四项联检对骨髓增生异常综合征诊断价值的初步研究  

Clinical Significance of Combined Examinations of Peripheral Blood Smear,Bone Marrow Smear,Bone Marrow Biopsy,and Chromosome Analysis in the Diagnosis of Myelodysplastic Syndromes

作　　者：郝建萍[1] 陈双[1] 马遇庆[1] 哈力达.亚森[1] 江明[1] 钟笛[1] 李玲[1] 

机构地区：[1]新疆医科大学第一附属医院血液科,新疆乌鲁木齐830054

出　　处：《中国全科医学》2012年第32期3742-3744,共3页Chinese General Practice

基　　金：新疆维吾尔自治区自然科学基金(2010211A45)

摘　　要：目的初步探讨外周血涂片、骨髓涂片、骨髓活检和染色体联合检查在骨髓增生异常综合征(MDS)中的诊断意义。方法对初诊MDS的89例患者同时进行外周血涂片、骨髓涂片、骨髓活检和染色体检查,分析四项联检对MDS的诊断价值。结果 46例患者外周血出现幼稚粒细胞、37例出现幼稚红细胞;骨髓涂片三系病态造血分别为:髓系76例(85%)、红系67例(75%)和巨核系35例(39%);骨髓活检对骨髓增生程度的判断优于骨髓涂片(P<0.05);骨髓活检中出现幼稚前体细胞异位(ALIP)27例(30%),CD3+4>5%28例(31%),巨核系病态造血检出率骨髓活检高于骨髓涂片(P<0.05);合并网状纤维增生18例(20%),染色体异常35例(39%)。外周血+骨髓涂片检查诊断MDS的阳性符合率为88%,外周血涂片+骨髓涂片+骨髓活检诊断阳性符合率为93%,外周血涂片+骨髓涂片+骨髓活检+染色体检查诊断阳性符合率为95%。但3种联检方法的诊断阳性符合率间差异无统计学意义(P>0.05)。结论 4种检查技术联合应用理论上能互相弥补、互相辅助,提高对MDS诊断的准确性,但统计学显示意义不大,今后应继续研究。Objective To investigate the value of combined examinations of peripheral blood smear,bone marrow smear,bone marrow biopsy,and chromosome analysis in the diagnoisis of myelodysplastic syndromes（MDS）.Methods Totally 89 MDS patients received the above four examinations.The results and their correlations were analyzed.Results Immature granulocytes and erythroblasts were detected in the peripheral blood smears of 46 and 37 patients,respectively.As shown by bone marrow smear,the dysplasias of granulocytic,erythrocytic,and megakaryocytic lines were found in 76 cases（85%）,67 cases（75%）and 35 cases（39%）,respectively.The bone marrow biopsy slice was superior to that in smear for the judgment of bone marrow hyperplasia（P0.05）.Upon biopsy,abnormal localization of immature precursor was found in 27 cases（30%） and CD＋345% in 28 cases（31%）.The detective rate of megakaryoid dysplasia in sections was higher than that of smear（P0.05）.Abnormal chromosomes were found in 35 cases（39%）.The agreement rate of peripheral blood smear and bone marrow aspiration was 88% in diagnosing MDS.The agreement rate of the combination of peripheral blood smear,bone marrow aspiration,and core biopsy was 93%,and that of the combination of peripheral blood smear,bone marrow aspiration,core biopsy,and chromosome analysis was 95%（P0.05）.Conclusion The combined examination of these four methods can improve the accuracy of MDS diagnosis,but without statistical significance.

关 键 词：骨髓增生异常综合征 外周血涂片 骨髓涂片 骨髓活检 染色体 

分 类 号：R551.31[医药卫生—血液循环系统疾病]