骨髓涂片有核细胞量减少的真实性研究

目的研究骨髓涂片有核细胞的假阳性和假阴性减少,提高对涂片评估有核细胞量不足的认识。方法用骨髓穿刺针抽吸髓液涂片272例,随后同步以活检术获取组织块置于载玻片上制成印片,组织块入Bouin液固定,以骨髓印片和切片为对照,评估涂片对检查有核细胞量的价值。结果272例骨髓涂片有核细胞减少和增多级别均显著低于骨髓印片和切片(P<0.05~<0.01)。以印片和切片为对照,124例涂片有核细胞减少中,58.9%和66.1%为假阳性减少,常见误诊疾病为再生障碍性贫血、造血减低;而印片和切片细胞量增加中,涂片仍有26%和36%为假阴性减少,常见疾病或结论为脾功能亢进、真性红细胞增多症、特发性血小板增多症等;印片和切片细胞减低者中,涂片符合率(91.2%和97.9%),以及涂片细胞增加者中,印片和切片符合率(95%和100%)均高。涂片诊断细胞量真性减少疾病或结论(再生障碍性贫血和造血减低)的假阳性分别为29.0%和37.1%,诊断真性增加疾病(脾功能亢进、特发性血小板增多症、真性红细胞增多症等)假阴性率为22.6%和21.8%,诊断指标性能评价均不佳。结论骨髓涂片评估有核细胞量差,常造成假阳性和假阴性结果,建议将印片作为常规项目以弥补涂片的不足。

The value of bone marrow smear in evaluating nucleated cells quantity

Objective To study the false positive and false negative of decreased nucleated cells in bone marrow smears,and improve recognization about the deficiency of smears in evaluating cellularity.Methods The bone marrow tissue in 272 cases was obtained by trephine biopsy,put on the slides to make the imprints,and fixed by Bouin reagent to makesections. Compared with imprints and sections,the value of smears was evaluated in examing the nucleated cells quantity. Results In bone marrow cellularity,four grades (distinct decrease,extreme decrease,distinct increase and extreme increase) were significantly higher in bone marrow imprints and sections than those in bone marrow smears (P<0.05~<0.01). Compared with imprints and sections,in 124 cases of bone marrow smears with cells decreasing,the percentages of false positive decrease was 58.9% and 66.1%,and often misdiagnose disedases were aplastic anemia and dyshaematopoiesis; while in imprints and sections with cells increase,there was also 26% and 36% false negative decrease in smears,which often occured in hypersplenism,polycythemia vera,essential thrombocythemia and so on; In imprints and sections with cells decrease,the accordence rates of smears were 91.2% and 97.9%,but in smears with cells increase,the accordence rates of imprints and sections were both high (95%and100%). The percentages of false positive in really decreased cellularity diagnosed by smears (aplastic anemia and dyshaematopoiesis) were 29.0%and 37.1%,and the percentages of false negative in really increased cellularity diagnosed by smears(hpersplenism,polycythemia vera,essential thrombocythemia and so on ) were 22.6% and 21.8%. The evaluation of the diagnosis guideline and performance were both poor.Conclusion The smears were poor in evaluating the nucleated cells quantity,and often resulted in false positive and false negative. We suggest that imprints shuld be taken as routine examination to remedy the deficiency of smears.