| Background:myelodysplastic syndrome (myelodysplastic syndromes, or MDS) are a group of abnormal of differentiation and mature myeloid cells, bone marrow failure myeloid neoplasms, characterized with red blood, peripheral blood cell reduction and grain, megakaryocytes, more than one department or department morphological abnormalities, due to the genetic instability and high risk to acute myeloid leukemia (AML). Its etiology and pathogenesis is not very clear. The diagnosis of MDS mainly refer to overall diagnostic criteria, standards, the WHO standards, and Vienna but whichever standards are not completely solve the problem of the diagnosis of MDS, especially for low-risk MDS diagnosis more difficult clinical problem, the diagnosis of MDS is still given priority to with exclusive diagnosis. Diagnostic criteria made a prerequisite for Vienna, condition, auxiliary diagnosis index, put forward the concept of multi-index comprehensive diagnosis of MDS, meta-analysis of the current research about MDS, and will be used in the diagnosis of MDS, even so, the standard morphological pathological hematopoietic still think is the basis for the diagnosis of MDS. But this pathological bone marrow hematopoietic number required by the standard in some patients is difficult to achieve, resulting in part of patients were missed diagnosis or misdiagnosis of hyperplastic anemia and chronic aplastic anemia (CAA) and so on, only appear in the follow-up of these patients or more typical pathological hematopoietic performance was confirmed, thus delay the treatment. So how to improve the morphological detection is the sensitive rate of actual problem in clinical doctors.Adult bone marrow hematopoietic function is centripetal distribution, different parts of the bone marrow cell hyperplasia degree and the count is not entirely consistent, of which the most bone hyperplasia is active. For those suspected of MDS, but there is lack of typical pathological bone marrow morphology of that part of the diagnosis of MDS patients is unknown, in addition to the line of iliac bone marrow test, still should line sternum marrow like analysis, thus is more accurate comprehensive analysis for the whole body blood, achieve the goal of early diagnosis of early treatment. In clinical work, actually has some low-risk MDS patients with sternal bone marrow test was used to diagnosis, but the sternum and iliac bone marrow is exactly exist difference, it is not clear. In this context, this study retrospectively analyzed the sternum and the iliac bone marrow examination in the diagnosis of MDS differences, what methods of bone marrow examination in order to further analysis of MDS diagnosed more meaningful.Objective:to analyse sternal bone marrow examination in the diagnosis of MDS.Methods:a retrospective analysis of our hospital between January2009and December2012diagnosis of21cases of MDS patients. All line into the group, all patients with iliac crest and the sternum puncture of the two parts. Iliac crest and the sternum marrow were compared as in MDS diagnosis and classification of cells, bone marrow hyperplasia degree, the original number, and the typical pathological differences.Results:1.21patients regularly ilium bone marrow test can be clearly diagnosed MDS was28.6%(6/21), the RA for1case (4.7%), RCMD in3cases (14.2%), RAEB for2cases (9.5%), MDS-u0cases. The other15cases:red pathological, except for9cases of MDS and increased poverty in4cases,1cases of aplastic anemia, red proportion reduce1case, the original grain of2%for1case. Sternal bone marrow examination, hitches of21cases were definitely diagnosed MDS, RA was2cases (9.5%), RCMD for10cases (47.6%), RAEB for6cases (28.5%), and MDS-U for3cases (14.2%). Iliac crest bone marrow in the no.15for the diagnosis of MDS patients, the sternal bone marrow were respectively diagnosed with MDS, including RA3cases,6cases RCMD, RAEB,4cases of MDS-u (3cases). There are four patients with iliac bone marrow test did not reach RAEB diagnostic criteria, sternal bone marrow tests are diagnosed with RAEB.2.(1) the iliac bone marrow examination in21patients with MDS were significantly active bone marrow hyperplasia in2cases (9.5%), active (including is active) in14cases (66.7%), hyperplasia to reduce4cases (19%). Sternum bone marrow examination obviously active bone marrow hyperplasia patients,4cases (19%), active (including is active),14cases (66.7%), hyperplasia to reduce3cases (14.2%). P>0.05, both comparison, there was no significant difference.(2)21cases of MDS patients with sternal bone marrow red ratio3.833+/-1.222, ilium bone marrow granulocyte red ratio of2.5971.418mm, P values<0.05, there are significant difference.(3)21cases of MDS patients with sternal bone marrow granulocyte possess nuclear cells percentage53.571%plus or minus41.996%, ilium bone marrow granulocyte possess nuclear cells percentage41.150%plus or minus18.047%, both comparison, P values<0.05, there are significant difference; Sternal bone marrow as red blood cell possess nuclear percentage34.925%plus or minus10.817%, red blood cell possess nuclear ilium bone marrow percentage29.214%plus or minus5.998%, both comparison, P values>0.05, there was no significant difference.3.21cases of MDS patients with sternal bone marrow myeloblast percentage of3.167%plus or minus3.2685%, ilium bone marrow myeloblast percentage of1.643%plus or minus2.510%, both comparison, P>0.05, there was no significant difference. Subgroup analysis showed that sternum RAEB subtype detection ratio is higher than original cells ilium RAEB subtype of primitive cells proportion, P values<0.05, there are significant difference. No more other subtypes sternum compared with ilium, P values>0.05).4.(1)9.023%sternal bone marrow granulocyte series pathological hematopoietic plus or minus3.120%, ilium bone marrow is8.928%plus or minus3.256%, P>0.05, there was no significant difference; Pathological hematopoietic proportion of red blood cell sternal bone marrow is12.261%plus or minus5.233%, iliac bone marrow of6.738%plus or minus4.226%, P values<0.05, there are significant difference.(2) in21patients with MDS ilium bone marrow granulocyte were massively in young patients (19%),4cases of pique deformity in1case (4.7%). Giant young red blood is getting7cases (33.3%), petals nuclear1case (4.7%), an odd number of cores and H-J corpuscle of0(0%), large oval red3cases (14.2%). Huge nuclear is a sick little megakaryocytes,4cases (19%); Sternal bone marrow granulocyte were massively in young patients,8cases (38%), peek malformation,4cases (19%). Giant young red blood is getting15cases (71.4%), petals3cases (14.2%), an odd number of nuclear3cases (14.2%), H-J corpuscle in2cases (9.5%), large oval red11cases (52.3%). Giant nucleus is a sick little big6cases (28.5%). Sternum grain is typical patients with pathological rate compared with ilium, P>0.05, there was no significant difference; Sternum detection and large oval red giant young red blood variation in patients with typical pathological rate higher than iliac detection, P values0.05, there are significant difference. Sternum and ilium were massively nuclear is typical patients with pathological rate comparison, P>0.05, there was no significant difference.5.21in patients with MDS were7cases of iliac puncture chromosome detection, success in3,4cases of failure, success rate42.8%;14cases of sternal puncture chromosome detection,12cases were successful, failure in2cases,85.7%success rate. Both compare, there are significant difference.6.21patients sternum and iliac bone marrow analysis respectively, and IPSS score, sternum median0.75, median0.5ilium detection, P values0.05, there was no significant difference; Subtype analysis shows that RAEB subtypes, sternum IPSS score was1.625+/-0.480, ilium IPSS score was1.125+/-0.480, both comparison, P values<0.05, there are significant difference; Other subtypes were compared, P values>0.05, there was no significant difference.7.21cases of MDS patients,9cases of patients with normal FISH test result,3cases of abnormal results, among them2cases results for+8,1case of-8. The rest of the7cases did not do this test.8.21cases of MDS patients, including10cases of patients with bone marrow test membrane antibody, test results are normal.19patients with PNH patients peripheral blood testing, PNH test results were normal;5patients with the peripheral blood T cell subsets in routine, the results are normal.Conclusion:1for the diagnosis of MDS are significantly higher than iliac, breastbone classification more accurate.2bone marrow hyperplasia degree of sternum and iliac bone marrow, no significant difference between the sternum red ratio above the iliac crest.3sternum primitive cells in MDS RAEB-ratio than ilium.4sternum tests, grain is pathological hematopoietic rate, there are typical proportion of neutrophils in patients with pathological hematopoietic and ilium detect no difference; And red is pathological hematopoietic rate and existing typical pathological hematopoietic proportion is higher than in patients with iliac detection. The success rate of the chest of5chromosomes... |
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