多种方法联合应用在非霍奇金淋巴瘤骨髓侵犯中的诊断价值

发布时间：2018-01-26 09:20

本文关键词： 淋巴瘤非霍奇金骨髓涂片骨髓活检流式细胞术　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨骨髓涂片、骨髓活检、骨髓流式细胞术联合应用检测初治非霍奇金淋巴瘤骨髓侵犯的价值,分析非霍奇金淋巴瘤骨髓侵犯的组织病理学构成比,评估骨髓涂片、骨髓活检及流式细胞术对非霍奇金淋巴瘤临床分期的影响,判断骨髓检查对不明原因发热病人的诊断价值。方法:收集、整理2013年3月至2016年3月在青岛大学附属医院住院诊断的96例初治非霍奇金淋巴瘤患者的骨髓涂片、骨髓活检及骨髓流式细胞术检查结果,比较不同方法对非霍奇金淋巴瘤病人骨髓侵犯检测的阳性率,以及3种方法联合检测的价值。采用统计学软件SPSS17.0进行统计分析,计数资料采用X~2检验,以P0.05为差异有统计学意义。结果:骨髓涂片、骨髓活检、流式细胞术检查及3种方法联合应用对非霍奇金淋巴瘤病人骨髓侵犯检测的阳性率分别为19.8%、22.9%、36.5%、45.8%。流式细胞术检查对非霍奇金淋巴瘤骨髓侵犯检测阳性率显著高于单用骨髓涂片和骨髓活检(X~2=7.76,P0.05);三种方法联合应用对NHL骨髓侵犯检出率最高(X~2=19.69,P0.05);骨髓涂片与骨髓活检比较,差异无显著性(X~2=0.28,P0.05)。骨髓涂片、骨髓活检、流式细胞术都有助于修正非霍奇金淋巴瘤临床分期。弥漫大B细胞淋巴瘤骨髓侵犯比例最高。对于部分不明原因发热的病人,骨髓涂片、骨髓活检和骨髓流式细胞术单独或联合检查有助于诊断。结论:骨髓涂片、骨髓活检及骨髓流式细胞术检查联合应用有助于提高初治非霍奇金淋巴瘤骨髓侵犯检测的阳性率,其优势互补,不可替代;3种检查方法联合应用有助于修正临床分期,对于指导NHL的临床治疗及评估预后有重要的价值;对于部分不明原因发热病人进行骨髓检查有助于明确诊断。对于临床上高度怀疑淋巴瘤骨髓侵犯病人,若首次骨髓活检阴性并不能排除骨髓侵犯,换部位再次行骨髓相关检查则有助于明确诊断。
[Abstract]:Objective: to investigate the value of bone marrow smear, bone marrow biopsy and bone marrow flow cytometry in detecting bone marrow invasion of primary non-Hodgkin 's lymphoma, and to analyze the histopathological ratio of bone marrow invasion of non-Hodgkin 's lymphoma. To evaluate the effect of bone marrow smear, bone marrow biopsy and flow cytometry on the clinical staging of non-Hodgkin 's lymphoma, and to evaluate the diagnostic value of bone marrow examination in patients with fever of unknown origin. The results of bone marrow smear, bone marrow biopsy and bone marrow flow cytometry in 96 patients with newly diagnosed non-Hodgkin 's lymphoma were collected from March 2013 to March 2016 in the affiliated Hospital of Qingdao University. The positive rate of bone marrow invasion in patients with non-Hodgkin 's lymphoma and the value of three combined methods were compared. Statistical software SPSS17.0 was used for statistical analysis. The count data were measured by X2 test, with P0.05 as the difference. Results: bone marrow smear, bone marrow biopsy. The positive rate of bone marrow invasion in patients with non-Hodgkin 's lymphoma was 19.822.9% by flow cytometry and 36.5% by combined use of three methods. The positive rate of bone marrow invasion in non-Hodgkin 's lymphoma by flow cytometry was significantly higher than that by single bone marrow smear and bone marrow biopsy. The detection rate of bone marrow invasion in NHL was the highest (P 0.05). There was no significant difference between bone marrow smear and bone marrow biopsy. Flow cytometry helps to correct the clinical staging of non-Hodgkin 's lymphoma. Diffuse large B-cell lymphoma has the highest rate of bone marrow involvement. Bone marrow smears are found in patients with partial fever of unknown origin. Bone marrow biopsy and bone marrow flow cytometry are helpful for diagnosis. Conclusion: bone marrow smears. Combined use of bone marrow biopsy and bone marrow flow cytometry is helpful to improve the positive rate of bone marrow invasion in primary non-Hodgkin 's lymphoma. The combined use of the three methods is helpful for the revision of clinical staging and is of great value in guiding the clinical treatment and evaluating the prognosis of NHL. Bone marrow examination for some patients with fever of unknown origin is helpful to the diagnosis. For patients with clinically highly suspected lymphoma bone marrow invasion, bone marrow invasion cannot be ruled out if the first bone marrow biopsy is negative. Bone marrow-related examinations at different sites will help to make a clear diagnosis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.1

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