急性髓系白血病伴骨髓增殖异常相关改变的形态学及染色体核型研究  

The characteristic of acute myeloid leukemia with myelodysplastic related changes about the karyotype and morphology

作　　者：李佳[1] 墙星[1] 张曦[1] 刘思恒[1] 冉岑霞 张洪洋[1] 陶廷露 陈思宇 苟阳[1] 杨武晨[1] 杨程[1] 唐永杰 王平[1] 邓小娟[1] 彭贤贵[1] 

机构地区：[1]第三军医大学新桥医院血液科,重庆400030

出　　处：《检验医学与临床》2017年第18期2689-2691,共3页Laboratory Medicine and Clinic

基　　金：重庆市社会事业与民生保障科技创新专项项目(cstc2016shrns-ztzxl003)

摘　　要：目的研究急性髓系白血病伴骨髓增殖异常相关改变(AML-MRC)的遗传学及形态学改变,以提高检出率。方法通过对281例急性髓系白血病(AML)初诊患者回顾性研究,其中分别有60例AML-M2,68例AML-M4,54例AML-M5,51例AML-M6及48例AML-MRC。对各组的原始细胞数(原始细胞/原始粒细胞+原始幼稚单核细胞)、有核红细胞数、每个类型病态造血的细胞个数及染色体核型,进行统计学分析。结果原始细胞数比较:M2(99.70±36.11),M4(110.26±40.23),M5(159.77±29.22),M6(35.05±19.70),MRC(59.39±17.94),方差分析差异有统计学意义(F=121.456,P<0.05);MRC组与其他各组比较,M6原始细胞数<MRC组<AML-M2,4,5组(P均<0.05);有核红细胞数比较:M2(16.66±17.17),M4(14.15±14.64),M5(9.09±10.62),M6(126.31±27.75),MRC(47.43±21.21),方差分析结果差异有统计学意义(F=309.407,P<0.05),MRC与其他各组比较,M2/4/5组有核红细胞数<MRC组<M6组(P均<0.05)。各系病态造血:其中,粒系的假性佩许氏畸形、环状核等,红系的多/奇数核、母子核等,巨核系的小巨核、多核或单核圆核巨核细胞等,各组出现的个数比较,MRC组远高于其他组[(P<0.05)且异常细胞大于60%];另外,粒系的空泡、核溶解等,红系的核分裂相、芽孢等及巨核系的巨大巨核细胞、核断裂等比较,MRC组与其他组出现频率差异无统计学意义[(P>0.05)且均低于20%]。染色体核型分析:AML-MRC核型异常58.8%(20/34),包括MDS相关改变核型14例,及其他复杂核型6例。结论染色体核型异常的MRC仅58.8%;AML-MRC的形态学特征:原始细胞轻度增高,但较其他组增多并不明显,红系不受抑;各系病态造血现象:病态造血现象中前部分为异常特征性改变,主要见于AML-MRC及MDS,对AML-MRC具有诊断意义;后部分为非特征性改变,可见于各类疾病,包括感染、巨幼细胞贫血、白血病等。通过以上特征,可以更好的鉴别AML-MRC与其他各亚型。Objective Aim to research the characteristic of acute myeloid leukemia with myelodysplastic related changes to improve the diagnosis in clinical.Methods 281 patients surfing from AML divided into 5groups,including AML-M2,AML-M4,AML-M5,AML-M6 and AML-MRC.The quantity,morphology and the karyotype of the bone marrow cells were analyzed.And then Statistics analyzed by SPSS19.0The Tunnett C in each group.Results The number of blasts：M2（99.700±36.109）,M4（110.260±40.234）,M5（159.770±29.215）,M6（35.050±19.701）,MRC（59.390±17.944）.Compared to the groups,the variance analysis showed the F value 121.456（P0.001）.It meant the number of blasts of AML-M6the ones of AML-MRCthe ones of AMLM2/4/5.The number of erythroblasts：M2（16.660±17.165）,M4（14.150±14.643）,M5（9.090±10.619）,M6（126.310±27.750）,MRC（47.430±21.209）.Compared to the groups,the variance analysis showed the F value 309.407（P0.001）.And it meant the number of erythroblasts of AML-M6the ones of AML-MRCthe ones of AML-M2/4/5in contrary.Then the dysplastic include Pseudo-Pelger-Hu3 t cells,absence of granules,abnormal segmentation of cells,red cell with abnormal chromatin clumping（nuclear budding,internuclear bridging,karyorrhexis,multinuclearity）.The frequency of them were different in AMLMRC and AML-2/4/5/6.Karyotype analysis showed 58.8%（20/34）abnormality in AML-MRC,including 14 MDS related karyotype（-7/del（7q）,-5/del（5q）,＋8）,and 6others changes.Conclusion（1）Not all karyotype can be in AML-MRC.（2）The morphological characteristic of AML-MRC：The blasts are slightly higher than 20%.The erythroid is uninhibited.（3）Dysplastic shows the different in AML-MRC.It means the part of them could be the powerful dependence of the diagnosis in AML-MRC.

关 键 词：白血病 病态造血 核型 

分 类 号：R596[医药卫生—内科学]