目的利用骨髓活检切片进行小巨核细胞酶标染色以检测骨髓增生异常综合征(MDS)患者小巨核细胞的情况,从而判断骨髓活检小巨核细胞酶标染色对MDS的诊断价值。方法分别对我院52例初诊为MDS患者的骨髓涂片及骨髓活检切片进行巨核细胞特异性抗体(CD41a)标记碱性磷酸酶抗碱性磷酸酶(APAAP)方法染色并与骨髓涂片常规瑞特染色方法对比镜检小巨核细胞的情况。结果 52例MDS患者骨髓涂片瑞特染色法中有18例检出小巨核细胞,阳性率为34.6%,0例检出淋巴样小巨核细胞,阳性率为0;骨髓涂片联合APAAP法中有30例检出小巨核细胞,阳性率为57.7%,22例检出淋巴样小巨核细胞,阳性率为42.3%;骨髓活检切片联合APAAP法有48例检出小巨核细胞,阳性率为92.3%,47例检出淋巴样小巨核细胞,阳性率为90.4%。三种方法检出小巨核细胞阳性率相比差异有统计学意义(P<0.05)。三种方法检出淋巴样小巨核细胞阳性率相比,差异有统计学意义(P<0.05)。其中骨髓活检切片酶标染色法检出小巨核细胞阳性率和淋巴样小巨核细胞阳性率最高。结论利用骨髓活检切片进行小巨核细胞酶标染色能更准确检出小巨核细胞和淋巴样小巨核细胞,并能直观显示巨核病态造血分布情况,为MDS早期诊断提供可靠依据。 Objective To detect the expression of small megakaryocytes in patients with myelodysplastic syndrome (MDS) by micro-megakaryocyte enzyme staining using bone marrow biopsy sections, and to determine the diagnostic value of microdissection of bone marrow biopsy for MDS. Methods The bone marrow smears and bone marrow biopsy specimens from 52 newly diagnosed MDS patients in our hospital were stained with APAAP and labeled with CD41a, Special staining method compared microscopic examination of small megakaryocytes situation. Results In 52 MDS patients, 18 cases of small megakaryocytes were found in the bone marrow smear smear method, the positive rate was 34.6%. The positive rate of lymphoid micromegakaryocytes was 0 in 0 cases. The bone marrow smear combined with APAAP method 30 cases detected small megakaryocytes, the positive rate was 57.7%, 22 cases detected lymphoid small megakaryocytes, the positive rate was 42.3%; bone marrow biopsy combined with APAAP method 48 cases detected small megakaryocytes, the positive rate was 92.3 %, 47 cases detected lymphoid small megakaryocytes, the positive rate was 90.4%. There was significant difference between the three methods in detecting the positive rate of small megakaryocytes (P <0.05). There were significant differences between the three methods in detecting the positive rate of lymphoid small megakaryocyte (P <0.05). In which the bone marrow biopsy biopsy microdissectomy detected the positive rate of positive cells and lymphoid-like megakaryocytes positive rate. Conclusion The detection of small megakaryocytes and lymphoid small megakaryocytes with bone marrow biopsy can be used to detect micromegakaryocytes and lymphoid small megakaryocytes. The distribution of megakaryocytopathic hematopoiesis can be directly visualized, providing a reliable basis for the early diagnosis of MDS.