【摘要】 目的 旨在了解骨髓涂片及活检在多发性骨髓瘤诊断与疗效判断中的优势与不足,明确骨髓涂片与活检同步检查在多发性骨髓瘤诊断以及治疗观察中的价值。方法 采用二步抽吸-活检双标本取材术,获取骨髓涂片及活检标本,回顾分析283例多发性骨髓瘤患者的骨髓涂片及活检结果,对骨髓增生程度、骨髓瘤细胞形态、浆细胞浸润度、增殖模式、骨髓间质病理改变及纤维化情况进行比较研究。结果 多发性骨髓瘤患者骨髓活检的增生程度及浆细胞浸润度明显高于涂片,差异有统计学显著性意义(P<0.01);骨髓活检对多发性骨髓瘤诊断的敏感度高于涂片,两者差异有统计学意义(P<0.05);骨髓活检中浆细胞增殖模式:簇片结节型33例(11.66%)、间质型86例(30.39%)、结节间质型112例(39.58%)、弥漫塞实型52例(18.37%);骨髓涂片中骨髓瘤细胞形态:小成熟浆细胞型77例(27.21%)、幼稚浆细胞型148例(52.30%)、原始浆细胞型36例(12.72%)、网状浆细胞型22例(7.77%)。结论 骨髓活检能够准确地反映骨髓增生程度、浆细胞增殖模式及浸润度、骨髓纤维化情况;骨髓涂片骨髓瘤细胞形态清晰、特征典型,容易辨认。骨髓涂片与活检同步检查能够提高多发性骨髓瘤诊断的敏感度及准确率,对于多发性骨髓瘤的诊断、治疗观察具有十分重要的意义。更多还原

【Abstract】 Objective The purpose of this paper is to understand the advantages and disadvantages of the bone marrow smears and bone marrow biopsy in multiple myeloma diagnosis and efficacy judgment,explicit the value of bone marrow smears and bone marrow biopsy synchronous check in the diagnosis and treatment observation of multiple myeloma.Methods With two step-suction two biopsy specimens assay,obtained specimens of bone marrow smears and bone marrow biopsy,retrospectively analysed results of 283 multiple myeloma patients bone marrow smear and biopsy,and made a comparative study on the degree of bone marrow hyperplasia,myeloma cell morphology,the degree of tumor cell infiltration,proliferation pattern,bone marrow stromal pathological changes,and fibrosis cases.Results The degree of proliferation of bone marrow biopsy sections and infiltration of plasma cells was significantly higher than that of bone marrow smears,statistically there was a significant difference(P<0.01).Multiple myeloma diagnostic sensitivity by bone marrow biopsy sections was significantly higher than by the bone marrow smears,the difference was statistically significant(P<0.05).Plasma cells in bone marrow biopsy tumor proliferation modes:clusterpiece nodular type 33 cases(11.66%),interstitial-type 86 cases(30.39%),among nodular interstitial type 112 cases(39.58%),diffuse cypriot real 52 cases(18.37%).Plasma cells in bone marrow smears tumor morphology:small mature plasma cell type 77 cases(27.21%),immature plasma cell type 148 cases(52.30%),protoplasmic cell type 36 cases(12.72%).reticular plasma cell type 22 cases(7.77%).Conclusion Marrow biopsy can accurately reflect the degree of bone marrow hyperplasia,plasma cell tumor proliferation mode and infiltration degree,myelofibrosis situation;bone marrow smears Wright-Giemsa staining,plasma cell tumor morphology was clear,typicalfeatured,and easily identifiable.Bone marrow smear and biopsy synchronous check can improve the sensitivity and accuracy for multiple myeloma diagnosis,which has very important significance for multiple myeloma diagnosis and treatment observation.更多还原