急性早幼粒细胞白血病细胞形态学分型临床意义分析  

Analasis of clinical significance on the morphological classification of acute hypergranular promeylocytic leukemia

作　　者：王克强[1] 亓云法[1] 王静[2] 亓贯和 苑振新 赵辉[5] 晋红梅[1] 朱莉[1] 朱蓓[1] 

机构地区：[1]泰山医学院附属医院检验科,山东泰安271000 [2]泰安市中医院检验科,山东泰安271000 [3]泰安市第一人民医院检验科,山东泰安271000 [4]泰安市肿瘤医院检验科,山东泰安271000 [5]新泰市人民医院检验科,山东新泰271200

出　　处：《中华肿瘤防治杂志》2014年第7期538-542,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省科技攻关计划(2003-58)

摘　　要：目的：探讨急性早幼粒细胞白血病（acute hypergranular promeylocytic leukemia, M3 ）细胞形态学分型的临床意义。方法：选取1980—01-06—2013-03—31泰安市不同医院检验科208例确诊为M3的患者为研究对象。以粗颗粒型早幼粒细胞百分率进行分型，规定粗颗粒型早幼粒细胞〉70％为M3a（粗颗粒型）；〉30％～70％为Msb（混合颗粒型）；≤30％为M3c（细颗粒型）。分析各亚型的诊断标准及其临床意义。结果：M3a88例（42．31％），M3b63例（30．29％），M3c57例（27．40％），3种亚型的发生率M3a〉M3b〉M3c。M3a男性明显多于女性，M3b性别差异无统计学意义，M3c女性明显多于男性；年龄分布M3a〈M3b〈M3c；初诊时发热症状M3b48例（76．19％），M3。44例（50．00％），M3c16例（28．07％），差异有统计学意义，P〈0．001；出血情况M3a5例（73．86％），M3b36例（57．14％），M3c24例（42．11％），差异有统计学意义，P=0．001；21例（23．86％）M3a和16例（25．40％）M3b患者胸骨压痛明显，M3c未见。37例（42．06％）M3a患者有肝肿大，M3b与M3c未见；淋巴结肿大M3b24例（38．10％），M3a21例（23．86％），M3c未见。Hb、RBC、BPC和WBC均值M3a〈M3b〈M3c；外周血中早幼粒细胞的数值M3c〉M3a〉M3b；骨髓中粒红比值、早幼粒细胞的百分率、粗颗粒型早幼粒细胞的百分率均M3a〉M3b〉M3c；Auer小体的发生M3b多见，M3c较少见，M3a不易见。结论：细胞形态学分型标准解决了M3因粗、细颗粒混杂而造成的分型困难，有利于今后以同一分型标准进行诊断与学术交流。OBJECTIVE： To explore the clinical significance on the morphological classification of acute hypergranu- lar promeylocytic leukemia. METHODS：All the patients came from varies hospital in Taian between 1980-01-06-2013 03-31. The proposed typing was based on the percentage of leukemia cells with coarse granules in the cytoplasm and divided M3 into three subtypes： M3a （coarse granule subtype） in which 〉 70% of the leukemia cells contained coarse granules, M3b （mixed granule subtype） in which 30% to 70% of the leukemia cells contained coarse granules,and M3c （fine granule sub-type） in which 430% of the leukemia cells contained coarse granules. The relationship between the new typing system and the clinico-pathologic characteristics were studied. RESULTS： M3a had 88 cases （42. 31%）, M3b had 63 cases （30.29 % ）, and M3c had 57 cases （27.40 % ）, accounted for M3a〉M3b 〉 M3c. There was a different sex distribution pattern among the three subtypes,with male dominance in M3a subtype,female dominance in M3c, subtype and no sex dominance in M3b, subtype. The age distribution pattern was that M3a〈M3b〈M3c. Fever as the first presenting symptom was most fre quently observed in 48 cases of M3b patients （76. 19%） ,followed by M3a 44 cases （50.00%） and M3c, 16 cases （28.07%）, difference was statistically significant,P〈0. 001. Hemorrhage was most frequent in M3a, as 65 cases （73.86 % ）, followed by M3b, 36 cases （57. 14%） and M3c 24 cases （42. 11%）,difference was statistically significant,P=0. 001. Stern tender-ness was observed in some Ma＋, patients （21 cases 23.86%） and M3b （16 cases 25. 40%）, but not in M3c. patients. There were 37 cases （42.06%） patients with hepatomegally in M3a, subtypes but not in M3b or M3c subtypes. Lymph node en-largement was most frequently observed in M3b as 24 cases （38. 10%）,followed by M3a, 21 cases （23.86%）,and then M3, as 0 case. The average levels of peripheral blood hemoglobin, red blood cell count, platelets

关 键 词：白血病 早幼粒细胞 急性 诊断学 白血病 早幼粒细胞 急性 治疗学 细胞形态学 亚型 

分 类 号：R733.7[医药卫生—肿瘤]