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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尿症 (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细胞 ;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。白前患者满足条件① ,并满足后 7项中任何 2项以上 (A)或满足 8项中任何 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 ,这些特点可能会有助于白前的前瞻性诊断。
Objective To explore the prospective diagnosis of pre-leukemia (white) indicators and methods. Methods A case-control study was conducted in the same period. Clinical and laboratory characteristics of 21 patients with white precneal disease were analyzed with chronic aplastic anemia (CAA) and non-emergent paroxysmal nocturnal hemoglobinuria (a PNH). Differences from the control group. Results Compared with CAA and a PNH, white before can have the following characteristics: 1 bone marrow smear can be seen or confirmed by micro-meganuclease labeling of lymphoid micromegakaryocytes; 2 immature granulocytes appear in peripheral blood; 3 bone marrow blasts ≥ 0. 0 2 0 ;4 Positive staining of bone marrow nucleated erythrocyte glycogen; 5) Myeloid cell differentiation index (DI) ≥ 1.8; 6 Typical karyotype abnormalities; 7 sister chromatid stain negative; 8 Hematopoietic progenitor cells in vitro Culturing mononuclear cell clusters/colony >4.0. White patients met condition 1 and satisfied any two or more of the following seven (A) or satisfied any four or more of eight (B) patients; neither CAA nor a PNH patient satisfies A or B conditions. CONCLUSIONS: There is a significant difference between CAA and a PNH in bone marrow cell morphology, histochemical staining, differentiation antigen expression, karyotype, cell division cycle, hematopoietic progenitor colony culture, and clinical response and prognosis. Assists in a forward-looking diagnosis.