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目的探讨联合多种检测技术的骨髓实验诊断体系诊断非霍奇金淋巴瘤骨髓浸润的价值。方法以骨髓涂片检查、切片检查、流式细胞术、荧光原位杂交技术和染色体核型分析技术为基础,建立骨髓实验诊断体系。体系内容包括实验流程和诊断结果评价体系。实验流程的检验顺序为:(1)骨髓涂片、骨髓切片;(2)FCM分析和染色体培养分析;(3)FISH探针检测。诊断结果评价体系以骨髓涂片(BMA)和病理切片(BMB)作为定性诊断指标,特异性的FCM或免疫组织化学(IHC)的免疫表型和FISH探针的基因表型作为分型依据。CAA结果作为诊断及预后判断指标。各项检测技术的实验操作按常规进行。结果总例数为115例,BMA和BMB完成检查各115例,FCM完成74例,FISH 85例,CAA 23例。各单项检出阳性率分别为BMA 72.17%,BMB 89.96%,FCM 90.54%,FISH 54.12%。实验诊断体系综合分析检出率为100%。单项比较,BMB和FCM的阳性检出率明显高于BMA和FISH,差异显著。将75例淋巴结病理确诊为NHL患者的诊断结论在定性、免疫分型和病理分型3个层面上,做骨髓实验诊断结果与淋巴结病理诊断结果的对比分析,其吻合率分别为98.67%,91.94%,72.00%,说明骨髓诊断NHL在较精准的病理分型水平上还有差距。结论骨髓实验诊断的各单项技术对NHL-BMI的诊断有其临床价值,也有不足和局限。骨髓涂片和骨髓切片检查是基本方法,可以做出定性诊断。进一步做FCM或IHC可以明确免疫分型,配合FISH及CAA可以得到精细的病理分型诊断。多技术联合应用的实验诊断体系是诊断NHL的有效方法,可以提高NHL-BMI的诊断正确性和阳性率。
Objective To explore the value of bone marrow experimental diagnosis system combined with multiple detection techniques in diagnosing bone marrow infiltration of non-Hodgkin’s lymphoma. Methods Based on bone marrow smears, biopsies, flow cytometry, fluorescence in situ hybridization and karyotype analysis techniques, a bone marrow test diagnosis system was established. The system content includes the experimental process and diagnostic evaluation system. The test sequence was: (1) bone marrow smear, bone marrow section; (2) FCM analysis and chromosome culture analysis; (3) FISH probe detection. The diagnostic evaluation system uses bone marrow smear (BMA) and pathological section (BMB) as qualitative diagnostic indicators, specific FCM or immunohistochemical (IHC) immunophenotype and FISH probe gene phenotype as typing basis. The CAA results serve as diagnostic and prognostic indicators. The experimental operation of each detection technique is performed as usual. The total number of cases was 115. The BMA and BMB completed 115 cases, FCM completed 74 cases, FISH 85 cases, and CAA 23 cases. The positive rate of each item was 72.17% for BMA, 89.96% for BMB, 90.54% for FCM and 54.12% for FISH. The detection rate of comprehensive analysis of the experimental diagnostic system was 100%. For single comparisons, the positive detection rates of BMB and FCM were significantly higher than those of BMA and FISH. The diagnostic results of 75 patients with lymph node pathology diagnosed as NHL were analyzed on the qualitative, immunophenotypic and pathological types. The results of bone marrow test and lymph node pathological diagnosis were compared and analyzed. The anastomosis rates were 98.67% and 91.94 respectively. %, 72.00%, indicating that there is still a gap in the accuracy of pathological classification of NHL in bone marrow diagnosis. Conclusion The individual techniques of bone marrow test diagnosis have clinical value in the diagnosis of NHL-BMI, and there are also deficiencies and limitations. Bone marrow smears and bone marrow biopsies are the basic methods for qualitative diagnosis. Further FCM or IHC can be used to define the immunophenotyping. FISH and CAA can be used to obtain a fine diagnosis of pathological type. The multi-technical combined experimental diagnostic system is an effective method for diagnosing NHL and can improve the diagnostic accuracy and positive rate of NHL-BMI.