| 通过血象变化判断神经母细胞瘤患者骨髓累及情况 |
| 投稿时间：2017-12-06 修订日期：2017-12-14 点此下载全文 |
| 引用本文：彭雄文,沈乐园,王维达,陈跃琼.通过血象变化判断神经母细胞瘤患者骨髓累及情况[J].医学研究杂志,2018,47(10):129-134 |
| DOI：
10.11969/j.issn.1673-548X.2018.10.034 |
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| 中文摘要:目的 神经母细胞瘤患者多为10岁以下儿童，而且骨髓累及率非常高。目前骨髓穿刺或者活检为确诊神经母细胞瘤累及比较有效的方法。但是这两种方法创伤、疼痛偏大，患儿多不配合检查，临床常出现患儿不配合造成骨髓稀释，降低检出率等情况，因此迫切需要一种简单的费用较低的创伤偏低的方法评估或者预测骨髓的肿瘤情况。本研究通过观察神经母细胞瘤骨髓侵犯对外周血象的变化情况，从而指导临床上通过血象变化预测神经母细胞瘤患者骨髓侵犯情况。方法 检测神经母细胞瘤患者未侵犯组、早期侵犯组、中期侵犯组和晚期侵犯组的血象，并相互对比研究及绘制ROC曲线以评价其诊断价值。结果 与神经母细胞瘤骨髓未侵犯组比较，早期侵犯组三系均无明显改变（P>0.05），中期侵犯组红细胞计数、血红蛋白及血小板计数降低，晚期侵犯组三系均降低（P<0.05）。早期侵犯组白细胞计数和红细胞计数减少、贫血及血小板计数升高发生率与未侵犯组比较差异均无统计学意义（P>0.05），中晚期各系变化与未侵犯组比较差异均有统计学意义（P<0.05），发生率有所增加。红细胞计数对神经母细胞瘤中晚期骨髓侵犯的诊断敏感度为90%，特异性为70%，ROC曲线下面积为0.855。结论 神经母细胞瘤早期骨髓侵犯对骨髓无明显抑制作用，中晚期侵犯造成骨髓抑制作用。中期侵犯主要抑制红系和血小板两系，晚期侵犯对骨髓抑制作用使三系均受到抑制。未侵犯组及早期侵犯组的血象特点主要是白细胞计数减少，血小板计数升高及轻中度贫血。中晚期白细胞计数和红细胞计数减少，多见中重度贫血，血小板计数多在正常范围。红细胞计数对神经母细胞瘤中晚期骨髓侵犯具有诊断价值。 |
| 中文关键词:神经母细胞瘤 血象 骨髓侵犯 |
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| Diagnosis of Bone Marrow Involvement in Patients with Neuroblastoma by Blood Changes |
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| Abstract:Objective The majority of patients with neuroblastoma are children under 10 years old, and the rate of involvement of bone marrow is very high. Current bone marrow aspiration or biopsy is a more effective method for diagnosis of neuroblastoma. However, children do not cooperate with the examination, because these two methods of trauma,pain is too large.In clinical case,it often occurs that the children do not cooperate with bone marrow aspiration or biosphy resulting in bone marrow dilution,lower detection and other conditions.Therefore, there is an urgent need for a simple,low-cost,low-wound method to assess or predict the bone marrow tumor condition. Methods In this study, by observing the changes of peripheral blood images of bone marrow invaded by neuroblastoma, we can guide the clinical prediction of the bone marrow invasion of neuroblastoma patients through the change of blood picture. Methods The blood samples of patients with neuroblastoma in noninvasive group, early aggressive group, intermediate aggressive group and late aggressive group were detected and compared with each other and the ROC curve was drawn to evaluate its diagnostic value. Results Compared with the noninvasive bone marrow group of neuroblastoma, there were no significant changes in three lines of the early invasion group (P>0.05). But the levels of erythrocyte, hemoglobin and platelet in the middle invasion group were lower than those in the neuroblastoma group,while the three lines in the late invasion group decreased(P<0.05).The incidence of leukocyte,erythrocyte reduction and the incidenceof anemia and platet increase were no statistically significant campared with the noninvasion group (P>0.05),but the difference of the changes of the middle and late group three lines have statistical significance(P<0.05) campared with the noninvasion group and the incidence increased. The diagnostic sensitivity of erythrocytes to advanced neuroblastoma was 90%, the specificity was 70%, and the area under the ROC curve was 0.855. Conclusion The early bone marrow invasion of neuroblastoma has no significant inhibitory effect on the bone marrow, and the invasion of the late stage leads to the bone marrow suppression. Medium-term violations mainly inhibit erythroid and platelet two lines, advanced violations of bone marrow suppression so that the three lines were inhibited. Non-violation group and early violations of blood group characteristics are mainly leukopenia, thrombocytopenia and mild to moderate anemia. In the late leukocyte and erythrocyte reduction, more common in severe anemia, platelets more in the normal range. Red blood cell count of neuroblastoma in advanced bone marrow invasion has diagnostic value. |
| keywords:Neuroblastoma Hematological Marrow invasion |
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