摘要
目的探讨骨髓涂片和切片中巨核细胞多形性改变在慢性MPD（CML-CP、ET、PV及PMF）中的诊断意义。方法182例MPD患者采用骨髓抽吸-活检双标本同步取材，获取骨髓涂片和切片标本。骨髓涂片行瑞氏-姬姆萨染色和CD41免疫组织化学染色，骨髓切片行苏木素-姬姆萨-酸性品红染色。将涂片和切片中的巨核细胞多形性形态定义为5类，分别为Ⅰ型（包含型）；Ⅱ型（少分叶核型）；Ⅲ型（巨大多分叶核型）；Ⅳ型（小核固缩型）和Ⅴ型（脱落型）。骨髓涂片和切片中的巨核细胞簇分别计为未见巨核细胞簇状分布（0）；小于6个的小簇巨核细胞组成为主（＋1）；至少6个以上的大簇巨核细胞组成为主（＋2）3种情况。同步分析骨髓涂片和切片中的各型巨核细胞多形性变化以及巨核细胞簇的检出率。结果CML—CP组Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ和正常型的巨核细胞在骨髓涂片中的检出率分别为（3．73±3．84）％、（14．19±7．62）％、（5．99±4．67）％、（34．37±10．79）％、（9．45±6．87）％及（32．28±7．67）％，在切片中的检出率分别为（3．13±2．30）％、（12．61±9．28）％、（4．94±4．27）％、（35．26±9．63）％、（9．47±5．89）％及（34.58±6．81）％，两者差异无统计学意义（t值分别为0．524、0．510、0．645、0．239、0．011、0．869，P均〉0．05）。ET组Ⅰ型巨核细胞的骨髓涂片检出率为（6．17±2．89）％，明显高于骨髓切片的（2.42±1．28）％，差异有统计学意义（t=7．183，P〈0．01）；Ⅴ型巨核细胞的骨髓涂片检出率为（6．28±3．34）％，明显低于骨髓切片的（10．18±4．03），差异有统计学意义（t=3．940，P〈0．01）；其余各型（Ⅱ、Ⅲ、Ⅳ和正常型）差异无统计学意义（t值分别为0．079、0．122、1．643、1．638，P均〉0．05）。PV组Ⅴ型巨核细胞的骨髓涂片检出率为（6．55±4．11）％，明显低于骨髓切片的（10．30±3．34）％，差异有统计学意义（t=2．351，P〈0．05），其余各型（Ⅰ、Ⅱ、Ⅲ、Ⅳ和正常型）差异无统计学意义（t值分别为1．635、0．301、0．132、0．704、0．681，P均〉0．05）。PMF组Ⅳ型巨核细胞的骨髓涂片检出率为（13．05±5．24）％，明显低于骨髓切片的（29．14±8．72）％，差异有统计学意义（t=5．245，P〈0．01）；正常型巨核细胞在骨髓涂片检出率为（33．58±14．39）％，明显高于骨髓切片的（23．01±7．96）％，差异有统计学意义（t=2．132，P〈0．05），其余各型（Ⅰ、Ⅱ、Ⅲ和Ⅴ型）差异无统计学意义（t值分别为0．787、0．646、2．062、0．869，P均〉0．05）。CML．CP组和PV组中骨髓涂片和切片中巨核细胞簇检出率差异无统计学意义（χ^2=2．772，P〉0．05），均以小簇检出为主。ET组中骨髓涂片中小簇状分布的巨核细胞簇的检出率明显高于切片，而大簇状分布的巨核细胞簇检出率明显低于切片（r=13．748，P〈0．01）。PMF组中骨髓涂片无巨核细胞簇的检出率明显高于切片，而大簇状分布的巨核细胞簇的检出率明显低于切片（χ^2=18．741，P〈0．01）。结论骨髓涂片与骨髓切片同样可以观察到巨核细胞多形性改变，通过仔细观察巨核细胞多形性改变，我们认为对MPD的分型和鉴别诊断具有一定的参考价值。
Objective To explore the diagnosis value of morphology changes of pleomorphie megakaryoeytes in the bone marrow （BM） smears and BM sections in chronic MPD（ CML-CP, ET,PV and PMF）. Methods BM aspiration was taken in 182 patients of MPD aspiration and biopsy examination was performed synchronously to obtain the BM smears and BM sections samples. The BM smears were subjected to Wright/Giemsa stain and immunohistochemistry stain, while the BM sections were subjected to Haematoxylin-Giemsa-Fuchsin stain. The morphology of pleomorphic megakaryoeytes was classified into five groups, which were Ⅰ type （ inclusion type ）, Ⅱ type （ hypolobulated muclei type ）, Ⅲ type （ giant hyperlobulated nuclei type）, Ⅳ type （ micro pyknotic type ）, and Ⅴ type （ extrusion type ）. The size of megakaryocytes clusters was recorded as no clusters（0）, predominantly small clusters of fewer than 6 cells （1） or predominantly large clusters of at least 6 cells （2）. The detection rates of various types of pleomorphie megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Resnits In CML-CP group, the detection rates were （3.73 ±3.84） %, （ 14. 19 ±7. 62 ） %, （5, 99 ±4.67）%,（34.37±10.79）%,（9.45±6.87）%, （32.28 ±7.67）% and 3.13 ±2.30）%,（12.61 ±9.28）%,（4.94±4.27）%,（35.26±9.63）%,（9.47±5.89）%,（34.58±6.81）% for Ⅰ type, Ⅱ type, Ⅲ type, Ⅳ type and Ⅴ type pleomorphic megakaryocyte in BM smears and BM sections. There were no significantly differences between the BM smears and BM sections（ t value were 0. 524,0. 510,0. 645, 0. 239,0. 011,0. 869, all P 〉 0. 05 ）. In ET group, the detection rate of I type [ （6. 17 ±2. 89 ） % ] in BM smears was significantly higher than that in BM sections [ 2. 42 ±1.28 ） % ] （ t = 7. 183, P 〈 0. 01 ）, while the detection rate of V type [ （6. 28 ±3.34 ） % ] in BM smears was significantly lower than that in BM sections [ （ 10. 18 ±4. 03 ） % ] （ t = 3. 940, P 〈 0. 01 ）. Besides these, the detection rates of other types were not significantly different between the BM smears and BM sections （ t value were 0. 079,0, 122,1. 643, 1. 638, all P 〉 0. 05 ）. In PV group, the detection rate of Ⅴ type in BM smears [ （ 6.55 ±4, 11 ） % ] was significantly lower than that in BM sections [ （ 10. 30 ±3. 34 ） % ] （ t = 2. 351, P 〈 0. 05 ）. However, the detection rates of the other types were not significantly different between the BM smears and BM sections （t value were 1. 635,0. 301,0. 132,0. 704,0. 681 ,all P 〉0. 05）. In PMF group, the detection rate of Ⅳ type in BM smears [ （13. 05 ± 5. 24 ）% ] was significantly lower than that in BM sections [ （29. 14 ±8.72）% ] （t =5.245, P 〈0.01）. And the detection rate of normal type in BM smears [（33.58 ±14. 39 ） % ] was significantly higher than that in BM sections [ （23.01 ±7. 96 ） % ] （ t = 2. 132, P 〈 0. 05 ）. Besides these, the detection rates of the other types were not significantly different between BM smears and BM sections（ t value were 0. 787,0. 646,2. 062,0. 869, P 〉 0. 05 ）. In CML-CP and PV groups, the detection rates of size of clusters were not significantly different between the BM smears and BM sections （χ^2 = 2. 772,P 〉 0. 05）. In ET group, the detection rate of small clusters （ 1 ） in BM smears was obviously higher than that in BM sections, however, the detection rate of larger clusters （2） in BM smears was obviously lower than that in BM sections （χ^2 = 13. 748 ,P 〈 0. 01 ）. In PMF group, the detection rate of no clusters（0） in BM smears was obviously higher than that in BM sections, however, the detection rate of large clusters（2） in BM smears was obviously lowers than that in BM sections （χ^2 = 18. 741 ,P 〈0. 01 ）. Conclusions Both BM smears and BM sections can be applied to observe pleomorphic megakaryocytes. The morphology changes of pleomorphic megakaryocytes have certain reference values for identification of MPD subtypes and differential diagnosis.
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2010年第2期143-148,共6页
Chinese Journal of Laboratory Medicine
基金
浙江省教育厅科研项目（Y200804673）
关键词
骨髓增殖性疾病
巨核细胞
骨髓检查
活组织检查
针吸
组织细胞学制备技术
Myeloproliferative disorders
Megakaryocytes
Bone marrow examination
Biopsy,needle
Histocytological preparation techniques
