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CD4_41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 4±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=3.944),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(x~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(x~2=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(x~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.
目的 探討骨髓塗片和切片中巨覈細胞多形性改變在慢性MPD(CML-CP、ET、PV及PMF)中的診斷意義.方法 182例MPD患者採用骨髓抽吸-活檢雙標本同步取材,穫取骨髓塗片和切片標本.骨髓塗片行瑞氏-姬姆薩染色和CD4_41免疫組織化學染色,骨髓切片行囌木素-姬姆薩-痠性品紅染色.將塗片和切片中的巨覈細胞多形性形態定義為5類,分彆為Ⅰ型(包含型);Ⅱ型(少分葉覈型);Ⅲ型(巨大多分葉覈型);Ⅳ型(小覈固縮型)和Ⅴ型(脫落型).骨髓塗片和切片中的巨覈細胞簇分彆計為未見巨覈細胞簇狀分佈(0);小于6箇的小簇巨覈細胞組成為主(+1);至少6箇以上的大簇巨覈細胞組成為主(+2)3種情況.同步分析骨髓塗片和切片中的各型巨覈細胞多形性變化以及巨覈細胞簇的檢齣率.結果 CML-CP組Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ和正常型的巨覈細胞在骨髓塗片中的檢齣率分彆為(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)%,在切片中的檢齣率分彆為(3.13±2.30)%、(12.61±9.28)%、(4.94±4.27)%、(35.26 4±9.63)%、(9.47±5.89)%及(34.58±6.81)%,兩者差異無統計學意義(t值分彆為0.524、0.510、0.645、0.239、0.011、0.869,P均>0.05).ET組Ⅰ型巨覈細胞的骨髓塗片檢齣率為(6.17±2.89)%,明顯高于骨髓切片的(2.42±1.28)%,差異有統計學意義(t=7.183,P<0.01):Ⅴ型巨覈細胞的骨髓塗片檢齣率為(6.28±3.34)%,明顯低于骨髓切片的(10.18±4.03),差異有統計學意義(t=3.944),P<0.01);其餘各型(Ⅱ、Ⅲ、Ⅳ和正常型)差異無統計學意義(t值分彆為0.079、0.122、1.643、1.638,P均>0.05).PV組V型巨覈細胞的骨髓塗片檢齣率為(6.55±4.11)%,明顯低于骨髓切片的(10.30±3.34)%,差異有統計學意義(t=2.351,P<0.05),其餘各型(Ⅰ、Ⅱ、Ⅲ、Ⅳ和正常型)差異無統計學意義(t值分彆為1.635、0.301、0.132、0.704、0.681,P均>0.05).PMF組Ⅳ型巨覈細胞的骨髓塗片檢齣率為(13.05±5.24)%,明顯低于骨髓切片的(29.14±8.72)%,差異有統計學意義(t=5.245,P<0.01);正常型巨覈細胞在骨髓塗片檢齣率為(33.58±14.39)%,明顯高于骨髓切片的(23.01±7.96)%,差異有統計學意義(t=2.132,P<0.05),其餘各型(Ⅰ、Ⅱ、Ⅲ和Ⅴ型)差異無統計學意義(T值分彆為0.787、0.646、2.062、0.869,P均>0.05).CML-CP組和PV組中骨髓塗片和切片中巨覈細胞簇檢齣率差異無統計學意義(x~2=2.772,P>0.05),均以小簇檢齣為主.ET組中骨髓塗片中小簇狀分佈的巨覈細胞簇的檢齣率明顯高于切片,而大簇狀分佈的巨覈細胞簇檢齣率明顯低于切片(x~2=13.748,P<0.01).PMF組中骨髓塗片無巨覈細胞簇的檢齣率明顯高于切片,而大簇狀分佈的巨覈細胞簇的檢齣率明顯低于切片(x~2=18.741,P<0.01).結論 骨髓塗片與骨髓切片同樣可以觀察到巨覈細胞多形性改變,通過仔細觀察巨覈細胞多形性改變,我們認為對MPD的分型和鑒彆診斷具有一定的參攷價值.
목적 탐토골수도편화절편중거핵세포다형성개변재만성MPD(CML-CP、ET、PV급PMF)중적진단의의.방법 182례MPD환자채용골수추흡-활검쌍표본동보취재,획취골수도편화절편표본.골수도편행서씨-희모살염색화CD4_41면역조직화학염색,골수절편행소목소-희모살-산성품홍염색.장도편화절편중적거핵세포다형성형태정의위5류,분별위Ⅰ형(포함형);Ⅱ형(소분협핵형);Ⅲ형(거대다분협핵형);Ⅳ형(소핵고축형)화Ⅴ형(탈락형).골수도편화절편중적거핵세포족분별계위미견거핵세포족상분포(0);소우6개적소족거핵세포조성위주(+1);지소6개이상적대족거핵세포조성위주(+2)3충정황.동보분석골수도편화절편중적각형거핵세포다형성변화이급거핵세포족적검출솔.결과 CML-CP조Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ화정상형적거핵세포재골수도편중적검출솔분별위(3.73±3.84)%、(14.19±7.62)%、(5.99±4.67)%、(34.37±10.79)%、(9.45±6.87)%급(32.28±7.67)%,재절편중적검출솔분별위(3.13±2.30)%、(12.61±9.28)%、(4.94±4.27)%、(35.26 4±9.63)%、(9.47±5.89)%급(34.58±6.81)%,량자차이무통계학의의(t치분별위0.524、0.510、0.645、0.239、0.011、0.869,P균>0.05).ET조Ⅰ형거핵세포적골수도편검출솔위(6.17±2.89)%,명현고우골수절편적(2.42±1.28)%,차이유통계학의의(t=7.183,P<0.01):Ⅴ형거핵세포적골수도편검출솔위(6.28±3.34)%,명현저우골수절편적(10.18±4.03),차이유통계학의의(t=3.944),P<0.01);기여각형(Ⅱ、Ⅲ、Ⅳ화정상형)차이무통계학의의(t치분별위0.079、0.122、1.643、1.638,P균>0.05).PV조V형거핵세포적골수도편검출솔위(6.55±4.11)%,명현저우골수절편적(10.30±3.34)%,차이유통계학의의(t=2.351,P<0.05),기여각형(Ⅰ、Ⅱ、Ⅲ、Ⅳ화정상형)차이무통계학의의(t치분별위1.635、0.301、0.132、0.704、0.681,P균>0.05).PMF조Ⅳ형거핵세포적골수도편검출솔위(13.05±5.24)%,명현저우골수절편적(29.14±8.72)%,차이유통계학의의(t=5.245,P<0.01);정상형거핵세포재골수도편검출솔위(33.58±14.39)%,명현고우골수절편적(23.01±7.96)%,차이유통계학의의(t=2.132,P<0.05),기여각형(Ⅰ、Ⅱ、Ⅲ화Ⅴ형)차이무통계학의의(T치분별위0.787、0.646、2.062、0.869,P균>0.05).CML-CP조화PV조중골수도편화절편중거핵세포족검출솔차이무통계학의의(x~2=2.772,P>0.05),균이소족검출위주.ET조중골수도편중소족상분포적거핵세포족적검출솔명현고우절편,이대족상분포적거핵세포족검출솔명현저우절편(x~2=13.748,P<0.01).PMF조중골수도편무거핵세포족적검출솔명현고우절편,이대족상분포적거핵세포족적검출솔명현저우절편(x~2=18.741,P<0.01).결론 골수도편여골수절편동양가이관찰도거핵세포다형성개변,통과자세관찰거핵세포다형성개변,아문인위대MPD적분형화감별진단구유일정적삼고개치.
Objective To explore the diagnosis value of morphology changes of pleomorphic megakaryocytes 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 megakaryocytes was classified into five groups, which were Ⅰ type ( inclusion type), Ⅱtype ( 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 pleomorphic megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Results 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 tⅠype,Ⅱ type,Ⅲ type, Ⅳtype 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 (x~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 (x~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 (x~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.
