The Clinical Study Of Correlation Research Of The Atypia Change Megakaryocytes In The Myeloproliferative Neoplasms With Bone Marrow Fibrosis

ObjectiveMyeloproliferative neoplasm(MPN) mainly consists of chronic myeloid leukemia (CML),essentia thrombocythemia(ET), polycythemia vera(PV) and primary myelofibrosis(MF). During the disease progression of CML, ET, PV and other diseases,which are often associated with bone marrow fibrous, and which cause the failure of clinical treatment and prognosis. The morphological characteristics is atypia megakaryocyte. The Bcr/Abl fusion gene and JAK2V617F gene which are the main mechanisms of pathogenesis of CML, ET and PV, respectively. At present, it is found that95%of Bcr/Abl in patients of CML, and50%ET and65%-97%PV in patients have JAK2V617F mutation.We collect165cases of CML, ET, PV,which observe the morphological characteristics of megakaryocyte in bone marrow smears and bone marrow biopsy during three years;and discuss that the Bcr/Abl and JAK2V617F mutation effect on megakaryocyte morphology; and analysis of changing trend of peripheral blood (HB, WBC, PLT) and megakaryocytes with the change of myelofibrosis.Methodsl,Our collect165cases of diagnosis and treatment of CML, ET, PV in the second hospital of Shanxi Medical University from2009January to2012August.2, Observe the bone marrow smears and bone marrow biopsy by Olympus BX-51microscope.The typing standard reference Lu Xingguo, put forward the bone marrow megakaryocyte morphology divided into seven categories, respectively, type â…  (single karyotype), type â…¡ (a plurality of karyotype), type â…¢ (multilobated type), type â…£(leaf is not good), typeâ…¤ (a small nucleus karyotype), type â…¥ (megakaryocyte clusters), type â…¦ (trabecular bone side type).3, According to WHO classification standard, Clinical stage [chronic phase (CP), accelerated phase (AP), blastic phase (BP)] and the Bcr/Abl fusion gene and JAK2V617F mutation, divide CML, ET, PV into groups.(Specific groups see the experiment method of text)4, Analysis the difference of the effect on megakaryocyte morphology of the CML fusion gene and JAK2V617F mutations.5, Analysis the change trend of peripheral blood (HB, WBC, PLT) and median megakaryocytes with myelofibrosis.6, The data were analyzed by SPSS20.0software.Results1, The groups of group CP,AP and b3a2of CML, groups the negative JAK2V617F of ET and groups of PV which have not statistically difference (P>0.05)2,The plurality of karyotype of megakaryocyte (P=0.023, P<0.05) which in CML (BP) have significant difference. The cluster of megakaryocytes (P=0.024,P<0.05),and trabecular side megakaryocyte (P=0.000,P<0.05) and cluster of megakaryocytes (P=0.030,P<0.05) which have statistically difference in the groups of b2a2and positive JAK2V617F of ET3,The multilobular megakaryocyte (P=0.033, P<0.05), nuclear small megakaryocyte (P=0.004, P<0.05) and leaves no megakaryocyte (P=0.016, P<0.05) in the CML b2a2group, positive JAK2V617F of ET group and PV,which have statistically significant differences (p<0.05) in bone marrow smear, respectively.4, Megakaryocytes in bone marrow are negatively correlated with bone fiber grade in bone marrow smear.5,The HB was significantly decreased in the progress of CML (b3a2,AP) with myelofibrosis, it was statistically significant difference (P=0.009, P=0.004).The other groups have no statistically significant difference (P>0.05).Conclusion1, The CML, PV, ET with different fiber hyperplasia degree in HB, WBC, PLT have no significant difference.2, The fusion gene b2a2of CML and the genic mutation of JAK2V617F of ET, PV have high rate of myelofibrosis.3, The megakaryocyte of bone marrow have important diagnostic value in CML, ET, PV with myelofibrosis.4, Multilobated megacaryocyte in bone marrow smears and megakaryocytes clusters in bone marrow biopsy which can be used as b2a2type CML patients with myelofibrosis for early diagnosis.5, The small nucleus karyotype megakaryocyte and leaf is not good type megakaryocyte in bone marrow smear, trabecular bone side type megakaryocyte and megakaryocyte clusters in bone marrow biopsy which can be used as the early diagnosis of ET patients with JAK2V617F gene with myelofibrosis.