几种血液病骨髓活检中细胞凋亡的形态学观察

细胞凋亡(apoptosis)不同于坏死的细胞死亡方式,它是由基因控制的细胞自我消亡过程。细胞凋亡与白血病发生的关系已有不少报道,但有关血液病骨髓活检中细胞凋亡的形态学观察及意义报告尚少。我们对95例未经特殊治疗的各种良性和恶性血液病骨髓活检塑料包埋切片进行了仔细地形态学观察。发现各种白血病、骨髓增生异常综合征(MDS)和一些良性血液病均存在典型的凋亡细胞,并对其出现率和数量进行了比较分析。1 材料与方法1.1 病例资料 本院门诊及住院未经特殊治疗的慢性粒细胞白血病(CML)10例,急性非淋巴细胞白血病(ANLL)10例(M_2b 2例,M_6 1例,M_4 2例,M_2a 2例,M_3 2例,M_1 1例),MDS 30例（RA 9例,RAEB 11例,RAEB-T 10例）,真性红细胞增多症(PV)10例,溶血性贫血10例（自身免疫溶血性贫血2例,阵发性睡眠性血红蛋白尿6例,遗传性球形红细胞增多症2例）,原发性血小板减少性紫癜(ITP)10例,慢性再生障碍性贫血(CAA)10例,巨幼细胞性贫血（简称巨幼贫,包括不同病因的）5例。以上均由本院血液内科按国内有关标准诊断。1.2 方法 常规骨髓活检,PCF 固定,塑料包埋切片,H-Giemsa-E染色,光镜观察计数O.5mm~2内     

骨髓活检对血液病的诊断价值

为了探讨骨髓活检对各种血液病的诊断价值,自１９９０年以来,我们对１０４例临床疑诊为血液病的患者在做骨髓涂片检查的同时做骨髓活组织检查（骨髓活检）。现将检测结果分析如下。１资料与方法１．１临床资料本组男６７例,女３７例;年龄１４～７７岁。临床表现为不同...     

恶性血液病并发骨髓纤维化

报告原发性骨髓纤维化１例及恶性血液病并发骨髓纤维化１３例，其基础疾病包括骨髓增生异常综合征５例，慢性粒细胞白血病４例，骨髓转移性肿瘤２例，急性巨核细胞白血病及多发性骨髓瘤各１例。对骨髓纤维化的发病机理及其对预后的影响略予讨论。     

血液病与骨髓微血管研究进展

骨髓微血管在血液系统疾病的发生发展中具有重要作用,其形成受多种调控因子的交互影响。目前在多种恶性血液病及非恶性血液病均发现存在血管生成的异常,骨髓微血管密度可作为判断疾病预后的重要指标,并在部分疾病中具有分层意义。通过给予相应的治疗,抑制或促进血管新生对提高疾病疗效具有重要意义,但部分疗效机制仍有待于深入探讨。     

血液病骨髓活检GMA冷包埋切片单克隆标记物表达检测方法的初步研究

目的：报道一种简易骨髓活检块乙二醇甲基丙烯酸酯（ＧＭＡ）冷包埋技术。方法：应用冷的Ｂｏｕｉｎ 液固定、冷甲醇脱水、冷ＧＭＡ 中浸渍与包埋，然后在４℃真空下聚合，从而提供了一种有效制冷系统，可防止许多细胞抗原标记物因聚合过程中过度产热所致的热损伤。结果：为研究同一切片内骨髓细胞形态和免疫组化反应提供了一种有用的诊断工具。结论：建立了一种骨髓活检的冷包埋技术，细胞抗原标记物的保存良好，又可对免疫组化标记物表达的形态学细节进行研究。     

骨髓根除性治疗恶性血液病临床研究

目前恶性血液病的治疗,化疗完全缓解率（ＣＲ）已达６０％～９０％。同基因或自体骨髓移值５年生存率４０％～５０％,治疗水准已达平台期,控制恶性血液病复发是血液学学者急需探索的主要课题。为探讨恶性血液病低复发,提高无病生存率（ＤＦＳ）、长期生存率（ＬＦＳ）及生存质量。我们设计了骨髓根除性治疗（ＭｅｇｌｏａｂｌａｔｉｒｅＴｈｅｒａｐｙＭＡＴ）方案。即在超大剂量化疗杀灭体内残留恶性细胞,动员大量干细胞增殖、分化迁移基础上,进行交替ＨＢＩ治疗,进一步清除恶性克隆细胞,再以过继免疫疗法目的性攻击超微量残留恶性…     

血液病骨髓活检GMA冷包埋切片单克隆标记物表达检测方法的初步 …

目的：报道一种简易骨髓活检块乙二醇内烯酸酯（ＧＭＡ）冷包埋技术。方法：应用２冷的Ｂｏｕｉｎ液固定、甲醇脱水、冷ＧＭＡ中浸渍与包埋，然后在４℃真空下聚合，从而提供了一种有效制系统，可防止许多细胞抗的标记物因聚合过程中过度产热所致的热损伤。结果：为研究同一切片内骨髓细胞开矿和免疫组化反应提供了一种有用的诊断工具。结论：建立了一种骨髓活检的冷包埋技术、，细胞怕民物的保存良好，又可对免疫组化标记物表达的形     

血液病外周性及中心性骨髓SPECT显像规律初探

目的：探讨各种血液病单光子发射电子计算机断层扫描(SPECT)骨髓显像的特点及其规律。方法：对148例不同类型血液病患者，包括再生障碍性贫血(再障)72例，白血病32例，骨髓增生异常综合征(MDS)20例，缺铁性贫血14例，慢性溶血性贫血(慢性溶贫)l0例，静脉注射^99mTc—植酸钠后进行全身骨髓SPECT显像，观察外周及中心骨髓活性及分布情况。结果：148例受检者中，外周骨髓扩张率为44．6％，其中再障未缓解期与缓解期分别占28．6％和39．1％；白血病未缓解期与缓解期分别占78．6％和33．3％；缺铁性贫血占21．4％，慢性溶贫占80．0％，MDS占75．0％。几种血液病骨髓扩张的好发部位不同，再障与白血病患者处于不同临床阶段，中心骨髓活性受抑制程度不同，分别是未缓解期再障73．5％，白血病71．4％，缓解期再障43．5％，白血病27．8％，同类两者间比较差异均有显著性意义(P＜0．05)。20例MDS患者中有13例显示中心骨髓处于高活性状态。结论：了解不同血液病外周及中心骨髓活性及分布的特点和规律，有助于其诊断及疗效的监测。     

81例血液病骨髓涂片病态巨核细胞检出率分析

病态巨核细胞主要表现为原始巨核细胞增多 ,以及出现各种形态的小巨核细胞。参考国内车春兰的形态学分类 ,我们对 81例各种血液病的骨髓涂片进行了观察分析 ,报告如下。1 　 材料与方法笔者近期收集和总结了 81例已明确诊断的血液病骨髓涂片 ,并按照全国统一标准对原诊断逐一进行了复核和确认。各病例数见表 1。对每例骨髓涂片计数 1 0 0 0个非红系细胞 (NEC) ,计算出病态巨核细胞 (MK)出现的百分率。重点观察小 MK形态变化 ,记录其病态造血的表现。2 　 结果病态 MK的类型及出现率 (占 NEC% )见表 1。表 1　病态 MK的类型及出现率 (…     

Serial Morphologic Observation of Bone Marrow in Aplastic Anemia in Children

Recent reports of myelodysplastic syndrome/acute myeloid leukemia (t-MDS/AML) developing after treatment with immunosuppressants and granulocyte colony-stimulating factor (G-CSF) has raised the question of whether previously unrecognized myelodysplastic features had been present or whether actual transformation had occurred. We undertook a multi-institutional study of 112 children with aplastic anemia diagnosed between 1976 and 1996 and then treated with immunosuppressants with or without G-CSF. In each case, bone marrow specimens were tested at study entry and every 6 months for 3 years to detect t-MDS/AML as defined by morphologic and molecular/cytogenetic criteria. As of December 2001, all eligible patients had been followed for a median of 3 years. Morphologic abnormalities were found in 17 cases. The patients in 4 of these cases had clonal cytogenetic abnormalities and received MDS diagnoses. The morphologic features of the patients with and without clonal cytogenetic abnormalities were indistinguishable. However, the mast cell content was lower in cases with cytogenetic abnormalities than in cases without them. An elucidation of the role of mast cells may provide information about the differences between aplastic anemia and MDS or about the transition of aplastic anemia to MDS.     

急性髓性白血病骨髓组织学分型的研究

目的：探讨塑料包埋骨髓活检切片对急性髓性白血病（AML）进行组织学分型的可能性。方法：对92例初诊AML患者的骨髓切片进行常染色观察。结果：5例属增生减退型，87例为增生活跃型。43例分入白血性原始细胞的纯一性浸润型，另49例为非纯一性浸润型。内59例为纤维增生型，33例分入非纤维增生型AML。结论在AML的分型中，活检切片对涂片有补充与纠正作用。     

Comparative Evaluation of Simultaneous Bone Marrow Aspiration and Bone Marrow Biopsy: An Institutional Experience

Bone marrow aspirations and bone marrow biopsies are important diagnostic procedures. A comparative study of both the procedures done simultaneously was retrospectively reviewed in 160 cases where the clinical history is correlated with BMA and BMB results. The advantage of each method is analyzed. Correlation of our findings with that given in the literature is done to give a guideline for both techniques. We have found that 61.25% of the cases showed a positive correlation between bone marrow aspiration and bone marrow biopsy. However, we found that tuberculous granulomas and Hodgkin disease involvement of the marrow were detected better in bone marrow biopsies. The advantage of both the procedures done together provided more material and enabled us to study the cytomorphology of the cells, with the pattern of distribution of the cells depending on the cases. However, when both the procedures are done simultaneously, a proper technique is required so as to yield good diagnostic material.     

骨髓检查在临床诊断中的价值：附722例分析

目的 :探讨骨髓像对临床 ,尤其是血液病诊断的意义。方法 :结合 72 2例骨髓穿刺检查结果进行回顾性分析 ,其中 2 10例进行了骨髓活检。结果 :对各类型白血病、多发性骨髓瘤、骨髓转移癌、部分恶性组织细胞病及疟疾可确诊。可协助增生性贫血、再障等疾病的诊断及与某些疾病的鉴别诊断。结论 :骨髓检查、周围血检查及临床资料对诊断血液系统疾病、感染性疾病是重要的     

52例白血病骨髓活组织检查的观察

采用塑料包埋薄切片技术对52例白血病骨髓活组织进行病理检查结果显示:32例急性白血病中24例伴有不同程度纤维细胞增加或纤维化,其程度越重预后越差。20例慢性粒细胞白血病全部伴有纤维细胞增加或不同程度纤维化,程度越严重脾脏越大。同时本文对化疗前后基质损伤程度与预后关系等问题进行了讨论。     

骨髓活检对急性白血病的治疗方案制定及预后评估

比较了５３例治疗前急性白血病骨髓穿刺涂片及民埋骨髓活检切片标本，发现其骨髓增生程度判断结果差异明显，真正的低增生型及伴骨髓纤维化的急性白血病并不多见。原始细胞非均一性浸润的白血病患者，对常规化疗效果差，可能需要特殊的改良方案。     

骨髓切片的诊断价值:906例骨髓切片分析

分析906例骨髓活检切片,其中再生障碍性贫血(AA)496例,骨髓增生异常综合征(MDS)组188例,骨髓纤维化(MF)组222例.在抽吸涂片的基础上经切片诊断后使确诊率分别由40.9%,67.0%和55.4%提高到74.6%、93.1%和94.6%,差异均有显著性(P<0.01).在骨髓干抽或混血时,切片具有确诊价值.切片能纠正涂片检查对慢性粒细胞白血病急性变和真性红细胞增多症诊断的某些错误,对低增生型骨髓增生异常综合征(HMDS)提出了切片诊断要点.切片在细胞分类时尚不能定量化,辨认细胞巨幼样变和胞浆异常颗粒也不如徐片准确是其不足.     

慢性粒细胞白血病的骨髓组织病理学研究

应用国产塑料包埋剂对23例慢粒慢性期患者进行了骨髓塑包切片的组织病理学研究,证明慢粒属于异质性疾病,分两类组织学亚型:即以粒系细胞极度增殖为主的粒细胞(GRAN)型和以粒系细胞—巨核细胞混合性增殖,且伴巨核细胞多形性与异位的粒细胞/巨核细胞(GRAN/MEG)型。本文对两型的其它组织学特点一并进行了讨论。     

Histomorphometrical Determination of Bone Marrow Cellularity in Iliac Crest Biopsies

The point-count principle is an exact method of bone marrow quantitation but fairly good correlation was found between quantitated and estimated values of the cellularity in iliac crest biopsies, although the latter values were significantly lower. No intraspecimen variation was found, but the cellularity in the individual biopsies varied considerably from field to field, indicating that quantitation and estimation on small samples obtained by aspiration may be misleading. The correlation between the values from undecalcified and decalcified sections was high, but decalcification of the biopsies resulted in an underestimation of the amount of haemopoietic tissue.     

Prognostic relevance of histological findings on bone marrow biopsy in myelodysplastic syndromes

Summary Bone marrow biopsy (BMB) has aroused growing interest as a possible aid in the diagnostic and prognostic evaluation of myelodysplastic syndromes (MDS). Previous reports have pointed out that MDS patients with blastic aggregates or severe bone marrow (BM) fibrosis are characterized by a worse clinical outcome. BMBs of 106 MDS patients were retrospectively reviewed, and relationships among the different histological parameters as well as clinicopathological correlations were looked for. Three patterns of BM blastic infiltration (diffuse, cluster, and large) were recognized. Overt leukemic transformation and overall survival were selected as prognostic end points. BM infiltration was diffuse in 18, cluster in 48, and large in 40 cases. RAEB-t patients accounted for about half of the large cases, and none had a diffuse pattern (p<0.01). Nineteen patients showed extensive BM fibrosis; most of them were characterized by cluster blastic infiltration and megakaryocyte hyperplasia. Leukemic transformation occurred in 67% of large cases (p<0.001) and in none of the cluster cases with severe BM fibrosis (p<0.01); however, survival was equally poor in these two groups because of early leukemic transformation (large cases) and BM failure (cluster cases). The FAB classification did not significantly correlate with prognosis. Patients with cluster BM infiltration and severe fibrosis can be regarded as a true separate MDS subset characterized by unique clinicopathological and prognostic features. Because of the subacute clinical behavior of most cases, and the poor performance status of many elderly patients, there is still controversy as to the best therapeutic approach in MDS. Histological analysis allowed two groups of MDS patients to be identified, both characterized by poor life expectancy, who could benefit from early aggressive chemotherapy.