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目的探讨骨髓活检在骨髓转移癌及血液病诊断中的价值。方法 391例骨髓转移癌及血液病患者均行骨髓穿刺涂片、骨髓活检切片组织病理检查,镜下观察骨髓增生情况,比较2种方法单独及联合诊断的符合率。结果骨髓涂片显示,骨髓增生极度活跃64例(16.37%),明显活跃83例(21.23%),活跃115例(29.41%),减低99例(25.32%),重度减低30例(7.67%);骨髓活检组织切片显示,骨髓增生极度活跃81例(20.72%),明显活跃156例(39.90%),活跃91例(23.27%),减低54例(13.81%),重度减低9例(2.30%),增生明显活跃、增生减低及增生重度减低比率比较差异均有统计学意义(P<0.011);与临床诊断结果进行比较,骨髓涂片与骨髓活检联合诊断符合率(97.44%)高于骨髓涂片(69.05%)、骨髓活检(89.00%)(P<0.05),骨髓活检高于骨髓涂片(P<0.05);骨髓活检诊断骨髓转移癌(100.00%)、淋巴瘤(76.74%)、骨髓纤维化(100.00%)、原始细胞过多的难治性贫血(93.88%)、再生障碍性贫血(94.83%)、恶性组织细胞白血病(71.43%)、多发性骨髓瘤(100.00%)和骨髓硬化症(100.00%)符合率高于骨髓涂片(77.78%、44.20%、28.95%、57.14%、81.03%、57.14%、73.33%、0)(P<0.05),诊断环形铁粒幼细胞难治性贫血(6.67%)、难治性贫血伴多系病态造血(38.46%)的符合率低于骨髓涂片(100.00%、92.31%)(P<0.05)。结论骨髓穿刺、骨髓活检在骨髓转移癌及血液病诊断中各有优势,二者联合可提高诊断准确率。
Objective To investigate the value of bone marrow biopsy in the diagnosis of bone marrow metastases and hematological diseases. Methods 391 cases of bone marrow metastases and patients with hematological diseases underwent bone marrow biopsy, bone marrow biopsy sections histopathological examination, microscopic observation of bone marrow hyperplasia, the two methods were compared individually and combined diagnostic accuracy. Results The bone marrow smears showed that the bone marrow hyperplasia was extremely active in 64 cases (16.37%), significantly active in 83 cases (21.23%), active in 115 cases (29.41%), reduction in 99 cases (25.32%) and severe reduction in 30 cases ; Bone marrow biopsy showed that myeloproliferation was extremely active in 81 cases (20.72%), significantly active in 156 cases (39.90%), active in 91 cases (23.27%), reduction in 54 cases (13.81%), severe reduction in 9 cases (2.30% ), Significantly increased hyperplasia, decreased hyperplasia and severe hyperplasia decreased significantly (P <0.011). Compared with clinical diagnosis, the coincidence rate of bone marrow smear and bone marrow biopsy (97.44%) was higher than that of bone marrow Bone marrow biopsy was higher than that of bone marrow smear (P <0.05); bone marrow biopsy diagnosis of bone marrow metastasis (100.00%), lymphoma (76.74%), bone marrow biopsy (89.05% Myelofibrosis (100.00%), refractory anemia (93.88%), aplastic anemia (94.83%), malignant histiocytic leukemia (71.43%), multiple myeloma (100.00%) and bone marrow The coincidence rate of scleroderma (100.00%) was higher than that of bone marrow smears (77.78%, 44.20%, 28.95%, 57.14%, 81.03%, 57.14%, 73.33%, 0) The coincidence rate of treatment of anemia (6.67%), refractory anemia with multiple systems of pathological hematopoiesis (38.46%) was lower than that of bone marrow smears (100.00%, 92.31%) (P <0.05). Conclusion Bone marrow aspiration and bone marrow biopsy have their own advantages in the diagnosis of bone marrow metastases and hematological diseases. The combination of the two can improve the diagnostic accuracy.