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目的 探索前瞻性诊断白血病前期 (白前 )的指标和方法。方法 采用同期病例对照研究 ,以慢性再生障碍性贫血 (CAA)和不发作型阵发性睡眠性血红蛋白症 (a PNH)为对照组 ,分析 2 1例白前患者临床和实验室特征及其与对照组间的差异。结果 白前与CAA、a PNH相比较 ,可以有以下特点 :①骨髓涂片可见或经微巨核酶标证实有淋巴样微巨核 ;②外周血中出现幼稚粒细胞 ;③骨髓原始粒细胞≥ 0 0 2 0 ;④骨髓有核红细胞糖原染色阳性 ;⑤髓系细胞分化指数 (DI)≥ 1 8;⑥有典型染色体核型异常 ;⑦姐妹染色单体分染阴性 ;⑧造血祖细胞体外培养粒 单核细胞集簇 /集落 >4 0。白前患者均满足条件① ,并满足后 7项中任 2项以上 (A)或满足 8项中任 4项以上 (B) ;CAA和a PNH患者皆不满足A或B条件。结论 白前在骨髓细胞形态、组织化学染色、分化抗原表达、染色体核型、细胞分裂周期、造血祖细胞集落培养及临床治疗反应和预后方面与CAA和a PNH有明显差异 ,这些特点可能会助于白前的前瞻性诊断。
Objective To explore the prospective diagnosis of leukemia (pre-white) indicators and methods. Methods A case-control study was conducted in the same period. Chronic aplastic anemia (CAA) and non-paroxysmal nocturnal hemoglobin (a PNH) were used as control group. The clinical and laboratory characteristics of 21 patients with preeclampsia were analyzed. Differences between control groups. Results Compared with CAA, a PNH, there were the following characteristics: (1) The bone marrow smears showed micro-megakaryocytes with micro-megakaryocyte enzyme markers; (2) The immature granulocytes appeared in peripheral blood; (3) 0 2 0; ④ bone marrow nucleated erythrocytes glycogen staining positive; ⑤ myeloid cell differentiation index (DI) ≥ 18; ⑥ typical chromosomal abnormalities; ⑦ sister chromatid dye negative; ⑧ hematopoietic progenitor cells cultured in vitro Mononuclear cell clusters / colonies> 40. Patients with pre-white meet the conditions ①, and to meet any of the latter seven in any two (A) or meet the eight in any of more than four (B); CAA and a PNH patients do not meet the A or B conditions. Conclusions There were significant differences between CAA and a PNH in morphology, histochemical staining, differentiation antigen expression, chromosome karyotype, cell division cycle, hematopoietic progenitor cell colony culture, clinical response and prognosis of white marrow before white, which may help Prospective diagnosis in white.