骨髓活检及涂片对多发性骨髓瘤的诊断价值的比较

目的探讨骨髓涂片及活检对多发性骨髓瘤（MM）的诊断价值。方法同步观察302例MM患者骨髓涂片和活检塑料包埋切片。观察骨髓增生程度、浆细胞形态、增殖模式及浸润程度、网硬蛋白积分。结果MM患者骨髓造血组织在骨髓活检中观察到的增生程度明显高于骨髓涂片,两者差异有统计学意义（P〈0.05）。99例患者（32.7%）骨髓瘤负荷处于Ⅰ期,140例（46.4%）处于Ⅱ期,63例（20.9%）处于Ⅲ期。骨髓切片中浆细胞以簇片-间质型、结节-间质型、结节型及塞实型为主,以结节状浆细胞瘤出现为阳性诊断标准,其敏感性273例（90.4%）明显高于涂片中浆细胞〉15%的指标（70.5%）。136例（45.0%）显示骨髓涂片与活检切片内浆细胞的浸润度相符,109例（36.1%）患者的骨髓涂片浆细胞浸润度较活检低,57例（18.9%）患者的骨髓涂片浆细胞浸润度较活检高。骨髓涂片中双核、多核及火焰型浆细胞,以及浆细胞胞浆中出现Auer氏小体、鲁氏小体对诊断MM有重要的参考价值。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;骨髓涂片典型的浆细胞形态对确诊MM有重要作用,骨髓涂片结合骨髓活检能提高MM诊断的准确率,减少误诊。

Comparison of diagnosis value of bone marrow smear and biopsy for multiple myeloma

Objective To explore the diagnosis value of bone marrow biopsy for multiple myeloma（MM）.Methods The bone marrow hyperplasia degree,the proliferation and infiltration of plasmocyte,and the reticulin integral were synchronous observed and compared respectively in the plastic embedded bone marrow sections and the bone marrow smears of 302 cases of MM.Results In MM group,the proliferating degree in sections was higher than in smears.The differences had statistical significance（P0.05）,the myeloma load of 99 cases（32.7%） were in stageⅠ,140 cases in stage Ⅱ,63 cases in stage Ⅲ.The infiltration patterns of plasmocyte in sections in MM group were mainly regarded as cluster-stromal,nodus-stromal,nodular and packed.The positive diagnostic criterion was nodular plasmacytoma.The sensitivity of the nodular pattern to diagnosis of MM was 90.7%（273 cases） and higher than that which plasmocyte was exceed 15% in smears（70.5%）.The infiltration degree of bone marrow slides of plasmocyte was consistent with biopsy sections in 136 cases（45.0%）;it also was lower than that of biopsy in 109 cases（36.1%） and higher in 57 cases.The dicaryon,polycaryon and flame type plasmocyte in bone marrow slides and Auer＇s bodies,Lu＇s bodies in cytoplasm of plasmocyte had important reference value for MM dignosis.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 and differential diagnosis of MM.The typical plasmocyte of bone marrow slides plays an important role on the diagnosis of MM.Combined bone marrow biopsy and slides can rise rate of diagnosis and reduce misdiagnosis.