骨髓活检在多发性骨髓瘤诊断及鉴别诊断中的价值

目的:探讨骨髓活检在多发性骨髓瘤(MM)诊断与鉴别诊断中的价值。方法:同步观察多发性骨髓瘤38例患者骨髓涂片和活检塑料包埋切片。并与反应性浆细胞增多症20例患者作比较,以正常人20例作对照。观察骨髓增生程度、浆细胞增殖模式及浸润程度、网硬蛋白积分。结果:MM组患者骨髓造血组织在切片中的增生度明显高于涂片,两者差异有统计学意义(P<0.05);与反应性浆细胞增多症及正常对照组比较差异亦有统计学意义(P<0.05)。MM组切片中浆细胞以簇片-间质型、结节-间质型、结节型及塞实型浸润为主,以结节出现为阳性诊断敏感性36例(94.7%)明显高于涂片中浆细胞>15%的指标(71.0%);MM组网硬蛋白纤维积分为1 以上为63.2%,与反应性浆细胞增多症组及正常对照组比较差异有统计学意义(均为P<0.05)。结论:骨髓活检能准确反映骨髓组织的增生程度、浆细胞浸润情况及增殖模式、纤维增生程度,对MM的诊断及鉴别诊断有较高价值。

The diagnosis and differential diagnosis value of bone marrow biopsy for multiple myeloma

Objective: To explore the diagnosis and differential diagnosis value of bone marrow biopsy for multiple myeloma(MM).Method: The bone marrow hyperplasia degree,the proliferation and infiltration of plasmocyte,and the reticulin integral were compared respectively in the plastic embedded bone marrow sections and the bone marrow smears of 38 cases of MM,20 cases of reactive plasmacytosis(RP) and 20 cases of normal control group.Result: In MM group,the proliferating degree in sections was higher than in smears.The differences were significant(P<0.05);compared with the RP group and normal control group,the differences were all significant(P<0.05).The infiltration patterns of plasma cells in sections in MM group were mainly regarded as cluster-stromal,nodus-stromal,nodular and packed.The sensitivity of the nodular pattern to diagnosis of MM was 94.7% and higher than that which plasmocyte was exceed 15% in smears(65.8%).When the integral of reticulin was 1 ,the positive ratio in MM group was 63.2%,and compared with the RP group and normal control group,the differences were all significant(P<0.05).Conclusion: Bone marrow biopsy could exactly reflect the bone marrow hyperplasia degree,the proliferation and infiltration of plasmocyte,the fibre hyperplasia degree,and there is a favourable value in diagnosis of multiple myeloma.