55例骨髓增生异常综合征-难治性贫血误诊、漏诊原因
|
摘要
目的:分析骨髓增生异常综合征-难治性贫血(myelodysplastic syndromes-refractory anemia,MDSR A)误诊、漏诊原因,并探究降低误诊、漏诊率的有效方法。方法:统计中国知网(CNKI)中有关MDS-R A误诊、漏诊方面的文献,并统计出误诊、漏诊的高发病种及原因;通过取材、阅片及临床提供患者信息进行统计学分析,分析北京友谊医院平谷医院2006—2016年误诊、漏诊的55例MDS-RA患者高发病种及原因。最后将北京友谊医院平谷医院检验科骨髓室与文献的数据进行比较分析。结果:北京友谊医院平谷医院骨髓室误诊、漏诊的几种情况和文献基本一致,略有差别。从一般临床症状和基础检查方面看,这几种高发疾病与MDS-RA确实存在容易混淆的地方;但从细胞形态学角度存在显著差异,MDS-RA有较特异性的病态造血。结论:加强临床医生与检验技术人员的沟通、联合多种检测方法筛查是有效降低误诊、漏诊的重要预防措施。
Objective: To analyze the cause of misdiagnosis and missed diagnosis of 55 cases with myelodysplastic syndromes-refractory anemia(MDS-RA) in the bone marrow chamber, and to find effective means to reduce the misdiagnosis rate. Methods: The literature on MDS-RA misdiagnosis and misdiagnosis in CNKI was counted, and the high incidence and causes of false/missed diagnosis were also calculated. After that, the patient information was analyzed by means of materials, tablets and clinical data, and analyzed the incidence and causes of the misdiagnosis and misdiagnosis of 55 MDS-RA patients in Pinggu Hospital of Beijing FriendshipHospital from 2006 to 2016. Finally, the data of this room and literature were analyzed. Results: The cases of misdiagnosis and misdiagnosis in the bone marrow chamber were basically consistent with the literature. From general clinical symptoms and basic examination, there were some areas where there was indeed confusion between these highonset diseases and the MDS-RA; however, there were significant differences in morphology of cells, and MDS-RA had more specific pathological hematopoiesis. Conclusion: Strengthen communication between clinicians and laboratory workers and combined with multiple detection methods for screening are important preventive measures to effectively reduce misdiagnosis and missed diagnosis.
Objective: To analyze the cause of misdiagnosis and missed diagnosis of 55 cases with myelodysplastic syndromes-refractory anemia(MDS-RA) in the bone marrow chamber, and to find effective means to reduce the misdiagnosis rate. Methods: The literature on MDS-RA misdiagnosis and misdiagnosis in CNKI was counted, and the high incidence and causes of false/missed diagnosis were also calculated. After that, the patient information was analyzed by means of materials, tablets and clinical data, and analyzed the incidence and causes of the misdiagnosis and misdiagnosis of 55 MDS-RA patients in Pinggu Hospital of Beijing FriendshipHospital from 2006 to 2016. Finally, the data of this room and literature were analyzed. Results: The cases of misdiagnosis and misdiagnosis in the bone marrow chamber were basically consistent with the literature. From general clinical symptoms and basic examination, there were some areas where there was indeed confusion between these highonset diseases and the MDS-RA; however, there were significant differences in morphology of cells, and MDS-RA had more specific pathological hematopoiesis. Conclusion: Strengthen communication between clinicians and laboratory workers and combined with multiple detection methods for screening are important preventive measures to effectively reduce misdiagnosis and missed diagnosis.
引文
1.温顺祝,傅红春,李晓明,等.骨髓增生异常综合征的细胞免疫异常相关进展[J].西南国防医药,2017,27(9):1024-1027.WEN Shunzhu,FU Hongchun,LI Xiaoming,et al.Cellular immune abnormalities related progress of myelodysplastic syndrome[J].Journal of Southwest National Defense Medicine,2017,27(9):1024-1027.
2.胡蕊,李刚,孙洁,等.病态造血质与量在骨髓增生异常综合征诊断中的重要性[J].国际检验医学杂志,2013,34(1):29-31.HU Rui,LI Gang,SUN Jie,et al.The pathological hematopoietic quality and quantity importance in the diagnosis of myelodysplastic syndrome[J].International Journal of Laboratory Medicine,2013,(1):29-31.
3.史杏英.骨髓增生异常综合征58例误诊分析[J].浙江中西医结合杂志,1994(4):12-13.SH I X ing y ing.Mi sdiagnosi s and analysi s of 58 cases w ith myelodysplastic syndrome[J].Zhejiang Journal of Integrated Traditional Chinese and Western Medicine,1994(4):12-13.
4.曲士强,徐泽峰,李承文,等.FISH在骨髓增生异常综合征患者细胞遗传学评估中的作用[J].中华血液学杂志,2012,33(10):839-842.QU Shiqiang,XU Zefeng,LI Chengwen,et al.Study on the role of fluorescence in situ hybridization in cytogenetic evaluation of myelodysplastic syndrome[J].Chinese Journal of Hematology,2012,33(10):839-842.
5.肖志坚.骨髓增生异常综合征的分子生物学研究:现况与启示[J].白血病·淋巴瘤,2014,23(9):513-514.XIAO Zhijian.Myelodysplastic syndrome of molecular biology:status and enlightenment[J].Journal of Leukemia&Lymphoma,2014,23(9):513-514.
6.林凤茹.骨髓增生异常综合征诊断体会[J].中国实用内科杂志,2010,30(5):410-411.Lin Fengru.The diagnosis of myelodysplastic syndrome[J].Chinese Journal of Practical Internal Medicine,2010,30(5):410-411.
7.廖丽娟.对比分析巨幼细胞性贫血与难治性贫血的骨髓形态检验方法临床意义[J].医学检验与临床,2013,24(6):66-67.LIAO Lijuan.Analysis of gigantic young cell anemia with refractory anemia bone marrow morphology inspection methods clinical significance[J].Medical Laboratory Science and Clinices,2013,24(6):66-67.
8.丛玉隆,李顺义,卢兴国.中国血细胞诊断学[M].北京:人民军医出版社,2010:127-139.CONG Yulong,LI Shuny i,LU Xingguo.Chinese blood cell diagnostics[M].Beijing:People’s Military Medical Press,2010:127-139.
9.肖志坚.正确认识细胞形态学在骨髓增生异常综合征诊断中的地位[J].诊断学理论与实践,2013,12(1):1-3.XIAO Zhijian.The correct understanding of cell morphology in the diagnosis of myelodysplastic syndrome status[J].Journal of Diagnostics Concepts&Practice,2013,12(1):1-3.
10.周格琛.骨髓增生异常综合征骨髓涂片检查误诊7例分析[J].中国误诊学杂志,2009,9(11):8172-8173.ZHOU Gechen.Seven cases of myelodysplastic syndrome bone marrow smears misdiagnosis analysis[J].Chinese Journal of Misdiagnostics,2009,9(11):8172-8173.
11.程虹,江明,杜伟,等.难治性贫血与其它贫血性疾病骨髓及血细胞形态学比较分析[J].中国实验血液学杂志,2012,20(6):1423-1426.CHENG Hong,JIANG Ming,DU Wei,et al.Refractory anemia and other diseases of the bone marrow and blood cells morphological comparison analysis[J].Journal of Experimental Hematology,2012,20(6):1423-1426.
12.韩爱兰,杨长春,王艳,等.特殊类型骨髓增生异常综合征形态学误诊4例分析[J].中国误诊学杂志,2005,5(19):1898-1899.HAN Ailan,YANG Changchun,WANG Yan,et al.Special type myelodysplastic syndrome morphologic misdiagnosed 4 cases analysis[J].Chinese Journal of Misdiagnostics,2005,5(19):1898-1899.
13.陈赛,李拮,陈冰,等.骨髓增生异常综合征WHO新分型(附93例报道)[J].中国实验诊断学,2003,7(5):388-391.CHEN Sai,LI Jie,CHEN Bing,et al.Myelodysplastic syndrome WHOnew type(with 93 case reports)[J].Chinese Journal of Laboratory Diagnosis,2003,7(5):388-389.
14.郑小江,李其文,廖丽娟.外周血涂片与骨髓细胞形态、骨髓活检用于骨髓增殖性疾病患者诊断中的临床效果[J].检验医学与临床,2016,13(A02):95-96.ZHENG Xiaojiang,LI Qiwen,LIAO Lijuan.Peripheral blood,bone marrow biopsy for bone marrow smear and bone marrow cells hyperplastic disease diagnosis in patients with clinical effect[J].Laboratory Medicine and Clinic,2016,13(A02):95-96.
15.肖志坚.骨髓增生异常综合征的精确诊断[J].中华血液学杂志,2015,36(5):361-362.XIAO Zhijian.Accurate diagnosis of myelodysplastic syndrome[J].Chinese Journal of Hematology,2015,36(5):361-362.
2.胡蕊,李刚,孙洁,等.病态造血质与量在骨髓增生异常综合征诊断中的重要性[J].国际检验医学杂志,2013,34(1):29-31.HU Rui,LI Gang,SUN Jie,et al.The pathological hematopoietic quality and quantity importance in the diagnosis of myelodysplastic syndrome[J].International Journal of Laboratory Medicine,2013,(1):29-31.
3.史杏英.骨髓增生异常综合征58例误诊分析[J].浙江中西医结合杂志,1994(4):12-13.SH I X ing y ing.Mi sdiagnosi s and analysi s of 58 cases w ith myelodysplastic syndrome[J].Zhejiang Journal of Integrated Traditional Chinese and Western Medicine,1994(4):12-13.
4.曲士强,徐泽峰,李承文,等.FISH在骨髓增生异常综合征患者细胞遗传学评估中的作用[J].中华血液学杂志,2012,33(10):839-842.QU Shiqiang,XU Zefeng,LI Chengwen,et al.Study on the role of fluorescence in situ hybridization in cytogenetic evaluation of myelodysplastic syndrome[J].Chinese Journal of Hematology,2012,33(10):839-842.
5.肖志坚.骨髓增生异常综合征的分子生物学研究:现况与启示[J].白血病·淋巴瘤,2014,23(9):513-514.XIAO Zhijian.Myelodysplastic syndrome of molecular biology:status and enlightenment[J].Journal of Leukemia&Lymphoma,2014,23(9):513-514.
6.林凤茹.骨髓增生异常综合征诊断体会[J].中国实用内科杂志,2010,30(5):410-411.Lin Fengru.The diagnosis of myelodysplastic syndrome[J].Chinese Journal of Practical Internal Medicine,2010,30(5):410-411.
7.廖丽娟.对比分析巨幼细胞性贫血与难治性贫血的骨髓形态检验方法临床意义[J].医学检验与临床,2013,24(6):66-67.LIAO Lijuan.Analysis of gigantic young cell anemia with refractory anemia bone marrow morphology inspection methods clinical significance[J].Medical Laboratory Science and Clinices,2013,24(6):66-67.
8.丛玉隆,李顺义,卢兴国.中国血细胞诊断学[M].北京:人民军医出版社,2010:127-139.CONG Yulong,LI Shuny i,LU Xingguo.Chinese blood cell diagnostics[M].Beijing:People’s Military Medical Press,2010:127-139.
9.肖志坚.正确认识细胞形态学在骨髓增生异常综合征诊断中的地位[J].诊断学理论与实践,2013,12(1):1-3.XIAO Zhijian.The correct understanding of cell morphology in the diagnosis of myelodysplastic syndrome status[J].Journal of Diagnostics Concepts&Practice,2013,12(1):1-3.
10.周格琛.骨髓增生异常综合征骨髓涂片检查误诊7例分析[J].中国误诊学杂志,2009,9(11):8172-8173.ZHOU Gechen.Seven cases of myelodysplastic syndrome bone marrow smears misdiagnosis analysis[J].Chinese Journal of Misdiagnostics,2009,9(11):8172-8173.
11.程虹,江明,杜伟,等.难治性贫血与其它贫血性疾病骨髓及血细胞形态学比较分析[J].中国实验血液学杂志,2012,20(6):1423-1426.CHENG Hong,JIANG Ming,DU Wei,et al.Refractory anemia and other diseases of the bone marrow and blood cells morphological comparison analysis[J].Journal of Experimental Hematology,2012,20(6):1423-1426.
12.韩爱兰,杨长春,王艳,等.特殊类型骨髓增生异常综合征形态学误诊4例分析[J].中国误诊学杂志,2005,5(19):1898-1899.HAN Ailan,YANG Changchun,WANG Yan,et al.Special type myelodysplastic syndrome morphologic misdiagnosed 4 cases analysis[J].Chinese Journal of Misdiagnostics,2005,5(19):1898-1899.
13.陈赛,李拮,陈冰,等.骨髓增生异常综合征WHO新分型(附93例报道)[J].中国实验诊断学,2003,7(5):388-391.CHEN Sai,LI Jie,CHEN Bing,et al.Myelodysplastic syndrome WHOnew type(with 93 case reports)[J].Chinese Journal of Laboratory Diagnosis,2003,7(5):388-389.
14.郑小江,李其文,廖丽娟.外周血涂片与骨髓细胞形态、骨髓活检用于骨髓增殖性疾病患者诊断中的临床效果[J].检验医学与临床,2016,13(A02):95-96.ZHENG Xiaojiang,LI Qiwen,LIAO Lijuan.Peripheral blood,bone marrow biopsy for bone marrow smear and bone marrow cells hyperplastic disease diagnosis in patients with clinical effect[J].Laboratory Medicine and Clinic,2016,13(A02):95-96.
15.肖志坚.骨髓增生异常综合征的精确诊断[J].中华血液学杂志,2015,36(5):361-362.XIAO Zhijian.Accurate diagnosis of myelodysplastic syndrome[J].Chinese Journal of Hematology,2015,36(5):361-362.