骨髓穿刺涂片联合骨髓活检切片在骨髓增生异常综合征诊断中的应用

目的 探讨骨髓穿刺涂片联合骨髓活检切片在骨髓增生异常综合征(myelodysplastic syndrome,MDS)诊断中的应用价值。方法 对59例血细胞减少患者采取骨髓穿刺和骨髓活检同步取材法,两种方法对其骨髓的增生程度,各系细胞的病态造血及网硬蛋白进行分析。结果 59例患者经骨髓活检切片观察其骨髓增生程度,其中增生活跃、明显活跃及极度活跃的患者共为53例,占89.8%; 骨髓穿刺涂片为40例,占67.8%,两者比较差异具有统计学意义(χ²=5.087,P=0.023)。26例MDS患者骨髓涂片发现粒系病态造血16例,占61.5%,骨髓切片为25例,占96.2%,两者比较差异具有统计学意义(χ²=5.092,P=0.021)。骨髓涂片发现红系病态造血24例,占92.3%,骨髓切片为7例,占26.9%,两者比较差异具有统计学意义,(χ² =16.705,P=0.00)。骨髓涂片发现巨核系病态造血12例,占46.1%,骨髓切片为10例,占38.5%,两者比较差异无统计学意义(χ²=0.387,P=0.513)。26例MDS患者网硬蛋白纤维组织增生者16例,占61.5%; 33例非MDS患者为6例,占18.2%,MDS组患者显著高于非MDS组患者,两者比较差异具有统计学意义(χ²=10.086,P=0.001)。结论 骨髓穿刺涂片同时结合骨髓活检切片,可提高MDS诊断分型的准确性。

Value of Both Bone Marrow Biopsy and Smearin Diagnosis of Myelodysplastic Syndrome

Objective To investigate the clinical significance of both marrow biopsy and smear methods for the diagnosis of myelodysplastic syndrome(MDS).Methods The bone marrow biopsy and aspiration were simultaneously conducted,and then histologic sections and cytologicsmears prepared and observed under microscope from 59 patients with pancytoniadysplastic.Results In 59 patients with pancytonia dysplastic diagnosed by both methods,the difference of bone marrow proliferative degree between histologic sections and cytologic smears was statistically significant(χ²=5.087,P=0.023).The detective rate of myeloid dysplasia in histologic sections was higher than that of cytologic smears(χ²=5.092,P=0.021).That of erythoid dysplasia in histologic sections was lower than that of cytologic smears(χ²=16.705,P=0.00),but that of megakaryoid dysplasiawas of no difference between these two methods(χ²=0.387,P=0.513)from26 patients with myelodysplastic syndromes.The results showed that of 26 MDS patients,16(61.5%)patients Gomori's stain showed positive.Of 33 Non-MDS patients,6(18.2%)patients Gomori's stain showed positive,and the difference was statistically significant significantly(χ²=10.086,P=0.001).Conclusion The histologic sections and cytologic smears have their advantages in the diagnosis of MDS,and the combination of these two methodswill achieve much better results.