骨髓增生异常综合征患者外周血细胞计数及病态造血特点分析  

Peripheral blood cell count and characteristics of dyshaematopoiesis in patients with myelodysplastic syndrome

作　　者：高远[1] 罗宇珊 仝凯 王天娇 马静[1] 李润青 董静肖 GAO Yuan;LUO Yushan;TONG Kai;WANG Tianjiao;MA Jing;LI Runqing;DONG Jingxiao(Department of Laboratory Medicine,Beijing Tsinghua Changgung Hospital,Tsinghua University(School of Clinical Medicine,Tsinghua University),Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院(清华大学临床医学院)检验医学科,北京102218

出　　处：《国际检验医学杂志》2024年第18期2201-2206,共6页International Journal of Laboratory Medicine

摘　　要：目的分析骨髓增生异常综合征(MDS)患者外周血细胞计数及外周血、骨髓细胞病态造血的特点。方法选取2015年1月至2022年12月于该院初诊的40例MDS患者作为试验组,以及17例巨幼细胞性贫血(MA)患者(MA组)、11例再生障碍性贫血(AA)患者(AA组)、24例自身免疫性疾病(AID)患者(AID组)作为非MDS组。采用全血细胞分析仪Sysmex XN20检测各组患者血常规,比较分析4组患者的白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)、平均红细胞体积(MCV)、红细胞分布宽度变异系数(RDW-CV);通过人工镜检对4组患者骨髓及外周血细胞形态进行观察并记录,比较分析4组患者中常见病态造血的阳性率。结果与MA组比较,MDS组RBC、Hb明显升高(P<0.05),MCV明显减少(P<0.05);与AA组比较,MDS组WBC、MCV、RDW-CV及PLT均明显升高(P<0.05);与AID组比较,MDS组WBC、RBC、Hb、PLT均明显减少(P<0.05),而MCV及RDW-CV均明显升高(P<0.05)。MDS组外周血原始细胞阳性率明显高于非MDS组(P<0.05);MA组外周血病态造血以大红细胞、粒细胞多分叶为主,病态造血阳性率均明显高于MDS组(P<0.05)。与非MDS组比较,MDS组骨髓涂片中原始细胞增多、细胞质颗粒减少或缺如、假Pelger中性粒细胞、双核粒细胞小巨核5种病态造血阳性率明显升高(P<0.05),而MA组粒系出现多分叶现象及巨变、红系出现巨幼变、大红细胞、嗜碱性点彩红细胞、H-J小体病态造血阳性率明显高于MDS组(P<0.05);AA组及AID组骨髓涂片中病态造血未见或少见。结论特征性的病态造血联合外周血细胞计数,有助于MDS的诊断及鉴别诊断,减少误诊、漏诊发生的可能。Objective To investigate peripheral blood cell count and characteristics of dyshaematopoiesis of peripheral blood and bone marrow cells in patients with myelodysplastic syndrome(MDS).Methods A total of 40 patients with MDS newly diagnosed in the hospital from January 2015 to December 2022 were selected as the experimental group,while 17 patients with megaloblastic anemia(MA group),11 patients with aplastic anemia(AA group),and 24 patients with autoimmune disease(AID group)were selected as the non-MDS group.Blood routine of patients in each group was detected by whole blood cell analyzer Sysmex XN20,and the white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),platelet count(PLT),mean red blood cell volume(MCV)and coefficient of variation of red blood cell distribution width(RDW-CV)of patients in 4 groups were compared and analyzed.Bone marrow and peripheral blood cell morphology in 4 groups were observed and recorded by artificial microscopy.The positive rate of common dyshaematopoiesis of peripheral in 4 groups was compared and analyzed.Results Compared with MA group,RBC and Hb in MDS group were significantly increased(P<0.05),while MCV was significantly decreased(P<0.05).Compared with AA group,WBC,MCV,RDW-CV and PLT in MDS group were significantly increased(P<0.05).Compared with AID group,WBC,RBC,Hb and PLT in MDS group were significantly decreased(P<0.05),while MCV and RDW-CV were significantly increased(P<0.05).The positive rate of peripheral blood primitive cells in MDS group was significantly higher than that in non-MDS group(P<0.05).Large red blood cells and polylobulated granulocyte were the main dysplasia types in the peripheral blood of MA group,and the positive rate of dyshematopoietic was significantly higher than that in MDS group(P<0.05).Compared with the non-MDS group,the positive rates of five types of dyshaematopoiesis in the MDS group were significantly higher than those in the control group(P<0.05),including increased blasts,decreased or absent cytoplasmic granules,pseudo Pelger

关 键 词：骨髓增生异常综合征 血细胞计数 细胞形态学 病态造血 

分 类 号：R446.1[医药卫生—诊断学] R551.3[医药卫生—临床医学]