骨髓细胞形态学检查对风湿免疫病的诊断价值探讨  

Diagnostic Values of Bone Marrow Cell Morphology for Rheumatic Diseases

作　　者：王娟[1] 吕娟[1] 宗红[1] 马国斌[1] 魏秀珍[1] 赵燕田[1] Wang Juan;Lv Juan;Zong Hong;Ma Guohin;Wei Xiuzhen;Zhao Yantian(Department of Clinical Laboratory,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院检验科

出　　处：《中国病案》2019年第12期95-99,共5页Chinese Medical Record

基　　金：国自然青年科学基金(81301796);北京市医院管理中心“青苗”计划专项经费资助(QML20150304);北京市医院管理局临床医学发展专项经费资助(ZYLX201811)

摘　　要：目的分析风湿免疫病患者的骨髓细胞形态学特点,探讨骨髓形态学检查对该类疾病的诊断价值。方法回顾性分析2016年1月1日-2018年9月30日来自某院风湿免疫科就诊且行骨髓形态学检查的69例患者资料,对确诊风湿免疫病患者的外周血白细胞、红细胞和血小板变化对应的骨髓粒系、红系、巨核系形态学进行相关性分层分析及疾病分层分析。结果 51例确诊风湿免疫病患者血象变化主要表现为贫血(78.4%)、白细胞减少或升高(49%)、血小板减少或升高(25.5%)。从血象-骨髓形态学相关性分层及疾病分层分析发现骨髓粒系、红系、巨核系细胞均可见轻度病态改变或中毒改变,56.9%患者胞浆存在颗粒变化(颗粒增多、减少或缺乏),15%患者可见细胞中毒改变;13.7%患者成熟红细胞可见缗钱状排列,10%患者红系可见不同程度的病态改变;约95%患者巨核系统未见明显病态改变。约20%患者浆细胞伴有形态改变。骨髓铁染色提示不足10%的风湿免疫病患者贫血由缺铁造成。13例以风湿免疫性症状为主就诊的患者通过骨髓形态学检查确诊为血液系统疾患。结论风湿免疫病因其自身免疫系统异常引起血液系统改变,骨髓形态学检查对风湿免疫病的诊断治疗、疗效监测,及与血液系统疾患的鉴别诊断提供重要依据,具有广泛的临床应用价值。Objective To analyze the morphological characteristics of bone marrow cells in patients with rheumatic disease and to explore the diagnostic values of bone marrow morphology for the disease.Methods A retrospective analysis was made of 69 patients from the Department of Rheumatology and Immunology, a Three A and Tertiary hospital in Beijing from 2016 to 2018.The stratified analysis of the morphology of bone marrow myeloid cells, erythrocytic cells and megakaryocytic cells corresponding to the changes of peripheral blood leukocytes, red blood cells and platelets in patients with rheumatic disease and disease stratified analysis were made. Results The peripheral blood changes of 51 patients with rheumatic diseases mainly included anemia(78.4%), leukopenia or elevation(49%), thrombocytopenia or elevation(25.5%). The slight pathological changes or toxic changes were observed in granulocytes, erythrocytes and megakaryocytes of bone marrow by hemogram-bone marrow morphological correlation stratifiedand disease stratified analysis: 56.9% of patients had granules changes(granules increase, decrease or lack) and 15% of patients had toxic changes. Rouleaux was seen in 13.7% of the patients on the erythrocyte morphology,and 10% of patients had different degrees of erythrocyte pathological changes. About 95% of patients had no obvious pathological changes in megakaryocytes.Plasma cell activation can be seen in 20% of patients.Iron staining of bone marrow indicated that iron deficiency was responsible for 10% of anemia in patients with rheumatic diseases.13 patients with rheumatic immune symptoms were diagnosed as hematological diseases by bone marrow morphology.Conclusion The abnormal immune system of rheumatic diseases causes the changes of blood system. Bone marrow morphology examination provides important basis for the diagnosis and treatment of rheumatic disease, monitoring the curative effect, and differential diagnosis with the diseases of blood system, which has important clinical application value.

关 键 词：骨髓细胞形态学 风湿免疫病 贫血 

分 类 号：R593.2[医药卫生—内科学]