巨核细胞在骨髓增生异常综合征中的临床价值  

Megakaryocyte Clinical Value in Myelodysplastic Syndrome

作　　者：朱琳[1] 安利[1] 毛敏[1] 宋静雯[1] 任雪瑞[1] 王晓敏[1] 仝凤娟 

机构地区：[1]新疆维吾尔自治区人民医院血液科,乌鲁木齐830001 [2]新疆乌鲁木齐市第一人民医院,乌鲁木齐830000

出　　处：《血栓与止血学》2017年第3期369-371,375,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的通过对低原始细胞骨髓增生异常综合征(MDS)与特发性血小板减少性紫癜(ITP)、阵发性睡眠性血红蛋白尿(PNH)、非重症再生障碍性贫(NSAA)骨髓巨核细胞的比较观察,探讨其在MDS鉴别诊断中的价值。方法回顾性分析我院确诊的低原始细胞(<5%)MDS患者78例,特发性小板减少性紫癜(l TP)50例,阵发性睡眠性血红蛋白尿(PNH)20例、非重症再生障碍性贫(NSAA)18例患者的骨髓穿刺涂片,对巨核细胞进行观察分类、比较及分析。结果 MDS主要以单圆核巨核及多圆核巨核细胞为主要病态造血表现,其次为小巨核细胞。比较上述病态巨核细胞形态在各组的分布情况,发现MDS组显著高于ITP、PNH、NSAA组(P<0.05),而小巨核细胞几乎只出现在MDS病例中。ITP组病态巨核细胞的检出率明显高于PNH、NSAA组,但两组间比较差异无统计学意义(P>0.05);而多分叶巨核细胞主要见于ITP和MDS组,并且ITP组与MDS、PNH、NSAA组比较显示有统计学意义(P<0.05)。结论骨髓象中小巨核及单圆核和多圆核巨核细胞病态巨核细胞检出率与MDS病态造血程度有关,其病态巨核细胞特征的观察对MDS的诊断及鉴别诊断有重要临床意义。Objective To explore the value of bone marrow megakaryocytes in the diagnosis of myelodysplastic syndrome （MDS）, by analyzing bone marrow megakaryocytes in MDS with low blasts, idiopathic thrombocytopenic purpura （ITP）, paroxysmal nocturnal hemoglobinuria （PNH）, non severe aplastic anemia（NSAA）. Methods We retrospectively analyzed bone marrow smears of 166 patients diagnosed in our hospital,including 78 MDS with low blasts cell （ 〈 5%）, 50 ITP, 20 PNH, 18 NSAA, and then did classification, comparison and analysis on megakaryocyte. Results The main manifestations of MDS were single nuclear megakaryocytes and multi-nuclear megakaryocytes, followed by mieromegakaryocytes. Compared the distribution of the morbidness megakaryocytes mentioned above, the morbidness megakaryocytes of MDS group was significantly higher than that of ITP, PNH, NSAA （ P 〈 0.05 ）, while the micromegakaryoeytes were only found in MDS. The detection rate of megakaryoeyte in the ITP group was also significantly higher than that in PNH and NSAA group, it has no statistical difference between groups （ P 〉 0. 05 ） ; but multi- leaf nucleus megakaryocyte were mainly found in ITP and MDS, and there was statistically significance among ITP and MDS, PNH, NSAA （P 〈 0.05 ）. Conclusion The detection rate of morbidness megakaryocytes in micromegakaryocyte and single nuclear megakaryocyte ,muhi-nuclear megakaryocytes of bone marrow is related to the degree of morbidness megakaryocytes of MDS, and the Characteristics of morbidness megakaryocyte has great clinical significance of the diagnosis and differential diagnosis of MDS.

关 键 词：骨髓增生异常综合征 特发性血小板减少性紫癜 阵发性睡眠性血红蛋白尿 非重症再生障碍性贫血 病态巨核细胞 

分 类 号：R551.3[医药卫生—血液循环系统疾病]