CAJ | 학술논문

目的分析骨髓增生异常综合征(MDS)病态造血特点.方法收集2003年7月4日至2007年3月14日原因不明血常规异常的成年患者标本716例,以WHO MDS分类标准为诊断金标准,分别进行细胞形态学、细胞化学染色、骨髓病理检查、细胞遗传学、流式细胞术等检测.分析骨髓细胞学检查中病态造血特征在判断克隆性和非克隆性疾病中的诊断价值,计算灵敏度和特异度.结果 MDS病态造血形态学诊断的主要依据:粒系Auer小体、核出芽、微核有其中之一者;红系核出芽;外周血片中出现巨核细胞;外周血片中出现原粒细胞或早幼红细胞;环状铁粒幼细胞>1%.次要依据:粒系假Pelger-H ǚet异常、不能分叶中性粒细胞、同一细胞内核发育不同步、环形核、核染色质聚集;红系的多核、奇数核、子母核、核碎裂、空泡、成熟红细胞大小悬殊;微巨核.结论细胞形态学是诊断MDS的基础,但也存在一定的局限性,尤其是对于早期MDS细胞形态学改变不典型时,需要结合其他检测手段分析.
목적 분석골수증생이상종합정(MDS)병태조혈특점.방법 수집2003년7월4일지2007년3월14일원인불명혈상규이상적성년환자표본716례,이WHO MDS분류표준위진단금표준,분별진행세포형태학、세포화학염색、골수병리검사、세포유전학、류식세포술등검측.분석골수세포학검사중병태조혈특정재판단극륭성화비극륭성질병중적진단개치,계산령민도화특이도.결과 MDS병태조혈형태학진단적주요의거:립계Auer소체、핵출아、미핵유기중지일자;홍계핵출아;외주혈편중출현거핵세포;외주혈편중출현원립세포혹조유홍세포;배상철립유세포>1%.차요의거:립계가Pelger-H ǚet이상、불능분협중성립세포、동일세포내핵발육불동보、배형핵、핵염색질취집;홍계적다핵、기수핵、자모핵、핵쇄렬、공포、성숙홍세포대소현수;미거핵.결론 세포형태학시진단MDS적기출,단야존재일정적국한성,우기시대우조기MDS세포형태학개변불전형시,수요결합기타검측수단분석.
Objective To investigate the characteristics of dysplasia in myeledysplastic syndrome (MDS). Methods 716 samples of adult patients with abnormal blood routine and unelear cause were collected between July 04, 2003 and March 14, 2007. Based on the gold diagnostic standard of WHO MDS classification, all eases were detected on cytomorphology, cytochemical stain, bone marrow pathological assay,cytogenetics, flow eytometry et al. The cytological study of bone marrow on some abnormal hematopaietie cells has a diagnostic value to determine clonal or non-clonal diseases and assess sensitivity and specificity. Results in the complicated various dysplasia of hematopeiefic ceils, the following characteristics can be the main basis of cytomorphological diagnosis: one of granular Auer bodies, micronuclens (MN), or nuclear budding, erythroid nuclear budding, megakaryocytes presented in peripheral blood, myeloblast or prorubricyte exhibited in peripheral blood, ringed sideroblasts>1%. The subordinate basis of cytomorphological diagnosis development of nuclei, ring-shaped nuclei, and aggregation of nuclear chromafin, erythroid multi-nuclei, odd nucleus, mother-daughter nucleus, nuclear fragmentation, vacuole, anisoeytosis and mieromegakaryocytes.Conclusion Cytomorphologic assay is the base for the diagnosis of MDS, however, it presents certain limit,especially when eytomnrphoiogical change does not possess specificity for early MDS. Hereby, it requires to combine other deteetion methods.