以血液系统表现为首发的骨髓转移瘤62例临床特点分析

目的：总结以血液系统表现为首发的骨髓转移瘤患者的临床特点,提高对骨髓转移瘤的认识,以便指导治疗及延长患者的生存时间和提高患者的生存质量。方法：回顾性分析1995～2008年我院收治的以血液系统为首发表现的62例骨髓转移瘤患者的临床资料,总结骨髓转移瘤患者的临床表现和血象、骨髓象等特点。结果：62例患者中有51例最终查明了原发肿瘤部位,患者的平均生存时间为（11.16±7.72）月,临床上除均有不同程度的骨痛症状外,主要还有贫血、发热和出血等表现,分别占90.3%（56/62）、62.9%（39/62）和37.1%（23/62）;WBC计数正常占19.4%（12/62）、增高占62.9%（39/62）、降低占17.7%（11/62）;骨髓象示有核细胞增生活跃者占56.5%（35/62）、增生减低者占19.4%（12/62）,骨髓核细胞增生低下者占24.2%（15/62）;骨髓转移瘤患者生存期的影响因素有骨髓核细胞增生程度、Hb水平、是否行化疗及放疗和是否有出血。结论：以血液系统表现为首发的患者,应考虑到骨髓转移瘤的可能,需及时作骨髓穿刺或骨髓活检。

The clinical analysis of 62 patients with bone marrow metastatic carcinoma and hematological manifestations

Objective：Bone metastases and haematological symptomes are sometimes the first manifestation of carcinoma.The present study aimed to reveal the clinical characteristics of bone marrow metastatic carcinoma;to improve the recognition of metastatic carcinoma of bone marrow;to treat patients effectively;to prolong patient＇s survival time;and to raise life quality of those patients.Methods：The clinical data of 62 patients with bone metastases were obtained and analyzed from 1995 to 2008.Clinical manifestation,hemogram and bone marrow picture were summarized in these patients with bone metastases.Results：Haematological symptomes were first symptoms in 62 patients with bone metastases.Amony them,the primary location of carcinoma was eventually identified in 51 patients.The average survival time was（11.16±7.72）months.The most common symptom was bone pain,followed by anemia（90.3%,56/62）,fever（62.9%,39/62）and bleeding（37.1%,23/62）.71.4% of patients with anemia showed normochromic anemia.White blood cell count was normal in 12 patients（19.4%）,increased in 39 patients（62.9%）,decreased in 11 patients（17.7%）.bone marrow examination indicated that proliferation of nucleated cells active was presented in 35 patients（56.5%）,hyperplasia to reduce in 12 patients（19.4%）,bone marrow stem smoking in 15 patients（24.2%）.The impact factors of life span included the proliferation degree ofone nucleus pulposus cells,the hemoglobin,melts,the chemoradiotherapy and the hemorrhage.Conclusions：When aematological symptomes as the first manifestation were presented in patients,the diagnosis of bone marrow metastasis should be considered.The bone marrow aspiration or bone marrow biopsy should be performed timely.