骨髓组织印片在浆细胞骨髓瘤诊断及化疗后形态学缓解度监测中的价值  

The value of bone marrow imprint in diagnosis of plasma cell myeloma and monitoring the remission after chemotherapy

作　　者：莫伟明[1] 苏萍[2] 刘军[1] 周其良[2] 陈琴琴[1] 

机构地区：[1]浙江萧山医院检验科,杭州311202 [2]浙江萧山医院血液内科,杭州311202

出　　处：《中国医师杂志》2017年第9期1361-1365,共5页Journal of Chinese Physician

基　　金：杭州市萧山区社会发展重大科技攻关项目（2016204）

摘　　要：目的研究骨髓组织印片在浆细胞骨髓瘤诊断及化疗后形态学缓解度监测中的价值。方法收集128例次同步进行骨髓涂片、组织印片和活检切片检查的浆细胞骨髓瘤，以骨髓活检切片为标准，比较骨髓组织印片、骨髓涂片在显示有核细胞量、浸润度及诊断符合率之间的差异，以及评价其敏感度、特异度、阳性预测值、Youden指数各项性能指标。结果骨髓组织印片显示有核细胞量评估性能优于涂片（P〈0．05），而与切片相近（P〉0．05）。以骨髓切片结合CD38（＋）显示骨髓瘤浸润度为标准，骨髓组织印片优于骨髓涂片（／9〈0．05），而与切片相近（P〉0．05）。评价骨髓组织印片显示骨髓瘤浸润度符合率方面：在Ⅰ期中，骨髓组织印片符合率[95．83％（23／24）]与骨髓涂片[91．67％（22／24）]比较差异无统计学意义（P〉0．05）；在Ⅱ期中，组织印片符合率[92．86％（65／70）]明显高于骨髓涂片[65．71％（46／70）]，差异有统计学意义（P〈0．05）；Ⅲ期中，组织印片符合率[79．41％（27／34）]亦明显高于骨髓涂片[44．12％（15／34）]，差异有统计学意义（P〈0．05）。其他性能指标上，骨髓组织印片的敏感度、特异度、阳性预测值、Youden指数等指标性能总体上优于骨髓涂片。结论骨髓组织印片兼有涂片和切片的特征，在浆细胞骨髓瘤诊断及化疗后形态学缓解度监测中具有明显优势。Objective To investigate the value of bone marrow imprint in the diagnosis of plasma cell myeloma and the remission rate after chemotherapy. Methods Bone marrow aspiration, bone marrow imprint, and bone marrow biopsy of plasma ceil myeloma with 128 patients were coilected. The bone marrow biopsy was used as the standard. Bone marrow imprint was compared to bone marrow aspiration in bone marrow nucleated ceils quantity, infiltration degree, and diagnostic coincidence rate. Sensitivity, specificity, positive predictive value, and Youden index were evaluated. Results The results of bone marrow imprint showed that the number of nucleated cells was better than that of bone marrow aspiration （ P 〈 0. 05 ）, and was similar to that of bone marrow biopsy （ P 〉 0. 05 ）. Bone marrow biopsy combined with CD38 （ ＋ ） showed the degree of infiltration of bone marrow as the standard, and the bone marrow imprint was better than that of bone marrow aspiration （ P 〈 0. 05 ）, and was similar to that of bone marrow biopsy （ P 〉 0. 05 ）. To evaluate the compliance rate of bone marrow infiltration in bone marrow imprint ： In phase Ⅰ, the compliance rate of bone marrow aspiration was 95.83% （23/24） and bone marrow imprint of 91.67% （22/24）, the difference was not statistically significant （P 〉0. 05） ; In phase Ⅱ, bone marrow imprint coincidence rate was 92. 86% （65/70） , which was significantly higher than that of bone marrow aspiration in 65.71% （46/70） （P 〈 0. 05 ）; In phase Ⅲ, bone marrow imprint coincidence rate was 79.41% （27/ 34）, which was significantly higher than that of bone marrow aspiration in 44. 12% （15/34） （P 〈 0. 05 ）. The other parameters, such as sensitivity, specificity, positive predictive value, and Youden index were better than those of bone marrow aspiration. Conclusions Bone marrow imprint has characteristics that both bone marrow aspiration and bone marrow biopsy have. It has obvious advantages in diagnosis of plasma cell myeloma and

关 键 词：骨髓检查 活组织检查 显微切片术 多发性骨髓瘤/诊断/药物疗法 

分 类 号：R733.3[医药卫生—肿瘤]