伴嗜酸粒细胞增多的髓系白血病形态学研究  

Morphology research of eosinophils in myeloid leukemia patients

作　　者：于明华[1] 张悦[1] 蔡文宇[1] 李梅[1] 于成龙[1] 肖志坚[1] 

机构地区：[1]中国医学科学院中国协和医科大学血液学研究所血液病医院实验血液学国家重点实验室,天津300020

出　　处：《临床血液学杂志》2009年第2期137-140,共4页Journal of Clinical Hematology

基　　金：新世纪优秀人才资助计划(No:NCET-05-0173)

摘　　要：目的:探讨伴有嗜酸粒细胞增多的髓系肿瘤嗜酸粒细胞的形态学特征。方法:回顾性分析13例慢性嗜酸粒细胞白血病(CEL)、17例急性髓系白血病(AML)伴有t(8;21)(q22;q22),(AML/ETO)、25例AML伴有骨髓异常嗜酸粒细胞,inv(16)(p13;q22)或t(16;16)(p13;q22),(CBFβ/MYH11)和20例慢性粒细胞白血病慢性期(CML-CP)患者骨髓及外周血涂片嗜酸粒细胞细胞形态学,每例患者计数200个骨髓嗜酸粒细胞,分析各阶段嗜酸粒细胞比例及其形态特征。结果:CEL患者骨髓嗜酸粒细胞以嗜酸杆状核和分叶核细胞为主,形态学主要表现为细胞质嗜酸性颗粒减少,空泡及碱性颗粒。AML伴骨髓异常嗜酸粒细胞,inv(16)(p13;q22)患者骨髓嗜酸粒细胞以中晚阶段嗜酸粒细胞为主,细胞明显成熟障碍,形态学改变主要表现为粗大紫红色嗜碱性颗粒增多并覆盖细胞核,少数伴有细胞质空泡。AML伴t(8;21)(q22;q22)患者骨髓嗜酸粒细胞以嗜酸晚幼粒细胞为主,成熟阶段粒细胞减少,其形态学主要表现为颗粒增多但细小,多数表现为金黄色颗粒覆盖细胞核上。CML-CP患者骨髓嗜酸粒细胞以嗜酸晚幼粒细胞和杆状核细胞为主,颗粒以细小密集增多为主,颗粒减少及空泡不明显。结论:伴嗜酸粒细胞增多的髓系肿瘤,除各自原发病的特点之外,其嗜酸粒细胞比例以及形态学改变不尽相同,通过详细细胞形态学分析能够为上述疾病的诊断与鉴别提供初步依据。Objective：To explore the morphologic characters of eosinophils in myeloid leukemia patients with increased eosinophils. Method：A retrospective study of 75 patients with myeloid leukemia were performed, including 13 cases of chronic eosinophil leukemia （CEL）, 17 of acute myeloid leukemia （AML） with t （8;21）（q22; q22） ; AML1-ETO, 25 of AML with inv（16） （p13 ;q22） or t（16 ; 16） （p13 ;q22） ; CBFβ-MYH11 and 20 of chronic myeloid leukemia in chronic phase （CML-CP）. The morphology of eosinopils for each patients, both from bone marrow aspiration and peripheral blood, were analyzed. Result：Band and segmented eosinophils were predominant- [y found in patients with CEL. The main eosinophil abnormalities included sparse granulation, vacuoles and baso- philic granules in their cytoplasm. In AML with inv（16）（p13;q22）, eosinophilic myelocyte and metamyelocyte were notable with obvious maturation arrest. Purple-violet basophilic granules were large and dense, partly cov- ered on the nucleus. Eosinophils in the bone marrow of AML with t（8 ;21）（q22 ;q22） are mainly consisted of eo- sinophilic metamyelocytes, charactered by increasing fine orange-red granules covered on nucleus. Eosinophilic metamyelocyte and band eosinophils were the main components of eosinophils in marrow of CML-CP patients. The eosinophilic granules were small and dense. Conclusion：The ratio and morphologic features of eosinophils were va- rious in patients with different myeloid leukemia with increased eosinophils. Detailed cytomorphologic analysis may supply clues for diagnosis and differential for these diseases.

关 键 词：白血病 嗜酸粒细胞 形态学 

分 类 号：R733.3[医药卫生—肿瘤]