目的 探讨PI-PLCβ1的表达水平在骨髓增生异常综合征(myelodysplastic syndromes,MDS)发病过程中的意义.方法 采用骨髓形态学和细胞遗传学分析,选取初诊确诊的典型MDS 30例,复诊确诊的不典型MDS 10例;用荧光定量PCR的方法检测40例MDS和10例正常骨髓中PI-PLCβ1的表达水平.结果 初诊确诊MDS和复诊确诊MDS的PI-PLCβ1表达水平低于正常对照组(P＜0.05);不同分型的MDS中,高危组PI-PLCβ1表达水平低于低危组(P＜0.05).结论 在早期MDS的诊断及MDS的临床预后中,检测PI-PLCβ1的表达水平有重要的应用价值.

Objective To investigate the significance of C-reactive protein(CRP) expression in patients with diffuse large B lymphoma(DLBCL) and its relationship with prognosis.Methods 91 cases of DLBCL patients in our hospital were selected, and the healthy subjects were selected in the same period of time.The concentrations of CRP in all subjects were measured by enzyme-linked immunosorbent assay(ELISA) in 87 cases.Results The expression level of CRP in patients was DLBCL(24.03 + 6.92) mg/L.Compared to healthy people(6.59 + 2.87) mg/L, it increased significantly.When compared the control group and the different pathological stages of CRP levels, there was a statistically significant difference(P<0.05), and with the level increased with clinical stage increased.The high expression rate in patients with CRP chemotherapy was 44.83%, and the low expression of CRP group was 77.27%.There were significant differences between groups χ2=31.728, P<0.05.The serum CRP level in control group were lower than that of GCB group and NGCB group, while the GCB group was lower than in NGCB group, and the difference between groups was statistically significant(P<0.05).Conclusion CRP detection can effectively reflect the different types, stages and severity of disease in patients with DLBCL disease which can help to estimate the disease changes and prognosis.

Objective To explore the effect of karyotype analysis in the etiological diagnosis of pancytopenia .Methods Karyotype analysis was performed in 229 patients with pancytopenia using the direct method , 24-hour culture method and C-banding technique .Results In 229 cases of pancytopenia patients , aplastic anemia and megaloblastic anemia were without chromo-somal abnormalities , 77 cases of pancytopenia with chromosomal abnormalities were malignant diseases .Conclusion The karyotype analysis can help to diagnose the cause of pancytopenia , especially for the etiological diagnosis of pancytopenia without enough bone marrow blasts and obvious morbid hematopoiesis .

Objective To comparatively analyze the diagnostic value of marrow aspirate and biopsy in pancytopenia and the common causes that lead to the pancytopenia.Methods The conventional position was choosed for marrow aspirate,firstly bone marrow for smears was aspirated with the aspirate needle,then a good core of marrow for biopsy was obtained with the biopsy needle 2 mm far away,lastly the results of the marrow smears and biopsy specimen about 500 pancytopenia cases were comparatively analyzed.Results Through the comprehensive analysis of marrow aspirate and marrow biopsy,the causes of the 495 cases were defined out of 500.Compared with the simple marrow aspirate smear,the diagnostic rate improved by 40.6%,and three most possible causes were 200 cases of aplastic anemia(40%),110 cases of myelodysplastic syndrome(22%),40 cases of acute leukemia(8%),respectively.Conclusion The combination of marrow aspirate and marrow biopsy can further reflect the hematopoiesis of the marrow cells,define the etiology and improve the diagnostic rate.The diseases of hematopoietic system are the common causes of pancytopenia,but the pancytopenia caused by other diseases cannot be ignored.

Objective To explore the value of karyotype analysis in myelodysplastics syndrome(MDS) for diagnosis,treatment and prognosis.Methods The karyotype analysis was performed for 83 patients with MDS using the direct method,24-hour culture method and C-banding technique.Results Among 83 patients,46 cases were found with abnormal karyotype.The abnormal rate was 55.4%.Abnormal chromosomes mainly showed +8,5q-,-7,7q-,20q-and other abnormalities in quantity or structure.The patients with complicated chromosomal abnormalities tended to acute leukemia.Six cases without significant morphological dysplasia in preliminary diagnosis were found clonal chromosomal abnormalities.Conclusion The karyotype analysis is very important for early diagnosis,early treatmeant and prognosis of MDS.

Objective To investigate the significance of immunophenotypic characteristics of myeloma cells in patients with multiple myeloma(MM).Methods The expression of CD56,CD117,CD138 on myeloma cells in 17 MM patients were examined by a direct immunofluorescent straining technique and analyzed by 3-colour flow cytometry.Results Among 17 patients with MM,13(76.47%)had positive CD56 expression on myeloma cells,5(33.33%)had positive CD117 expression,and 4(44.44%)had positive CD138 expression;Expression of CD56,CD117,CD138 antigens was not positive correlated with the proportion of MM cells in morphology in bone marrow;There was some relation between CD117 and the level of anemia of patients,and it was more serious when CD117 was negative;But there was no relation between CD56 and the level of anemia;There was no relation between the expression of CD56,CD117 and different stages,therapeutic effect,anemia,osteoclasia either.It was discovered in the analysis of the relation between the expression and the type of M protein that among 4 patients with CD56 negative,there were 3 patients were all unsecretion type.Conclusion The immunophe notye of myeloma cells has its own characters.There is some relation between the expression of these antigens and the clinical manifestation of MM patients.

Objective To study the diagnostic significance of synchronism observation on both marrow biopsy and marrow smear in hematological diseases.Methods The marrow samples of 650 patients with hematological diseases were detected by peripheral blood smear,bone marrow biopsy and bone marrow smear.Those sections and smears were observed.Results Bone marrow biopsy showed the hyperplasia of bone cells more accurately and had a higher checkout rate of the malignant cells.Biopsy prefered to smear in the diagnosis of diseases such as lymphoma,myelofibrosis,myelodysplastic syndrome,metastatic carcinoma of bone marrow and multiple myeloma.Conclusion Bone marrow biopsy and bone marrow smear synchronous observation can effectively increase the diagnosis rate,decrease misdiagnosis rate, and judge correctly the stage of the disease.

Objective To further study the clinical features and results of cell/tissue morphology of myelodysplastic syndrome(MDS) associated with myelofibrosis(MDS-MF).Methods New patients blood roution,bone marrow,bone marrow biopsy were used in new patients and used Gomori method to judge-degnee of fibrosis.Results There was significant difference between the age 、HGB、PLT of MDS-MF and MDS not associated with Myelofibrosis(P<0.05),MDS-MF had obvious clinical manifestation.Most of MDS-MF patients Gomori's stain showed"+++ "positive.Conclusion MDS-MF may be a distinct clinical pathological entity which needs to be distinguished from other MDS subtype as well as from idiopathic myelofibrosis.

Objective To study the clinical features and results of bone marrow biopsy of secondary myelofibrosis(SMF). Methods The Gomori method was used to judge if the patients had MF or were not SMF patients. Results The most important etiology of 80 SMF cases were malignant disease of hematological system(87. 5% ),among them CMPD were most important (32. 5% ). The level of reticulin fiber were from+ + ～+ + + . The level of HGB and PLT in SMF patients had obviously compared with those in IFM patients(P 0. 05). Conclusion bone marrow biopsy may be used to intinal malignant disease of hematological system patients,and survey the condition of patients,judge if the patients had MF or not early,and the outcome of patients.

1 病例介绍 例1，男，23岁。1997年12月5日因高热、寒战、干咳、盗汗4月收入院。该患者发热以下午为重，体温在38℃～40.3℃之间。经多种抗生素治疗无效，每日用解热镇痛药。体格检查：体温：39℃，脉搏：120次／min，呼吸：18次／min，血压：15.96／9.31kPa。一般状态差，消瘦(4月体重约下降10kg)，贫血外观、巩膜无黄染，咽不红，扁桃体无肿大，心肺未见异常，肝脾肋下未触及，双下肢无水……

患者女,56岁.2000年8月22日因胸部及腰骶部骨痛3个月,乏力1周住院.该患3个月前无明显诱因出现胸部疼痛,深呼吸及咳嗽时加重.1个月前在哈尔滨市两家大医院检查,经CT诊断为胸骨占位性病变,未予治疗.患者胸痛加重,且出现腰骶部疼痛,活动受限,行走困难.

患者,女,56岁,2000年8月25日以骨痛伴头昏乏力入院.该患无明显诱因全身骨痛 ,持续性,无明显规律,呈酸胀感,游走性,痛时活动受限,伴发热,体温38℃左右,无齿龈出血、鼻出血、皮肤粘膜出血点,7月到当地医院就诊,诊断为"股骨头坏死”,给予丹参、黄芪治疗,但因对全身骨痛不能解释,不能确诊及治疗,症状无法缓解.

2000年1月我院门诊确诊一例急性淋巴细胞白血病伴嗜酸粒细胞增多(ALLEo)的患者,因病例罕见和细胞形态特殊,故报告如下: