白血病诊断综合分析的重要意义  

The significance of comprehensive analysis in the diagnosis of leukemia

作　　者：黄静沁[1] 许闪闪[1] 李智 郑特[1] 翁文浩[1] 王佳谊[1] 

机构地区：[1]同济大学附属第十人民医院检验科,上海200072 [2]杨浦区中心医院检验科,上海200090

出　　处：《检验医学》2014年第11期1158-1163,共6页Laboratory Medicine

摘　　要：目的证实白血病诊断综合分析的重要意义。方法通过血常规、骨髓细胞形态学、细胞化学染色、流式细胞学白血病免疫分型、细胞遗传学分析、分子生物学检测及骨髓病理诊断联合检查,对6例白血病,包括急性早幼粒细胞性白血病M3a、大颗粒淋巴细胞性白血病、多毛细胞白血病(HCL)、急性粒细胞性白血病部分分化型M2a、慢性淋巴细胞性白血病(CLL)和急性髓系白血病微分化型M0进行诊断。结果急性早幼粒细胞性白血病经骨髓细胞形态学、细胞化学染色后确诊;大颗粒淋巴细胞白血病经骨髓细胞形态学、细胞化学染色、流式细胞术检测后确诊;HCL经骨髓细胞形态学、细胞化学染色、流式细胞术和骨髓病理诊断确诊;急性粒细胞性白血病部分分化型经检查,骨髓细胞形态学、细胞化学染色和流式细胞术检查对该病例仍难以准确判断,最终行染色体核型分析和分子生物学检测帮助确诊。CLL经骨髓细胞形态学和流式细胞术确诊。急性髓系白血病微分化型经骨髓细胞形态学、细胞化学染色、流式细胞术检查和染色体核型分型综合确诊。结论综合运用多种检验项目对确诊环境改变、老龄化等原因引起的不典型白血病具有重要的临床意义。Objective To testify the significance of comprehensive analysis in the diagnosis of leukemia.Methods A total of 6 cases of leukemia,including acute promyelocytic leukemia M3a,large granular lymphocyte leukemia, hairy cell leukemia （HCL）,acute myeloblastic leukemia with significant maturation M2a,chronic lymphocyte leukemia （CLL）and acute myeloblastic leukemia without cytologic maturation M0 were diagnosed by routine blood testing,bone marrow morphology,cellular chemical dyeing,flow cytometry,cellular genetics,molecular biology analysis and bone marrow pathological diagnosis.Results Acute promyelocytic leukemia was confirmed through bone marrow morphology and cellular chemical dyeing.Large granular lymphocyte leukemia was confirmed through bone marrow morphology, cellular chemical dyeing and flow cytometry.HCL was confirmed through bone marrow morphology,cellular chemical dyeing,flow cytometry and bone marrow pathological diagnosis.However,the diagnosis of acute myeloblastic leukemia with significant maturation manifested that it was still hard to make the decision through bone marrow morphology, cellular chemical dyeing and flow cytometry.The confirmation was made in aid of chromosome examination and molecular biology analysis.CLL was confirmed through bone marrow morphology and flow cytometry.Acute myeloblastic leukemia without cytologic maturation was confirmed through bone marrow morphology,cellular chemical dyeing,flow cytometry and chromosome examination.Conclusions The comprehensive analysis of multiple laboratory items makes critical clinical importance in the confirmation of untypical leukemia as the results of environmental changes,aging of population and so on.

关 键 词：白血病 细胞形态学 流式细胞学 细胞遗传学 分子生物学 

分 类 号：R446.11[医药卫生—诊断学]