骨髓小粒拉片在全血细胞减少性疾病中的诊断价值  

Diagnostic Value of Fragments Smear in the Pancytopenia

作　　者：彭碧[1] 吕连华 杨晋[2] 

机构地区：[1]绵阳市人民医院检验科,四川绵阳621000 [2]绵阳市人民医院病理科,四川绵阳621000

出　　处：《现代检验医学杂志》2012年第6期148-151,共4页Journal of Modern Laboratory Medicine

摘　　要：目的研究骨髓不同制片技术对全血细胞减少性疾病的诊断价值及其差异性，提高实验室诊断水平。方法收集绵阳市人民医院2009年1月～2011年12月住院部全血细胞减少病例82例，制备骨髓涂片（简称涂片）和骨髓小粒拉片（简称拉片）进行Wright—Giemsa染色，并同步采集骨髓组织切片（简称切片）做H—E染色．观察三种标本制备下骨髓细胞增生程度、临床诊断符合率以及骨髓小粒的细胞类型、异常细胞和寄生虫的检出情况。结果以切片为金标准，拉片与切片对增生程度的判定差异无统计学意义（X2=0．5290，P〉0．05），但拉片显著高于涂片（X2=6．4029，P〈0．01）。三种方式中，拉片的临床诊断符合率最高为81．7％，显著高于涂片（X2=7．7347，P〈O．01），但与切片差异无统计学意义（X2=4．1432，P〉0．05），三种方式联合检测诊断符合率达92．7％；拉片对异常细胞及寄生虫的检出优于涂片；拉片的细胞形态学在再生障碍性贫血、增生性贫血、感染性疾病、MDS及白血病等疾病中各具特点。结论骨髓小粒拉片可作为骨髓形态学的常规检查项目．与涂片、切片联合检查，能提高全血细胞减少性疾病的诊断水平。拉片的细胞形态学观察对低增生性血液病有一定的鉴别诊断意义。Objective To study the diagnostic value and difference among the diverse bone marrow smear techniques in Pancy- ropenia disease,in order to get improvements in lab diagnosis. Methods To collect 82 cases of pancytopenia disease patients of the People＇s Hospital of Mianyang City inpatient department from Jan 2009～Oct 2011. First,got patients＇ bone marrow smears and fragment smears prepared and stain by Wright-Giemsa, simultaneously, collected bone marrow biopsy and stain by H-E, then observed the degree of bone marrow cell proliferation, the rate of conformity of clinical diagnosis and the detec- tion situation of the cell type of fragment smears,abnormal cells and parasites. Results Biopsy as a golden standard,there was no significant statistical difference between fragment smear and biopsy （X2= = 0. 529 0, P〉0.05）, but the fragment smear was significantly higher than bone marrow smear （X2= = 6. 402 9, P〈0. 01）. Among three patterns, the top rate of conformity of clinical diagnosis of fragment smear was 81.7 ~. It was significantly higher than bone marrow smear （X2= = 7. 734 7,P〈 0.01）, but it had no significant statistical difference with biopsy （X2= = 4. 143 2, P〉0.05）. The rate of conformity of clinical diagnoswas of the combination of three patterns＇ detection was 92.7 %. Fragment smear was better than bone marrow smear on the detection of abnormal cells and parasites. The cell morphology of fragment smear had distinct traits in aplastic anemi- a,proliferative anemia,infectious diseasesd, MDS,leukemia, and so on. Conclusion The fragment smear could be a routine test in bone marrow morphology examination,and combining with bone marrow smear and biopsy can promote the diagnostic level of Pancytopenia. The observation of fragment smear morphology has a certain role in low proliferative blood diseases differential diagnosis.

关 键 词：全血细胞减少 骨髓小粒拉片 骨髓涂片 骨髓切片 诊断价值 

分 类 号：R551[医药卫生—血液循环系统疾病] R446.113[医药卫生—内科学]