粒细胞病态造血及过氧化物酶缺乏对骨髓增生异常综合征诊断意义的探讨  

MYELODYSPLAST IC SYNDROME: THE SIGNIFICANCE OF DYSGRANULOPOIESIS AND MYELOPEROXIDASE DEFICIENCY IN POLYMORPHONUCLAR NEUTROPHILS

作　　者：金秋凤 杨志成[1] 姜禹贵 王学文[1] 姚海勤[1] 

机构地区：[1]南京军区南京总医院,210002

出　　处：《山西白血病》1993年第1期34-37,共4页

摘　　要：回顾性研究了52例MDS(RA31例、RAEB13例、RAEB_t 3例、PASA5例)的粒细胞形态及其过氧化物酶(POX)活性。发现粒细胞的核分叶过多、核形态异常、核染色质结构异常、胞浆内颗粒异常等是粒系病态造血主要的形态改变。进一步的研究发现,核染质结构异常(核染质缺失或周边聚集)几乎只见于MDS和各种急慢性髓系白血病,故该指标对MDS诊断特异性最好。各指标的联合分析,对MDS的诊断甚或早期诊断具重要意义。粒细胞POX缺乏亦为病态造血重要内容。对其诊断标准,率先提出了POX阳性率及阳性积分值双重指标,并证明此较文献的单纯阳性率指标更为实用。而且POX缺乏与MDS亚型之间存在一定相关性。探讨了MDS细胞POX缺乏的原因及其在预后中的作用。Fifty two patients (31 RA, 13 RAEB. 3 RAEBt, 5 PASA)with myelodysplastic syn- drome (MDS) were studied in this paper both for their dysgranulopoiesis and myeloperoxi- dase (MPO) deficiency in polymorphonuclear neutrophils (PMN). Dysgranulopoiesis within the neutrophils were characterized by hypersegmentation (4. 8%), bizarre nuclear anomaly (18. 6%), agranular or hypogranular feature (31. 6%), abnormal chromatin clumping and /or loss of chromatin (24. 8%) on Wright--Giemsa stain. Since chromatin anomaly only appears in MDS or various myeloid leukemias, it is considered that abnormal chromatin and/or loss of chromatin are the most valuable parameters in diagnosis of MDS. It seems that MPO--de-- ficient MDS shares different prognosis from MPO--normal cases. And it is hypothesized that existence of MPO--deficient PMN predicts the presence of leukemic evolution in MDS.

关 键 词：骨髓增生异常 综合征 过氧化物酶 

分 类 号：R551.304[医药卫生—血液循环系统疾病]