论文部分内容阅读
目的探讨骨髓涂片及活检对多发性骨髓瘤(MM)的诊断价值。方法同步观察302例MM患者骨髓涂片和活检塑料包埋切片。观察骨髓增生程度、浆细胞形态、增殖模式及浸润程度、网硬蛋白积分。结果MM患者骨髓造血组织在骨髓活检中观察到的增生程度明显高于骨髓涂片,两者差异有统计学意义(P<0.05)。99例患者(32.7%)骨髓瘤负荷处于Ⅰ期,140例(46.4%)处于Ⅱ期,63例(20.9%)处于Ⅲ期。骨髓切片中浆细胞以簇片-间质型、结节-间质型、结节型及塞实型为主,以结节状浆细胞瘤出现为阳性诊断标准,其敏感性273例(90.4%)明显高于涂片中浆细胞>15%的指标(70.5%)。136例(45.0%)显示骨髓涂片与活检切片内浆细胞的浸润度相符,109例(36.1%)患者的骨髓涂片浆细胞浸润度较活检低,57例(18.9%)患者的骨髓涂片浆细胞浸润度较活检高。骨髓涂片中双核、多核及火焰型浆细胞,以及浆细胞胞浆中出现Auer氏小体、鲁氏小体对诊断MM有重要的参考价值。结论 骨髓活检能准确反映骨髓组织的增生程度、浆细胞浸润情况及增殖模式、纤维增生程度,对MM的诊断及鉴别诊断有较高价值;骨髓涂片典型的浆细胞形态对确诊MM有重要作用,骨髓涂片结合骨髓活检能提高MM诊断的准确率,减少误诊。
Objective To investigate the diagnostic value of bone marrow smears and biopsy in multiple myeloma (MM). Methods The bone marrow smears and biopsies of 302 MM patients were observed simultaneously. The degree of myeloproliferation, plasma cell morphology, proliferative pattern and infiltration degree, reticulin protein score were observed. Results The proliferative degree of bone marrow hematopoietic tissue in MM patients was significantly higher than that in bone marrow biopsy, the difference was statistically significant (P <0.05). Ninety-nine patients (32.7%) had a myeloma load in stage I, 140 (46.4%) in stage II and 63 (20.9%) in stage III. In the marrow slices, the plasma cells were cluster-interstitial, nodular-interstitial, nodular and plug-shaped, and nodular plasmacytoma was positive diagnostic criteria. The sensitivity was 273 (90.4 %) Was significantly higher than the target of> 15% of plasma cells in smears (70.5%). Thirty-six patients (45.0%) showed a consistent infiltration of the plasma cells in the biopsy and in 109 (36.1%) patients, compared with the biopsy in the bone marrow smear in 57 patients (18.9%) Plasma cell infiltration rate higher than the biopsy. Bone marrow smear in the dual-core, multi-core and flame plasma cells, and plasma cells appeared in the cytoplasm Auer’s body, Lu body of the diagnosis of MM has important reference value. Conclusion Bone marrow biopsy can accurately reflect the degree of bone marrow hyperplasia, plasma cell infiltration and proliferation mode, the degree of fibrosis, the diagnosis of MM and differential diagnosis of high value; bone marrow smear typical of the plasma cell morphology plays an important role in the diagnosis of MM , Bone marrow smear combined with bone marrow biopsy can improve the accuracy of MM diagnosis and reduce misdiagnosis.