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目的探讨特发性血小板减少性紫癜(ITP)、再生障碍性贫血(AA)和骨髓异常增生综合征(MDS)骨髓活检组织定量病理学及临床相互关系。方法从收集的小儿骨髓活检标本中抽取ITP 127例,AA 204例,MDS 26例,定量观察骨髓造血容积及巨核细胞变化,结合病史进行分析。结果造血容积:ITP(67.0±20.1)%,AA(19.8±15.6)%,MDS(59.4±24.8)%。ITP、MDS造血容积显著高于AA(P<0.05)。巨核细胞计数:ITP(9.6±4.1)/低倍视野(LPF),AA(1.5±1.3)/LPF,MDS(4.0±2.3)/LPF。病史回顾及随访:ITP患儿中8例转变为AA;AA中28例有ITP病史,2例有MDS病史,1例转化为急性淋巴细胞白血病;MDS中5例转化为AA,1例转化为慢性粒细胞白血病,1例转化为急性骨髓性白血病。结论骨髓定量病理学差别可作为三种病重要的鉴别诊断依据。ITP和MDS低增生型有可能发展为AA。
Objective To investigate the quantitative pathological and clinical correlation between idiopathic thrombocytopenic purpura (ITP), aplastic anemia (AA) and bone marrow biopsy of myelodysplastic syndrome (MDS). Methods A total of 127 cases of ITP, 204 cases of AA and 26 cases of MDS were collected from the collected bone marrow biopsy samples. The hematopoietic volume and the changes of megakaryocytes were quantitatively observed and analyzed according to the medical history. Results Hematopoietic volume: ITP (67.0 ± 20.1)%, AA (19.8 ± 15.6)% and MDS (59.4 ± 24.8)%. ITP, MDS hematopoietic volume was significantly higher than AA (P <0.05). Megakaryocyte count: ITP (9.6 ± 4.1) / low power field (LPF), AA (1.5 ± 1.3) / LPF, MDS (4.0 ± 2.3) / LPF. A review of history and follow-up: Eight of the ITP children were converted to AA; 28 of the AA had a history of ITP, two had a history of MDS, one had a history of acute lymphoblastic leukemia; 5 were converted to AA in MDS and 1 to Chronic myeloid leukemia, 1 case converted to acute myeloid leukemia. Conclusion Bone marrow quantitative pathological differences can be used as an important basis for the differential diagnosis of the three diseases. ITP and MDS hypo-proliferative may develop into AA.