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目的研究急性髓系白血病伴骨髓增殖异常相关改变(AML-MRC)的遗传学及形态学改变,以提高检出率。方法通过对281例急性髓系白血病(AML)初诊患者回顾性研究,其中分别有60例AML-M2,68例AML-M4,54例AML-M5,51例AML-M6及48例AML-MRC。对各组的原始细胞数(原始细胞/原始粒细胞+原始幼稚单核细胞)、有核红细胞数、每个类型病态造血的细胞个数及染色体核型,进行统计学分析。结果原始细胞数比较:M2(99.70±36.11),M4(110.26±40.23),M5(159.77±29.22),M6(35.05±19.70),MRC(59.39±17.94),方差分析差异有统计学意义(F=121.456,P<0.05);MRC组与其他各组比较,M6原始细胞数0.05)且均低于20%]。染色体核型分析:AML-MRC核型异常58.8%(20/34),包括MDS相关改变核型14例,及其他复杂核型6例。结论染色体核型异常的MRC仅58.8%;AML-MRC的形态学特征:原始细胞轻度增高,但较其他组增多并不明显,红系不受抑;各系病态造血现象:病态造血现象中前部分为异常特征性改变,主要见于AML-MRC及MDS,对AML-MRC具有诊断意义;后部分为非特征性改变,可见于各类疾病,包括感染、巨幼细胞贫血、白血病等。通过以上特征,可以更好的鉴别AML-MRC与其他各亚型。
Objective To study the genetic and morphological changes of acute myeloid leukemia (AML-MRC) associated with abnormal proliferation of myeloid leukemia in order to improve the detection rate. Methods A retrospective study of 281 cases of acute myeloid leukemia (AML) newly diagnosed patients, including 60 cases of AML-M2, 68 cases of AML-M4, 54 cases of AML-M5, 51 cases of AML-M6 and 48 cases of AML-MRC . The number of primitive cells (primitive cells / primitive myelocytes + primitive naive monocytes), the number of nucleated red blood cells, the number of each type of pathological hematopoietic cells and the karyotype of each group were statistically analyzed. Results The number of primitive cells was significantly different between the two groups (M2 (99.70 ± 36.11, M4.110.26 ± 40.23, M5.159.77 ± 29.22, M6.35 ± 19.70, MRC59.39 ± 17.94, = 121.456, P <0.05). Compared with other groups, the number of M6 primitive cells in MRC group was lower than that in AML-M2, 4 and 5 groups (P <0.05), while the number of nucleated erythrocytes was M2 (16.66 ± 17.17 (14.15 ± 14.64), M5 (9.09 ± 10.62), M6 (126.31 ± 27.75) and MRC (47.43 ± 21.21) respectively. There was significant difference between the two groups (F = 309.407, P <0.05) Compared with other groups, the number of nucleated red blood cells in M2 / 4/5 group was lower than that in M6 group (all P <0.05). The Department of pathological hematopoiesis: Among them, the granular system of false Percy’s deformity, annular nucleus, erythroid multi / odd number of nuclei, mother and child nuclei, etc., megakaryocyte megakaryocyte, multinuclear or mononuclear nuclei megakaryocytes, MRC group was significantly higher than the other groups [(P <0.05) and abnormal cells were more than 60%]. In addition, there were vacuolar vacuoles and nucleolysis in erythrocytes, mitochondria and spores of erythroid There was no significant difference in the frequency of appearance of giant megakaryocytes and nuclear rupture between megacypole and other groups [(P> 0.05) and lower than 20% respectively. Chromosomal karyotype analysis: The AML-MRC karyotype was abnormal in 58.8% (20/34), including 14 cases of MDS related karyotype and 6 cases of other complex karyotypes. Conclusion The chromosomal aberration of MRC is only 58.8%. The morphological features of AML-MRC: the mild increase of primitive cells, but not obvious increase of other groups, but not of erythroid. The pathological hematopoiesis The anterior part of the abnormal characteristic changes, mainly seen in AML-MRC and MDS, AML-MRC has diagnostic significance; the latter part of non-characteristic changes can be found in various diseases, including infection, megaloblastic anemia, leukemia and so on. Through the above features, AML-MRC and other subtypes can be better identified.