三联检测法对低原始细胞MDS与HA的鉴别诊断价值
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摘要
目的探讨骨髓细胞形态、细胞化学染色及骨髓活检切片三联检测法对低原始细胞骨髓增生异常综合征与溶血性贫血的鉴别诊断价值。方法将2015年1月～2018年1月我院接诊的77例确诊为骨髓髓系原始细胞<5%的MDS患者纳入本研究,作为MDS组。选取溶血性贫血(HA)患者50例作为HA组。进行骨髓细胞形态、细胞化学染色、骨髓活检细胞化学染色检测。观察核型异常及分子生物学异常检测结果、骨髓原始细胞计数、红系比例、粒系病态造血、红系病态造血、巨核系病态造血情况、内铁阳性水平、铁颗粒数、环铁粒幼红细胞阳性率、骨髓活检切片检测结果,并对结果进行联合分析。结果 MDS组核型异常、分子生物学异常检出率高于HA组(P<0.05);MDS组、HA组骨髓原始细胞计数、红系比例对比,P>0.05;MDS组、HA组粒系病态造血、红系病态造血异常检出率对比,P>0.05;MDS组巨核系病态造血异常检出率高于HA组(P<0.05)。MDS组、HA组内铁阳性水平、铁颗粒数对比,P>0.05。MDS组环铁粒幼红细胞阳性检出率高于HA组(χ～2=19.659,P<0.05)。MDS组幼稚前体细胞异常定位(abnormal localization of immature precursors,ALIP)、巨核病态造血检出率高于HA组(P<0.05)。联合检测检出率为89.61%。结论骨髓细胞形态、细胞化学染色及骨髓活检切片三联检测法能够提高低原始细胞骨髓增生异常综合征检出率,辅助临床诊治。
Objective To investigate the differential diagnosis value of bone marrow cell morphology, cytochemical staining and bone marrow biopsy slice for low myogenic myelodysplastic syndrome and hemolytic anemia. Methods 77 MDS patients with bone marrow myeloid blasts <5% admitted in our hospital from January 2015 to January 2018 were enrolled in this study as the MDS group. 50 patients with hemolytic anemia(HA) were selected as the HA group. The bone marrow cell morphology, cytochemical staining, and bone marrow biopsy cytochemical staining were performed.The test results of karyotypic abnormalities and molecular biological abnormalities, bone marrow blast count,erythroid ratio,granulocyte pathogenic hematopoiesis, erythroid pathological hematopoiesis,megakaryocytic hematopoiesis, intra-iron positive level, iron particles, and ring iron red blood cell positive rate, and the results of bone marrow biopsy slide were observed. And the results were analyzed jointly. Results The abnormality rate of karyotype and molecular biological abnormality in MDS group was higher than that in HA group(P<0.05). There was no significant difference in the ratio of bone marrow blast cell count and red line ratio in MDS group and HA group(P>0.05).There was no significant difference in detection rate of morbid hematopoiesis and erythroid pathological hematopoietic abnormalities between MDS group and HA group(P>0.05). The detection rate of morbid hematopoietic abnormalities in MDS group was higher than that in HA group(P<0.05). There was no significant difference in iron positive level and the number of iron particles between the MDS group and the HA group(P>0.05). The positive rate of ring iron red blood cells in the MDS group was higher than that in the HA group(χ2=19.659, P<0.05). The detection rates of abnormal localization of immature precursors(ALIP) and megakaryocytic hematopoiesis were higher in the MDS group than those in the HA group(P<0.05). The combined detection rate was 89.61%. Conclusion The triple detection of bone marrow cell morphology, cytochemical staining and bone marrow biopsy can improve the detection rate of low-primary myelodysplastic syndrome and assist clinical diagnosis and treatment.
Objective To investigate the differential diagnosis value of bone marrow cell morphology, cytochemical staining and bone marrow biopsy slice for low myogenic myelodysplastic syndrome and hemolytic anemia. Methods 77 MDS patients with bone marrow myeloid blasts <5% admitted in our hospital from January 2015 to January 2018 were enrolled in this study as the MDS group. 50 patients with hemolytic anemia(HA) were selected as the HA group. The bone marrow cell morphology, cytochemical staining, and bone marrow biopsy cytochemical staining were performed.The test results of karyotypic abnormalities and molecular biological abnormalities, bone marrow blast count,erythroid ratio,granulocyte pathogenic hematopoiesis, erythroid pathological hematopoiesis,megakaryocytic hematopoiesis, intra-iron positive level, iron particles, and ring iron red blood cell positive rate, and the results of bone marrow biopsy slide were observed. And the results were analyzed jointly. Results The abnormality rate of karyotype and molecular biological abnormality in MDS group was higher than that in HA group(P<0.05). There was no significant difference in the ratio of bone marrow blast cell count and red line ratio in MDS group and HA group(P>0.05).There was no significant difference in detection rate of morbid hematopoiesis and erythroid pathological hematopoietic abnormalities between MDS group and HA group(P>0.05). The detection rate of morbid hematopoietic abnormalities in MDS group was higher than that in HA group(P<0.05). There was no significant difference in iron positive level and the number of iron particles between the MDS group and the HA group(P>0.05). The positive rate of ring iron red blood cells in the MDS group was higher than that in the HA group(χ2=19.659, P<0.05). The detection rates of abnormal localization of immature precursors(ALIP) and megakaryocytic hematopoiesis were higher in the MDS group than those in the HA group(P<0.05). The combined detection rate was 89.61%. Conclusion The triple detection of bone marrow cell morphology, cytochemical staining and bone marrow biopsy can improve the detection rate of low-primary myelodysplastic syndrome and assist clinical diagnosis and treatment.
引文
[1]王艳梅,陈荣华,范玮.血清LDH、β_2-MG、SF水平联合检测在骨髓增生异常综合征患者预后评估中的应用价值[J].实验与检验医学,2018,36(2):222-224.
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[10]顾李霖,康慧媛,潘玉玲,等.骨髓细胞形态、细胞化学染色及骨髓活检切片联合检测在低原始细胞骨髓增生异常综合征与溶血性贫血鉴别诊断中的价值[J].中国实验血液学杂志,2016,24(1):138-143.
[11]杨伟,张大燕.联合骨髓形态与基因检测在骨髓增生异常综合征与溶血性贫血中的诊断价值探究[J].中外医学研究,2015,13(27):49-50.
[12] Zheng Q,Zhao Y,Guo J,et al. Iron overload promotes mitochondrial fragmentation in mesenchymal stromal cells from myelodysplastic syndrome patients through activation of the AMPK/MFF/Drp1 pathway[J].Cell Death Dis,2018,9(5):515.
[13]李英,张金花,唐中.175例老年贫血患者血液细胞学检查特点与病因分析[J].国际检验医学杂志,2015,36(2):261-263.
[14]康慧媛,李绵洋,潘玉玲,等.联合骨髓形态与基因检测在骨髓增生异常综合征与溶血性贫血中的诊断意义[J].检验医学与临床,2014,11(23):3233-3235.
[15]贾红英.骨髓增生异常综合征与贫血性疾病骨髓及血细胞形态学比较分析[J].中国现代医生,2014,52(21):61-63,69.
[16]蔡清华.骨髓增生异常综合征伴溶血性贫血转单纯红细胞再生障碍性贫血1例报告[J].中国医师杂志,2006,(10):1384.
[2]朱香琴,张宗新,寿黎红.探讨胸苷激酶1对骨髓增生异常综合征的诊断与鉴别诊断价值[J].中国卫生检验杂志,2018,28(5):606-607,618.
[3]马茉娇,常晓慧,向阳.骨髓增生异常综合征伴PNH样缺陷自身免疫性溶血性贫血1例[J].临床肿瘤学杂志,2017,22(7):668-669.
[4] Taguchi T,Nishi H,Kurose K,et al. Minimally invasive mitral valve repair via right mini-thoracotomy in patient with myelodysplastic syndrome[J].J Cardiothorac Surg,2018,13(1):45.
[5]方悦之,倪军,王红,等.270例全血细胞减少患者骨髓形态学及外周血检查结果分析[J].中国实验诊断学,2017,21(5):795-799.
[6]徐旭栋,肖湘阳,陈龙,等.干扰素调节因子8在骨髓增生异常综合征伴原始细胞增多亚型中的表达研究[J].中国现代医生,2017,55(9):43-47,52.
[7] Brunner AM,Steensma DP.Recent advances in the cellular and molecular understanding of myelodysplastic syndromes:Implications for new therapeutic approaches[J].Clin Adv Hematol Oncol,2018,16(1):56-66.
[8]陈雷.特异性病态造血在骨髓增生异常综合征诊断中的应用价值[J].现代医用影像学,2016,25(6):1035-1039.
[9]丁飞,赵进容,晋家明,等.50例白细胞减少伴髓外造血患者骨髓细胞学检测的临床意义[J].甘肃医药,2016,35(12):937-938.
[10]顾李霖,康慧媛,潘玉玲,等.骨髓细胞形态、细胞化学染色及骨髓活检切片联合检测在低原始细胞骨髓增生异常综合征与溶血性贫血鉴别诊断中的价值[J].中国实验血液学杂志,2016,24(1):138-143.
[11]杨伟,张大燕.联合骨髓形态与基因检测在骨髓增生异常综合征与溶血性贫血中的诊断价值探究[J].中外医学研究,2015,13(27):49-50.
[12] Zheng Q,Zhao Y,Guo J,et al. Iron overload promotes mitochondrial fragmentation in mesenchymal stromal cells from myelodysplastic syndrome patients through activation of the AMPK/MFF/Drp1 pathway[J].Cell Death Dis,2018,9(5):515.
[13]李英,张金花,唐中.175例老年贫血患者血液细胞学检查特点与病因分析[J].国际检验医学杂志,2015,36(2):261-263.
[14]康慧媛,李绵洋,潘玉玲,等.联合骨髓形态与基因检测在骨髓增生异常综合征与溶血性贫血中的诊断意义[J].检验医学与临床,2014,11(23):3233-3235.
[15]贾红英.骨髓增生异常综合征与贫血性疾病骨髓及血细胞形态学比较分析[J].中国现代医生,2014,52(21):61-63,69.
[16]蔡清华.骨髓增生异常综合征伴溶血性贫血转单纯红细胞再生障碍性贫血1例报告[J].中国医师杂志,2006,(10):1384.