| 李洁霞,畅立铭.骨髓细胞学检查在免疫性血小板减少症、骨髓增生异常综合征及再生障碍性贫血鉴别诊断中的价值分析[J].安徽医药,2026,30(10):1968-1975. |
| 骨髓细胞学检查在免疫性血小板减少症、骨髓增生异常综合征及再生障碍性贫血鉴别诊断中的价值分析 |
| Value of bone marrow cytological examination in the differential diagnosis of immune thrombocytopenia, myelodysplastic syndrome and aplastic anemia |
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| DOI：10.3969/j.issn.1009-6469.2026.10.012 |
| 中文关键词: 骨髓检查 免疫性血小板减少症 骨髓增生异常综合征 再生障碍性贫血 鉴别诊断 血液系统疾病 |
| 英文关键词: Bone marrow examination Immune thrombocytopenia Myelodysplastic syndrome Aplastic anemia Differential di-agnosis Hematological diseases |
| 基金项目:山西省卫生计生委科研课题项目( 2024YK0135) |
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| 中文摘要: |
| 目的探讨骨髓细胞学检查在免疫性血小板减少症( ITP)、骨髓增生异常综合征( MDS)及再生障碍性贫血( AA)鉴别诊断中的临床价值。方法回顾性观察性对比研究。选取 2022年 3月至 2025年 3月运城市中医医院收治的 120例血液系统疾病病人为研究对象，其中 ITP组 40例、 MDS组 40例、 AA组 40例。所有研究对象均行骨髓细胞学检查，观察并比较三组骨髓有核细胞增生程度、粒细胞与红细胞比值( G/E)、巨核细胞数量及形态、各系细胞形态学异常表现，同时检测血小板相关指标，绘制受试者操作特征曲线( ROC曲线)并结合 DeLong检验进行曲线下面积( AUC)的组间比较，分析骨髓细胞学检查指标对 3种疾病的鉴别诊断效能，运用 Kappa检验，分析骨髓细胞学检查与临床最终诊断的一致性。结果三组骨髓有核细胞增生程度差异有统计学意义: ITP组以活跃、明显活跃为主，无重度低下； MDS组以活跃为主， 40.00%伴病态造血； AA组 95.00%为重度低下，无活跃及以上病例( P<0.001)。 AA组 G/E显著低于 ITP、MDS组( 1.28±0.61比 1.55±0.28、1.38±0.42，P<0.05)ITP组巨核细胞数量显著高于其余两组［(165.36±58.24)个/片比(105.62±32.15)个 /片、(98.86±2.14)个 /片， P<0.05］。形态学上，I，TP仅巨核系 |
| 英文摘要: |
| Objective To explore the clinical value of bone marrow cytological examination in the differential diagnosis of immunethrombocytopenia (ITP), myelodysplastic syndrome (MDS), and aplastic anemia (AA).Methods Retrospective observational compara-tive study. A total of 120 patients with hematological diseases admitted to Yuncheng Hospital of Traditional Chinese Medicine fromMarch 2022 to March 2025 were selected as the research subjects and assigned to three groups: ITP group (n=40), MDS group (n=40) and AA group (n=40). All the research subjects underwent bone marrow cytological examination to observe and compare the degree ofnucleated cell proliferation in the bone marrow, granulocyte-to-erythrocyte ratio (G/E), megakaryocyte count and morphology, and mor-phological abnormalities of various cell lineages. Platelet-related indicators were also detected. Receiver operating characteristic curves(ROC curves) were drawn, and the area under the curve (AUC) was compared between the groups using DeLong's test. The diagnosticefficacy of bone marrow cytological examination indicators for the three diseases was analyzed, and the consistency between bone mar-row cytological findings and the final clinical diagnosis was analyzed using Kappa test.Results There were significant differences inthe degree of nucleated cell proliferation in the bone marrow among the three groups: the ITP group predominantly showed active or sig-nificantly active proliferation, with no cases of severe hypoplasia; the MDS group mainly showed active proliferation, with 40.00% ac-companied by pathological hematopoiesis; and 95.00% of the AA group had severe hypoplasia, with no cases of active or above prolifer-ation (P < 0.001). The G/E ratio in the AA group was significantly lower than that in the ITP and MDS groups (1.28 ± 0.61 vs. 1.55 ± 0.28, 1.38 ± 0.42, P < 0.05), and the megakaryocyte count in the ITP group was significantly higher than that in the other two groups[(165.36 ± 58.24) cells/platelet vs. (105.62 ± 32.15) cells/platelet, (98.86 ± 2.14) cells/platelet, P < 0.05]. Morphologically, ITP onlyshowed mature disorder in the megakaryocyte lineage, without multilineage pathological hematopoiesis; MDS had abnormality rates of85.00% in the granulocytic lineage and 82.50% in the erythroid lineage, with 75.00% showing pathological hematopoiesis involving twoor more lineages; AA showed a significant decrease only in megakaryocyte count, with granulocytic and erythroid lineages remaining ba-sically normal (P<0.001). The platelet counts (PLT) of all three groups were decreased, with the lowest level observed in the AA group[(28.54± 11.62) × 10./L], significantly lower than that in the ITP group [(37.91±12.35) × 10./L] and the MDS group [(42.36±12.82) × 10./L] (P<0.05). Only the ITP group had a significantly higher mean platelet volume (MPV) [(12.58±2.14) fL], higher than the MDS group[(10.25±1.86) fL] and the AA group [(9.86±1.52) fL] (P<0.05). Multivariate logistic regression indicated that the degree of nucleatedcell proliferation in bone marrow, G/E ratio, megakaryocyte count, and PLT were independent risk factors for differentiating the threediseases, while MPV was associated only with ITP. ROC curve analysis suggested that the AUCs of the three cytological indicators ofbone marrow combined for differentiating ITP, MDS, and AA were 0.961, 0.859, and 0.956, respectively, with a sensitivity of 97.50%and a specificity of 95.00%, and the diagnostic specificity of AA reached 100.00%. The overall concordance rate between bone marrowcytological examination and the final clinical diagnosis was 95.83%, with a Kappa value of 0.90, indicating good consistency.Conclu. sions Bone marrow cytological examination can effectively distinguish ITP, MDS and AA by evaluating the degree of nucleated cellproliferation in bone marrow, G/E ratio, and megakaryocyte count and morphology. It has high sensitivity and specificity, providing a re-liable basis for the precise differentiation of thrombocytopenic hematological diseases. |
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