摘要
目的：利用^99mTc硫胶体全身骨髓显像结合穿刺细胞学对外周性骨髓进行研究，以证实外周性骨髓残留白血病的存在。方法：成人急性白血病420例，儿童急性白血病48例；静脉注射^99mTc硫胶体550～740MBq30min内行全身前、后位骨髓显像。常规骨髓穿刺部位取自髂骨，外周骨髓穿刺取自胫骨上端干骺线部位。结果：成人急性白血病未缓解期外周显像骨髓扩张率为73．1％，扩张部位以膝、踝关节多见（74．5％、51．9％）；缓解期发现30．9％外周扩张骨髓有高于缓解标准的白血病细胞存在；中心性骨髓及外周骨髓完全缓解时间分别为（42．5±31．28）d和（72．15±32．54）d，差异有统计学意义（P〈0．01）。外周骨髓未显影组及儿童白血病缓解期内未发现外周骨髓残留白血病。随访外周骨髓扩张病例组10个月以内复发者74．4％，较无扩张病例组复发者13．6％之间差异有统计学意义（P〈0．01）。结论：外周骨髓扩张、外周骨髓发生骨髓局部残留白血病并不是一种少见现象。外周骨髓达缓解时间较中心骨髓明显延迟是外周骨髓残留白血病存在的原因。外周性骨髓残留白血病的发现对白血病缓解标准的解释、指导临床对其诊断、提高白血病治疗缓解率有重要的价值。
Objective： To confirm the residual leukemia of peripheral bone marrow by using bone marrow scintigraphy with Tc-99m-sulfur colloid and bone marrow aspirations. Method： Whole-body bone marrow scans was performed in 420 adults and 48 children acute leukemia patients after i. v. injection of 550-740 MBq of ^99mTc-sulfur colloid. Comparative studies were performed in routine central bone marrow （CBM） aspiration at iliac crest and in expanded peripheral bone marrow （PBM） at proximal epiphyseal line of tibia. Result： The expansion rate of PBM in non-remission （NR） stage is 73.1% and decreases to 56.6% in complete remission （CR） stage. The most common expanded PBM sites are epiphysis and knee joint （74.5% ）. Residual leukemia of peripheral bone marrow can be detected in aspirates from 30.9% expanded PBM patients at early CR stage of CBM. CR of PBM （72.15± 32.54 days） is significantly delayed if compared with the CBM （42.5±31.28 days） （ P〈0.01）. No one got residual leukemia of PBM in children and non-expanded PBM patients. Relapse rate within 10 months in 74.4% expanded PBM patients was significant higher than that in 13.6 % non-expanded PBM patients （ P 〈0.01）. Conclusion ： The result shows the residual leukemia of CBM and PBM after chemotherapy is not always paralleled and synchronous. The expanded PBM is less sensitive to the chemotherapy due to less blood supply. It is apparently value to detect residual leukemia of PBM with bone marrow scintigraphy in treating leukemia patients.
出处
《临床血液学杂志》
CAS
2006年第6期327-329,333,共4页
Journal of Clinical Hematology
