回顾性研究骨髓标本巨核细胞微核检查对血液病诊断价值  

A retrospective study on the diagnostic value of bone marrow megakaryocyte micronuclei morphology for the hematological diseases

作　　者：朱金平[1] 卢兴国[2] 

机构地区：[1]浙江省浦江县人民医院检验科,322200 [2]浙江大学医学院附属第二医院骨髓室

出　　处：《中华检验医学杂志》2016年第3期197-200,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨骨髓标本巨核细胞微核检查在血液病诊断中的价值和意义。方法收集2002年至2009年期间在浙江大学医学院附属第二医院就诊并留取骨髓涂片的血液病患者863例，同时取25名健康体检者骨髓涂片作为对照。骨髓涂片行瑞氏-吉姆萨染色，低倍镜及油镜镜检，计数巨核细胞，观察巨核细胞微核形态和计算阳性检出率。分析巨核细胞微核阳性检出率在不同疾病、病理业型、巨核细胞总数和类型中的统计学差异。结果巨核细胞微核为网形或椭圆性，多个出现时为大小不一可位于核旁或远离细胞核甚至游离于细胞外，见于大型和中等类型巨核细胞。巨核细胞微核在髓系血液肿瘤中检出率最高，AML中尤以M6、M2、M4、M5b4种亚型和伴病态造血病例中多见，亦可见于巨幼细胞性贫血（MA）、感染及苯中毒，偶见于淋系血液肿瘤。结论巨核细胞微核的出现与细胞数目、大小和类型有关且不同血液疾病及病理亚型中巨核细胞微核阳性检出率具有一定统计学差异，巨核细胞做核检查在出液病诊断中具有较大的应用价值。Objective To evaluate the value and significance of testing megakaryoeyte micronuclei in bone marrow smears for hematopathy diagnosis. Methods Bone marrow smears from a total of 863 cases of patients with hemopathy were collected from 2002 to 2009 at the second affiliated hospital of zhejiang university school of medicine. Smears from 25 healthy individuals were used as control. The bone marrow smears were subjected to Wright-Giemsa staining. The number of megakaryocytes, morphous and positive rate of megakaryocyte micronucleis were recorded by using low power lens and immersion objective. Statistical differences of positive rate in the different diseases, pathologic subtypes, total number and type of megakaryocyte were analyzed. Results The megakaryocyte mieronucleis were round or oval with varying size, distributed in paranuclear or away from nuclear and even free in extracellular, which could be observed in large and medium megakaryocytes. The positive rate of megakaryocyte micronucleis was highest in myeloid leukemia, particularly in the subtype of M6, M2, M4 and M5b with dyshaematopoiesis. Megakaryocyte micronucleis could also be tbund in MA, infection and benzolism, but rarely observed in the lymphocytic leukemia. Conelution The detection of megakaryoeyte micronuclei was related with its amount, size and type. There is significant difference of the postive rates of megakaryocyte mieronuclei testing among the different hematopathies and pathologic subtypes. Megakaryocyte nficronuclei testing should be valuable in the the diagnoses of hematopathy.

关 键 词：巨核细胞 微核试验 骨髓细胞 

分 类 号：R55[医药卫生—血液循环系统疾病] R446.11[医药卫生—内科学]