巨核细胞数量及形态学改变在四种类型MPN中的诊断价值  

Diagnostic Value of Quantity and Morphology Change of Megakaryocytes in Four Types of MPN

作　　者：寿爽[1] 谭焕腾[1] 成军[1] 卢兴国[2] 余俊[1] 孙长贵[1] 

机构地区：[1]中国人民解放军第一一七医院检验科,杭州310013 [2]浙江大学医学院附属第二医院检验科,杭州310009

出　　处：《现代检验医学杂志》2014年第1期79-82,共4页Journal of Modern Laboratory Medicine

摘　　要：目的探讨骨髓涂片中巨核细胞数量和形态学改变在四种类型（CML，ET，PV，PMF）骨髓增殖性肿瘤（MPN）中的诊断价值。方法84例四种类型MPN患者与26例正常人（对照组）进行骨髓穿刺，获取骨髓涂片标本。分别计数CML，ET，PV和PMF组巨核细胞总数和不同型巨核细胞数并计算百分比，比较分析各组与对照组之间的差异，同时探讨各组不同型巨核细胞百分比对相应疾病的诊断价值。结果与对照组比较，CML组小巨核和低分叶巨核细胞数和百分比明显增高（t，t′=4．316～12．171，P均〈0．01），其百分比均在64．2％时，对cML具有诊断意义；ET组大巨核和高分叶核巨核细胞明显多见（t，t′=4．218～11．343，P均〈0．01），其百分比分别在12．3％和16．4oA时，对ET具有诊断意义；PV组不同型巨核细胞差异无统计学意义（t，t′=1．010～2．735，P均〉0．05），各型巨核细胞百分比对PV无诊断意义；PMF组巨核细胞总数明显减少（t=4．701，P〈0．01），其巨核细胞总数为25个时，对PMF具有诊断意义。结论通过观察巨核细胞数量及形态的变化，方法简单、直观，各型巨核细胞百分比对MPN分型和鉴别诊断具有一定的参考价值。Objective To explore the diagnositic value of quantity and morphology change of megakaryocytes in the bone mar- row smears in the four types （CML,ET,PV,PMF） of MPN. Methods Bone marrow smears of four types of 84 patients with MPN and 26 cases （control group） of normal people were obtained by bone marrow puncture. The total number of the type of CML,ET,PV and PMF megakaryocytes and the number of different types of megakaryocytes were counted, which the percentage were calculated. Comparative the difference between the analysis and control group, and also discussed the di- agnositic value of the different types of megakanyocytes percentage. Results Compared with the control group, the detection rate of micromegakaryocyte and the Low-scoring leaf megakaryocytes of CML was significantly higher （t, t＇= 4. 316 12. 171 ,P〈0.01）,when the percentage was both 64.2% ,which had diagnostic significance for CML. In the ET group, the common large megakaryocytes and score leaf nuclear megakaryocytes were significantly higher （t, t ~ ： 4.218 ~ 11. 343, P〈 0.01 ）, when each of the percentage was 12.3 % and 16.4 %, which had diagnostic significance for ET. There were no signifi- cant differences between the group of PV （t,t＇ = 1. 010~2. 735 ,P：〉0.05 ） though it had a higher number of egakaryocytes, the percentage of megakaryocytes had no diagnostic significance for PV. In PMF group, the reduced megakaryocytes （t＇= 4. 701 ,P〈0.01 ） was significance and when the total number of megakaryocytes was 25 ,which had diagnostic significance for PMF. Conclusion It was simple and intuitive to observe the number and morphological changes to the megakaryocytes. The percentage of the different disease groups of megakaryocytes has certain reference values for indentification of MPN subtypes and differential diagnosis.

关 键 词：骨髓增殖性肿瘤 巨核细胞 形态学 鉴别诊断 

分 类 号：R551.3[医药卫生—血液循环系统疾病] R446.113[医药卫生—内科学]