外周血涂片镜检联合微小残留病检测在急性髓系白血病复发诊断中的应用

目的分析急性髓系白血病(AML)患者完全缓解(CR)后外周血涂片镜检情况和微小残留病(MRD)检测水平,探讨两者在判断AML复发中的应用价值。方法回顾性分析36例AML复发患者的外周血涂片原始细胞检出情况和MRD值,MRD<0.1%为阴性、MRD≥0.1%为阳性。结果 36例复发患者中,外周血涂片检出原始细胞31例,其中21例报告时间早于骨髓送检时间;原始细胞检出患者中最常见的复检类型是血小板计数降低、单核细胞百分比增高和白细胞计数降低。MRD检测阳性29例,阴性7例,阳性明显多于阴性;复发期与缓解期相比,MRD显著增高,差异有统计学意义(P<0.05)。外周血涂片镜检和MRD检测对AML复发的诊断符合率分别为86.11%和80.55%,2种方法联合检测的符合率为94.44%。结论外周血涂片镜检联合MRD检测对早期发现急性髓系白血病的复发具有临床意义。

Application of peripheral blood smear microscopy combined with minimal residual disease detection in the diagnosis of relapse of acute myeloid leukemia

Objective To analyze the microscopic examination of peripheral blood smears and the detection level of minimal residual disease(MRD) in patients with acute myeloid leukemia(AML) after complete remission(CR),and to explore their application value in judging the recurrence of AML.Methods The detection of primordial cells and MRD values in 36 patients with AML recurrence were retrospectively analyzed.MRD<0.1% was negative and MRD≥0.1% was positive.Results Among the 36 patients with recurrence,primordial cells were detected in 31 cases by peripheral blood smear,of which 21 cases were reported earlier than the time of bone marrow examination.The most common types of re-examination in patients with primary cell detection decreased platelet count,increased percentage of monocytes and decreased white blood cell count.The most common types of review in patients with primordial cell detection were thrombocytopenia,increased percentage of monocytes and leukopenia.In MRD test,29 cases were positive and 7 cases were negative.The positive rate was significantly higher than the negative rate.Compared with remission stage,MRD increased significantly in relapse stage,with the differences statistically significant(P<0.05).The diagnostic coincidence rate of peripheral blood smear microscopy in diagnosis of AML recurrence was 86.11%,and the diagnostic coincidence rate of MRD was 80.55%.The diagnostic coincidence rate of the two methods was 94.44%.Conclusion Peripheral blood smear microscopy combined with MRD is of clinical significance in the early detection of acute myeloid leukemia recurrence.