骨髓涂片和切片中的巨核细胞多形性改变在慢性骨髓增殖性疾病中的诊断意义  

The diagnosis value of morphology changes of pleomorphic megakaryocytes in bone marrow smears and bone marrow sections in chronic myeloproliferative disorders

作　　者：朱蕾[1] 卢兴国[1] 赵小英[1] 徐根波[1] 张晓红[1] 王炜琴[1] 

机构地区：[1]浙江大学医学院附属第二医院血液内科,杭州310009

出　　处：《中华检验医学杂志》2010年第2期143-148,共6页Chinese Journal of Laboratory Medicine

基　　金：浙江省教育厅科研项目（Y200804673）

摘　　要：目的探讨骨髓涂片和切片中巨核细胞多形性改变在慢性MPD（CML-CP、ET、PV及PMF）中的诊断意义。方法182例MPD患者采用骨髓抽吸-活检双标本同步取材，获取骨髓涂片和切片标本。骨髓涂片行瑞氏-姬姆萨染色和CD41免疫组织化学染色，骨髓切片行苏木素-姬姆萨-酸性品红染色。将涂片和切片中的巨核细胞多形性形态定义为5类，分别为Ⅰ型（包含型）；Ⅱ型（少分叶核型）；Ⅲ型（巨大多分叶核型）；Ⅳ型（小核固缩型）和Ⅴ型（脱落型）。骨髓涂片和切片中的巨核细胞簇分别计为未见巨核细胞簇状分布（0）；小于6个的小簇巨核细胞组成为主（＋1）；至少6个以上的大簇巨核细胞组成为主（＋2）3种情况。同步分析骨髓涂片和切片中的各型巨核细胞多形性变化以及巨核细胞簇的检出率。结果CML—CP组Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ和正常型的巨核细胞在骨髓涂片中的检出率分别为（3．73±3．84）％、（14．19±7．62）％、（5．99±4．67）％、（34．37±10．79）％、（9．45±6．87）％及（32．28±7．67）％，在切片中的检出率分别为（3．13±2．30）％、（12．61±9．28）％、（4．94±4．27）％、（35．26±9．63）％、（9．47±5．89）％及（34.58±6．81）％，两者差异无统计学意义（t值分别为0．524、0．510、0．645、0．239、0．011、0．869，P均〉0．05）。ET组Ⅰ型巨核细胞的骨髓涂片检出率为（6．17±2．89）％，明显高于骨髓切片的（2.42±1．28）％，差异有统计学意义（t=7．183，P〈0．01）；Ⅴ型巨核细胞的骨髓涂片检出率为（6．28±3．34）％，明显低于骨髓切片的（10．18±4．03），差异有统计学意义（t=3．940，P〈0．01）；其余各型（Ⅱ、Ⅲ、Ⅳ和正常型）差异无统计学意义（t值分别为0．079、0．122、1．643、1．638，P均〉0．05）。PV组Ⅴ型巨核细胞的骨髓涂片检出率为（Objective To explore the diagnosis value of morphology changes of pleomorphie megakaryoeytes in the bone marrow （BM） smears and BM sections in chronic MPD（ CML-CP, ET,PV and PMF）. Methods BM aspiration was taken in 182 patients of MPD aspiration and biopsy examination was performed synchronously to obtain the BM smears and BM sections samples. The BM smears were subjected to Wright/Giemsa stain and immunohistochemistry stain, while the BM sections were subjected to Haematoxylin-Giemsa-Fuchsin stain. The morphology of pleomorphic megakaryoeytes was classified into five groups, which were Ⅰ type （ inclusion type ）, Ⅱ type （ hypolobulated muclei type ）, Ⅲ type （ giant hyperlobulated nuclei type）, Ⅳ type （ micro pyknotic type ）, and Ⅴ type （ extrusion type ）. The size of megakaryocytes clusters was recorded as no clusters（0）, predominantly small clusters of fewer than 6 cells （1） or predominantly large clusters of at least 6 cells （2）. The detection rates of various types of pleomorphie megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Resnits In CML-CP group, the detection rates were （3.73 ±3.84） %, （ 14. 19 ±7. 62 ） %, （5, 99 ±4.67）%,（34.37±10.79）%,（9.45±6.87）%, （32.28 ±7.67）% and 3.13 ±2.30）%,（12.61 ±9.28）%,（4.94±4.27）%,（35.26±9.63）%,（9.47±5.89）%,（34.58±6.81）% for Ⅰ type, Ⅱ type, Ⅲ type, Ⅳ type and Ⅴ type pleomorphic megakaryocyte in BM smears and BM sections. There were no significantly differences between the BM smears and BM sections（ t value were 0. 524,0. 510,0. 645, 0. 239,0. 011,0. 869, all P 〉 0. 05 ）. In ET group, the detection rate of I type [ （6. 17 ±2. 89 ） % ] in BM smears was significantly higher than that in BM sections [ 2. 42 ±1.28 ） % ] （ t = 7. 183, P 〈 0. 01 ）, while the detection rate of V type [ （6. 28 ±3.34 ） % ] in BM smears was significantly lower than that in BM sections [ （ 10. 18 ±4. 03 ） % ] （

关 键 词：骨髓增殖性疾病 巨核细胞 骨髓检查 活组织检查 针吸 组织细胞学制备技术 

分 类 号：R551.3[医药卫生—血液循环系统疾病]