骨髓形态检验在难治性贫血与巨幼细胞性贫血鉴别诊断中应用.docVIP

骨髓形态检验在难治性贫血与巨幼细胞性贫血鉴别诊断中应用 　　【关键词】 难治性贫血;巨幼细胞性?血;骨髓形态检验;鉴别诊断 　　中图分类号：R556 文献标识码：A DOI：10.3969/j.issn.1003-1383.2018.01.017 　　Application of bone marrow morphologic test in differential diagnosis of RA and MA 　　GUAN Ruixia，SUN Changjuan 　　【Abstract】 Objective To analyze the diagnostic value of bone marrow morphologic test in refractory anemia（RA） and megaloblastic anemia（MA）. 　　Methods 45 patients with RA and 45 patients with MA treated from June，2015 to June，2017 were selected.Then，the puncture of the posterior superior iliac spine was performed to obtain the bone marrow fluid for the bone marrow morphology test，and the examination results were observed and compared. 　　Results The positive rate of PAS in nuclear red cells in the RA group was 64.4%，which was higher than that in the MA group，difference was statistically significant（Plt;0.001）.In the RA group，the proportion of erythroid disease，granular disease and lymphoid megakaryocyte was respectively 62.2%，71.1% and 100.0%，higher than that（respectively 6.7%，17.8% and 8.9%） in the MA group，difference was statistically significant （Plt;0.001）.The diameter of primary erythrocyte and early erythrocyte in the MA group was larger than that in the RA group，difference was statistically significant（Plt;0.01）. 　　Conclusion Bone marrow morphologic examination is of high value in differential diagnosis of RA and MA.RA patients should pay attention to pathological hematopoiesis，lymphoid megakaryocyte phenomenon and the positive rate of PAS in nuclear red cells，and MA patients should pay attention to the diameter of megaloblastic erythrocytes. 　　【Key words】 RA;MA;bone marrow morphologic test;differential diagnosis 　　难治性贫血（RA）与巨幼细胞性贫血（MA）均属于特殊的贫血类型，其中前者属于骨髓增生异常综合征，50岁以上的中老年人是主要发病群体;后者是骨髓造血细胞数量减少造成的，患者体内的叶酸、维生素B12缺乏[1～2]。这两类患者的临床症状相近，外周血象特征相近，因此容易造成误诊。探讨一种安全高效的鉴别诊断方法，成为医师的重要研究课题。基于此，本文对我院RA和MA患者进行研究，探讨骨髓形态检验的应用价值，报告如下。 1 资料与方法 　　1.1 一般资料 　　选取我院2015年6月至2017年6月期间收治的RA病例45例，其中男性25例（55.6%），女性20例（44.4%）;年龄24～65岁，平均（44