比分析[J]. 现代肿瘤医学, 2016, 24(11): 1808-1812.
[3] 陈方平. 临床检验血液学[M]. 北京: 高等教育出版社, 2006: 150.
[4] 李玲, 江明, 程红, 等. 病态造血细胞与细胞遗传学改变对骨髓增生异常综合征诊断及分型的意义[J]. 白血病·淋巴瘤, 2012, 21(7): 40-411.
[5] 朱小平. 骨髓增生异常综合征与巨幼细胞性贫血诊治区别[J]. 国际检验医学杂志, 2016, 37(8): 1107-1108.
[6] Rosangela I, Federica Q, Matteo Giovanni DP. Importance of classical morphology in the diagnosis of myelodysplastic syndrome[J]. Mediterr J Hematol Infect Dis, 2015, 7(1): e2015035.
[7] Mufti GJ, Bennett JM, Goasguen J, et al. Diagnosis and classification of myelodysplastic syndrome: International Working Group on Morphology of myelodysplastic syndrome (IWGM-MDS) consensus proposals for the definition and enumeration of myeloblasts and ring sideroblasts[J]. Haematologica, 2008, 93(11): 1712-1717.
[8] 田旭, 闫振宇. 低增生性骨髓增生异常综合征与再生障碍性贫血鉴别诊断的研究进展[J]. 白血病·淋巴瘤, 2015, 24(10): 638-640.
[9] 陈雷. 特异性病态造血在骨髓增生异常综合征诊断中的应用价值[J]. 现代医用影像学, 2016, 25(6): 1035-1039.
[10] 侯仕荣. 骨髓小巨核细胞对骨髓增生异常综合征的诊断价值[J]. 医药卫生: 全文版, 2016(6): 167-167.
[11] 付佩一, 徐方明, 胡玫. 骨髓增生异常综合症分型及与巨幼细胞性贫血的鉴别[J]. 微量元素与健康研究, 2016, 33(6): 91-92.
[12] 浦节, 陈真, 石军, 等. 骨髓活检组织病理在骨髓增生异常综合征诊断中的价值[J]. 重庆医学, 2014, 43(3): 257-259.
[13] 李芳, 白洁, 朴文花. 骨髓涂片联合骨髓活检对骨髓增生异常综合征的诊断价值探讨[J]. 中国实验诊断学, 2011, 15(3): 508-510.
[14] 孙嘉峰, 黄艳, 杨佳, 等. 骨髓涂片及骨髓活检在骨髓增生异常综合征诊断中的意义[J]. 山西医科大学学报, 2011, 42(11): 912-914.
[15] 杨再林, 张勇, 徐双年, 等. 骨髓活检与涂片联检对诊断骨髓增生异常综合征的临床意义[J]. 临床与实验病理学杂志, 2011, 27(12): 1329-1332.