初诊急性白血病1 151例患者骨髓及外周血形态学特点分析  

Morphological characteristics of bone marrow and peripheral blood in 1151 cases diagnosed with de novo acute leukemia

作　　者：王海洋 孙增田 徐晓蕊 颜静 桑威 李振宇 李金荣 徐梦迪 袁玖莲 王志远 曾令宇 Wang Haiyang;Sun Zengtian;Xu Xiaorui;Yan Jing;Sang Wei;Li Zhenyu;Li Jinrong;Xu Mengdi;Yuan Jiulian;Wang Zhiyuan;Zeng Lingyu(Department of Hematology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;School of Medical Technology,Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院血液科,徐州221002 [2]徐州医科大学医学技术学院,徐州221002

出　　处：《中华检验医学杂志》2023年第3期295-303,共9页Chinese Journal of Laboratory Medicine

基　　金：江苏省青年医学重点人才(QNRC2016791);江苏省科技厅社会发展重点项目(BE2019638)。

摘　　要：目的观察并分析初诊急性白血病患者骨髓及外周血形态学特点。方法收集2015年10月1日至2021年12月31日在徐州医科大学附属医院血液科1151例初诊急性白血病患者,年龄47(26,62)岁,男602例,女549例,观察骨髓及外周血涂片形态学特点,综合形态学、免疫学、细胞遗传学、分子生物学诊断结果,在急性髓系白血病(AML)与急性淋巴细胞白血病(ALL)之间,AML伴RUNX1-RUNXITI基因、AML伴CBFβ/MYH11基因、急性早幼粒细胞白血病(APL)伴PML/RARA基因、AML伴NPM1基因、其余AML之间以及Ph+ALL与Ph-ALL之间进行比较,采用卡方检验,统计柴捆细胞、假Chediak-Higashi(PCH)包涵体、胞浆细小颗粒、核切迹、白血病细胞有杯口样改变(杯口细胞)比例差异;微小巨核、早期幼稚粒细胞、浆细胞、高嗜酸粒细胞等伴随细胞出现差异及“葡萄状”聚集分布差异。总结不同类型急性白血病细胞自身形态学特点、伴随细胞出现情况及排布方式之间的变化差异。结果AML与ALL之间,胞浆Auer小体[(45.5%比0),χ^(2)=211.400]、PCH包涵体[(28.9%比0),χ^(2)=114.100]、胞浆细小颗粒[(20.7%比2.9%),χ^(2)=53.798]、核切迹[(0.7%比6.1%),χ^(2)=30.906]、杯口细胞[(4.9%比0.3%),χ^(2)=13.495]比例差异均有统计学意义(P均<0.01)。微小巨核[(22.4%比0.3%),χ^(2)=80.398]、浆细胞[(87.6%比10.6%),χ^(2)=604.241]、高嗜酸粒细胞[(15.3%比1.0%),χ^(2)=46.116]等伴随细胞出现以及“葡萄状”聚集分布上差异均有统计学意义(P均<0.01)。AML伴RUNX1-RUNXITI基因以空泡与PCH包涵体变化较为明显、AML伴CBFβ/MYH11基因以高嗜酸粒细胞出现增多较为明显、APL伴PML/RARA基因以柴捆细胞增多较为明显、AML伴NPM1基因以杯口细胞增多较为明显。各组之间细胞核染色质、核仁、空泡形态也不相同;Ph+ALL与Ph-ALL之间比较,Ph+ALL更容易出现早期幼稚粒细胞与浆细胞(P均<0.05)。结论AML与ALL之间在白血病自身细胞特点,伴�Objective To observe and analyze the morphological characteristic of bone marrow and peripheral blood in patients diagnosed with de novo acute leukemia.Methods From October 1,2015 to December 31,2021,1151 patients aged 47(26,62)years,consisting of 602 males and 549 females with newly diagnosed acute leukemia in the Department of Hematology,Affiliated Hospital of Xuzhou Medical University,were collected to preform the morphological analysis in bone marrow and peripheral blood smears.Based on the comprehensive diagnosis results of morphology,immunology,cytogenetics,and molecular biology,comparison between acute myeloid leukemia(AML)and acute lymphoblastic leukemia(ALL),AML with RUNX1-RUNXITI gene,AML with CBFβ/MYH11 gene,acute promyelocytic leukemia(APL)with PML/RARA gene,AML with NPM1 gene,the rest of the AML,Ph+ALL and Ph-ALL were performed by Chi-square test along with analysis of the differences in the ratio of wood bundle cells,pseudo-Chediak-Higashi(PCH)inclusions,cytoplasmic small particles,nuclear notches,leukemia cells with cup-like changes(cup cells);as well as the differences in the micromeganuclei,early immature granulocytes,plasma cells,high eosinophils and other accompanying cells and the distribution of"grape-like"aggregation.Finally,the morphological characteristics of acute leukemia cells,the appearance and arrangement of accompanying cells were summarized.Results Between AML and ALL,there were statistically significant differences in cytoplasmic Auer bodies[(45.5%,0%),χ^(2)=211.400,P<0.01],PCH inclusion bodies[(28.9%,0%),χ^(2)=114.100,P<0.01],cytoplasmic fine particles[(20.7%,2.9%),χ^(2)=53.798,P<0.01],nuclear notches[(0.7%,6.1%),χ^(2)=30.906,P<0.01],and goblet cells[(4.9%,0.3%),χ^(2)=13.495,P<0.01],micromegakaryus[(22.4%,0.3%),χ^(2)=80.398,P<0.01],plasma cells[(87.6%,10.6%),χ^(2)=604.241,P<0.01],hyperacidophils[(15.3%,1.0%),χ^(2)=46.116,P<0.01]showed significant differences in the"grape-like"aggregation distribution.In AML with RUNX1-RUNXITI gene,the changes of vacuoles and PCH inclusion

关 键 词：急性白血病 PCH包涵体 微小巨核 杯口细胞 

分 类 号：R733.71[医药卫生—肿瘤]