骨髓核素显像在再生障碍性贫血鉴别诊断中的应用  

The value of 99m Tc sulfer colloid bone marrow scintigraphy in differential diagnosis of aplastic anemia

作　　者：刘勇[1] 夹访贤[1] 李梦龙[1] 张一帆[1] 康福[1] 

机构地区：[1]山东医科大学核医学教研室

出　　处：《中华血液学杂志》1999年第4期180-182,共3页Chinese Journal of Hematology

摘　　要：目的结合９９ｍＴｃ硫胶体全身骨髓显像对一些长期不能确诊的再生障碍性贫血（再障）病例作出诊断。方法对４７例不完全符合再障诊断标准患者进行９９ｍＴｃ硫胶体全身骨髓显像，９９ｍＴｃ硫胶体注射剂量（３７０～５５０）ＭＢｑ／（２～５）ｍｌ。结果一至两系或全血细胞减少，骨髓增生活跃伴显影骨髓减少及灶状显影组共３０例，确诊为慢性再障２８例、骨髓增生异常综合征（ＭＤＳ）２例，其表现为骨髓显影抑制型１２例、灶状显影型１８例。骨髓显影增强伴外周骨髓扩张组，确诊为ＭＤＳＲＡ８例、ＭＤＳＲＡＥＢ２例，其外周骨髓呈中度以上扩张。再障阵发性睡眠性血红蛋白尿症综合征７例，在病情转化过程中中心骨髓均有轻度增强表现。结论全身骨髓显影不良、显影骨髓总量减少有助于对不典型再障的诊断，显影骨髓分布不均及灶状显影为再障较特异的表现。中心性骨髓活性增强及分布扩张为ＭＤＳ与再障骨髓图像鉴别的重要依据，同时这一现象也有助于确定再障病情的转化。利用骨髓显像解释穿刺结果有实用价值。Objective To diagnose equivocal aplastic anemia(AA) patients by the combination of clinical data and bone marrow scintigraphy.Methods Bone marrow scintigraphy using 99m Tc sulfer colloid 370～550MBq was analysed in 47 patients,including 28 cases of AA,12 of myelodysplastic syndromes(10 MDS RA and 2 MDS RAEB) and 7 of AA PNH syndrome.Results Pancytopenia,hypercellular bone marrow associated with uneven disappearance of marrow image or focal hematopoiesis were found in 28 AA and 2 of 30 MDS RA cases.Marrow imaging showed uneven low accumulation of radioactivity in 12 and focal patterns in 18 patients.Normal or high activity and expanded periphery of bone marrow was found in MDS patients (8 RA and 2 RAEB cases).Changes of activity and distribution of bone marrow during the transforming course were noticed in 4 AA PNH syndrome patients.Conclusions Patch distribution and focal hemopoiesis is the outstanding features of AA marrow.The imaging features as well as expanded manner and increased activity of bone marrow are helpful to the differential diagnosis, evaluation of clinical status and explanation of marrow aspirate results.

关 键 词：诊断 再生障碍性贫血 骨髓 放射性核素显像 

分 类 号：R556.504[医药卫生—血液循环系统疾病] R817.43[医药卫生—内科学]