283 例急性白血病初诊时外周血象和髓象特点分析

摘要

目的 了解急性白血病(AL)初诊时外周血象和髓象情况及相关关系.方法 对283 例AL初诊时外周血象和骨髓象进行分析,包括血常规三系检测值、外周血细胞分类、骨髓细胞形态学分类等,并进行统计分析.结果 283 例AL的血常规均出现一系、两系或三系的异常,其中贫血占88.3%,PLT减少占86.6%,WBC增高占61.9%,WBC减少占24.0%, WBC正常占14.1%;综合三系分析,初诊AL最常见的外周血象为HB↓WBC↑PLT↓占49.5%,其次为HB↓WBC↓PLT↓占18.0%.外周血原幼细胞阳性检出率为92.9%;幼红细胞阳性检出率为17.3%.外周血原幼细胞(%)与血常规WBC、骨髓原幼细胞(%)为正相关;外周血幼红细胞(%)与血常规HB为负相关;外周血幼红细胞(%)与骨髓幼红细胞(%)为正相关,差异均有统计学意义(P＜0.05).结论 绝大多数(92.9%)AL初诊时外周血可检出原幼细胞,少部分(17.3%)可检验到幼红细胞,且外周血原幼细胞与血常规及骨髓细胞具有相关关系,应用显微镜进行外周血细胞分类对于AL的诊断和减少漏诊具有重要意义.%Objective To understand the characteristics and correlation of peripheral blood and myeloid cells in the initial diagnosis of acute leukemia (AL). Methods The peripheral blood and bone marrow smears from 283 cases of AL were analyzed, including three-lineage findings of blood routine, peripheral blood cell classification and bone marrow cell morphology classification; the statistical analysis was carried out. Results There were 1-, 2- or 3-lineage abnormalities in the blood routine evaluation of 283 cases of AL, including anemia of 88.3%, PLT reduction of 86.6%, WBC increase of 61.9%, WBC reduction of 24.0%, WBC normal account for 14.1%. According to the comprehensive 3-lineage analysis, the most common peripheral blood pattern of the newly diagnosed AL was HB↓WBC↑PLT↓ accounted for 49.5%, followed by HB↓WBC↓PLT↓ accounted for 18.0%. The positive detection rate of blasts in the patients from peripheral blood smears was 92.9%; the positive detection rate of erythroblast in the patients was 17.3%. Blasts in peripheral blood (%) were positively correlated with blood routine WBC and bone marrow blasts (%); Erythroblast in peripheral blood (%) were negatively correlated with blood routine HB; Peripheral blood erythroblast (%) was positively correlated with the bone marrow erythroblast (%), and these correlations were statistically significant (P＜0.05). Conclusion The blasts can be detected in the vast majority (92.9%) of AL in peripheral blood at the time of initial diagnosis. Erythroblasts can be detected in a small number of patients (17.3%), and peripheral blood blasts are correlated with the blood routine and bone marrow cells. The classification of peripheral blood cells is of great significance for the diagnosis of AL and for the reduction of missed diagnosis.