骨髓增生异常综合征与特发性血小板减少性紫癜骨髓巨核细胞的观察  

The Observation of Megakaryocytes from Bone Marrow in Myelodysplastic Syndrome and Idiopathic Thrombocytopenic Purpura

作　　者：杜伟[1] 程虹[2] 李玲[1] 钟笛[1] 许建华[3] 郝建萍[1] 江明[1] 温丙昭[1] 

机构地区：[1]新疆医科大学第一附属医院血液科,乌鲁木齐830054 [2]新疆医科大学附属肿瘤医院检验科,乌鲁木齐830011 [3]新疆医科大学第五附属医院,乌鲁木齐830000

出　　处：《血栓与止血学》2013年第1期19-22,共4页Chinese Journal of Thrombosis and Hemostasis

基　　金：新疆维吾尔自治区自然科学基金项目(201021100A45)

摘　　要：目的通过对骨髓增生异常综合征(MDS)与特发性血小板减少性紫癜(ITP)骨髓病态巨核细胞的比较观察,探讨其在MDS诊断中的意义。方法对72例MDS患者[包括26例难治性血细胞减少伴单系发育异常(RCUD)及46例难治性血细胞减少伴有多系发育异常(RCMD)]及44例ITP患者行骨髓穿刺涂片对巨核细胞进行分类、比较及分析。结果 RCUD、RCMD及ITP组各类病态巨核细胞检出率均高于对照组(P<0.01),尤以RCMD组病态巨核细胞检出率最高,明显高于RCUD及ITP组(P<0.05),RCUD组高于ITP组,但组间未见统计学差异(P>0.05)。关于病态巨核细胞形态的异常分布,在MDS主要以单圆核巨核及小巨核细胞为主要病态造血表现,其次为多圆核巨核细胞,虽MDS组与ITP组均显著高于对照组(P<0.01),但RCUD及RCMD组的检出率又明显高于ITP组(分别为P<0.05、P<0.01)。而多分叶巨核细胞主要见于ITP组,明显高于MDS与对照组(分别为P<0.05、P<0.01),并且MDS组与对照组比较也显示有统计学意义(P<0.05)。结论髓象中单圆核巨核及小巨核病态巨核细胞检出率与MDS病态造血程度有关,其病态巨核细胞特征的观察对MDS的诊断及鉴别诊断有重要意义。Objective The observing of morbidness megakaryocytes from bone marrow in myelodys- plastic syndromes（MDS） and idiopathic thrombocytopenic purpura （ITP）, and investigate the significance in the diagnosis of MDS. Methods Classification, comparison and analysis the megakaryocytes from bone mar- row in 72 patients with MDS（including 26 RCUD and 46 RCMD）and 44 ITP patients through the bone mar- row aspiration. Results The detection rates of all morbidness megakaryocytes in refractory cytopenia with uni- lineage dysplasia（RCUD） ,refractory cytopenia with multilineage dysplasia （RCMD）and ITP are higher than those in the control group（P 〈 0.01 ）, especially in RCMD the detection rates of morbidness megakaryocytes was the most highest, significantly higher than RCUD and ITP（ P 〈 0.05 ）, although RCUD group has also sig- nificantly higher than ITP groups, it has no statistical difference between groups（ P 〉 0.05 ）. Regarding the ab- normal distribution of morbidness megakaryocytes, the main manifest of dyshaematopoiesis in MDS are mainly by single nuclear megakaryocytes and micromegakaryocyte, the next is multi-nuclear megakaryocytes, although the MDS group and ITP group were significantly higher than the control group （P 〈 0.01 ）, thek detection rate of RCUD and RCMD as well as significantly higher than the ITP group （ respectivelyP 〈 0.05 ,P 〈 0.01 ）. Howev-er, multi-sublobe megakaryocytes mainly in ITP, significantly higher than the MDS and control group （respec- tivelyP 〈 0.05 ,P 〈 0.01 ） ,and MDS group compared with controls also showed has a statistically significant （P 〈 0.05 ）. Conclusion The detection rate of single nuclear megakaryocytes and micromegakaryocyte has the relationship with the degree of dyshaematopoiesis, the observation of the morbidness megakaryocytes have the important meaning to the diagnosis and differential diagnosis of MDS.

关 键 词：骨髓增生异常综合征 特发性血小板减少性紫癜 病态巨核细胞 

分 类 号：R446.113[医药卫生—诊断学]