高白细胞急性白血病的骨髓和外周血细胞学特点分析  

Analysis of Bone Marrow and Peripheral Blood Cytologic Features in Hyperleukocytic Acute Leukemia

作　　者：刘亚琳[1] 刘海波[1] 王雯娟[1] 马乐[1] 王晓宁[1] 刘华胜[1] 

机构地区：[1]西安交通大学医学院第一附属医院血液内科,陕西西安710061

出　　处：《中国实验血液学杂志》2013年第3期562-566,共5页Journal of Experimental Hematology

基　　金：2010中央高校基本科研业务费专项资金中标项目(编号xjj2010002)

摘　　要：本研究针对高白细胞急性白血病(HAL)预后不良的因素,探讨HLA的骨髓及外周血细胞学特征及临床意义。收集本院自2009年以来门诊及住院急性白血病患者共68例(其中28例为HAL,40例为非高白细胞急性白血病(NHAL)的骨髓涂片及外周血涂片。对骨髓涂片分别进行瑞氏染色、POX染色、PAS染色、NSE和NaF染色;对血涂片进行瑞氏染色。应用光学显微镜观察骨髓涂片以判断增生程度、各系细胞增生情况、形态及有无异常细胞等,结合细胞化学染色结果确定诊断,计数并分类200个有核细胞,计算各种细胞比例、各系细胞百分比总数、粒红比值等。同法观察血涂片,计数并分类100个有核细胞,计算各种有核细胞的百分比。结果数据应用SPSS 12.0软件进行统计,分析两组患者骨髓涂片的增生度、各系细胞比例数的差异,寻找外周血涂片与骨髓涂片在形态学特征方面的联系。结果表明,HAL组和NHAL组骨髓有核细胞增生程度均为明显至极度活跃,但HAL组骨髓增生活跃程度强于NHAL组,差异均有统计学意义(P<0.05)。红系及巨核系在两组均有不同程度受抑,HAL组骨髓中红系受抑程度强于NHAL组。HAL组外周血中血红蛋白含量及血小板数量明显低于NHAL组,差异均有统计学意义(P<0.05)。NHAL组中外周血白细胞分类仍可见白血病细胞,但其比例较HAL组小,差异均有统计学意义(P<0.05)。HAL组外周血白细胞数量与骨髓白血病细胞增生程度存在一定程度的正相关性(r=0.422)。结论:无论在骨髓还是外周血,HAL组与NHAL组相比,在增生程度、细胞数量及原始细胞比例方面均有显著性差别,而且HAL组外周血中的白血病细胞比例、白细胞数量及血红蛋白和血小板数量均有特征性改变。因此对比分析HAL实验室检测的特征变化有利于掌握其规律,对于指导临床准确诊断急性白血病和及时选择合适的治疗方案有重要价值。This study was purposed to investigate the cytologic features of bone marrow（BM） and peripheral blood （PB） in hyperleukocytic acute leukemia （HAL） and their clinical significance in accordance with high leukocyte count as poor prognostic factor for acute leukemia. The smears of BM and PB were collected from 68 out-patients and inpa dents including 28 cases of HLA and 40 cases of non HAL（NHAL） in our hospital since 2009. The proliferation degree, morphology and abnormal appearance in each cell lineage were observed with HE, POX, PAS, NSE ＋ NaF staining for BM meats and HE staining for PB smears by means of optical microscope. The final diagnosis was made by cellular chemical staining results, then the counting and classification were performed in 200 nucleated cells to calculate the percentage of each cell lineage, the myeloid/erythroid ratio and so on. The BP smears were observed with the same meth ods, the counting and classification of 100 nucleated cells were performed to calculate a varietry of nucleated cell percent- age. The resulted data were analyzed by the SPSS 12.0 statistical software, the difference of proliferation degree and ra tio of each cell linege in BM smears were compared, the relationship of morphological features of PB smears with BM smears was analyzed. The results showed that obvious or extreme active proliferation of nucleated cells was observed in HAL and NHAL groups, but the myeloproliferation in HAL group was more active than that in NHAL group （P 〈 0. 05 ）. The erythrocyte and megakaryocyte lineages were suppressed in both groups, while the HAL group showed a lower proportion of erythrocyte and megakaryocyte lineages in BM as compared with NHAL group（ P 〈0.05 ）. The he-moglobine and platelet levels in PB of HAL group were obviously lower than those in PB of NHAL group（ P 〈 0.05 ）. The leukemia cells could be seen in PB smears of NHAL, but the proportion of leukemia cells in NHAL group was smaller than that in HAL group（ P 〈 0.05）. The leukocyt

关 键 词：高白细胞急性白血病 白细胞计数 骨髓 外周血 

分 类 号：R733.71[医药卫生—肿瘤]