不典型再生障碍性贫血患儿骨髓巨核细胞、骨髓小粒和骨髓活检分析  

Significance of megakaryocyte, particles and biopsy of bone marrow in diagnosis of children with atypical aplastic anemia at early stage

作　　者：文金全[1] 冯海琳[1] 王华[1] 庞菊萍[1] 

机构地区：[1]陕西省西安市儿童医院血液科,陕西西安710003

出　　处：《临床儿科杂志》2007年第3期210-213,共4页Journal of Clinical Pediatrics

摘　　要：目的分析不典型再生障碍性贫血(AA)患儿的骨髓巨核细胞、骨髓小粒的特点,对其诊断进行探讨。方法对16例不典型AA初诊、15例慢性AA(CAA)和30例同龄正常骨髓标本进行骨髓有核细胞分类,每例随机选择10个骨髓小粒作有核细胞面积(%)评估及小粒中巨核细胞和组织嗜碱细胞计数,并将两组AA骨髓活检结果进行比较。结果骨髓巨核细胞不典型AA组(21.18±12.02)与CAA组(1.93±1.48)、淋巴细胞不典型AA组(27.82±9.89)与CAA组(43.78±12.47)比较,差异均有统计学意义(P均<0.001);骨髓小粒有核细胞面积和组织嗜碱细胞计数比较,两组差异均无统计学意义(P均>0.05);不典型AA骨髓小粒巨核细胞检出率(6.88%)与正常骨髓小粒检出率(92%)比较,差异有统计学意义(χ2=319.88,P<0.001);不典型AA组骨髓小粒组织嗜碱细胞(1～12个/粒)检出率为91.88%,正常骨髓检出率为0%;不典型AA和CAA组骨髓活检均示脂肪组织增多,造血组织减少,巨核细胞缺如。结论骨髓小粒有核细胞面积减少、巨核细胞缺如或罕见、检出组织嗜碱细胞为不典型AA的特征,活检示造血组织被脂肪组织代替。Objectives To explore the early diagnosis of atypical aplastic anemia （AAA） by analyzing the characteristic patterns of the megakaryocyte, particles and biopsy of bone marrow. Methods Nuclear cells of bone marrow in 16 children with AAA at early stage, 15 cases with definitive diagnosis of chronic AA （CAA） were classified and 30 samples of normal bone marrow were studied as controls. Ten particles were chosen randomly from each sample of bone marrow to evaluate the area proportions of the nuclear cells in the particles and count the basophilic histiocyte and megakaryocytes. The comparison of the difference in bone marrow biopsies between these two groups were made. Results The count of megakaryocyte was significantly higher in AAA group （21.18 ± 12.02） than that in CAA group （1.93 ± 1.48）, and the number of lymphocyte in AAA was significantly lower （27.82± 9.89） than that of CAA （43.78 ± 12.47） with significant differences （P 〈 0.001 ） . But there were no significant differences in the area proportions of nuclear cells in the particles and the counts of basophilic histiocyte between two groups （P 〉 0.05）. However, the megakaryocyte was significantly lower （6.88%） than that of the normal controls （92%） （P 〈 0.001 ）. In 91.8% of the bone marrow particles （1-12 per particle）, basophilic histiocyte could be found in the AAA while none was found in the normal controls. Decrease of the hemotopoietic tissue and the increase of the fat tissue was shown in the bone marrow biopsies of both AAA and CAA. Conclusions The features of AAA at early stage are decrease of the area proportion of nuclear cells in the bone marrow particles, deficiency of megakaryocytes, and basophilic histiocyte. Bone marrow biopsies showed that hemotopoietic tissue was replaced by fat tissue.

关 键 词：儿童 再生障碍性贫血 骨髓小粒 诊断 

分 类 号：R725.5[医药卫生—儿科]