11例急性巨核系白血病患者巨核细胞的超微结构分析.doc

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1、11例急性巨核系白血病患者巨核细胞的超微结构分析作者：茹永新，赵轼轩，刘津华，秘营昌，竺晓凡，王慧君，王建祥【摘要】为了研究急性巨核细胞白血病患者骨髓中幼稚巨核细胞的超微结构特点，根据电子显微镜观察结果，回顾性分析11例急性巨核白血病患者骨髓巨核细胞的形态结构和血小板过氧化物酶（PPO）表达情况。结果表明：11例中7例例巨核细胞直径在20μm以内，其中2例细胞直径10-15μm，PPO阳性率50%以上，大部分细胞外形规则，大小均匀，表面突起少，核不规则，核质比大，胞浆颗粒细小，分界膜发育不完全，管道排列无规律；5例巨核细胞直径20

2、μm左右，PPO阳性率在8%-22%之间，核呈圆形或马蹄形，异染色质不等，其中3例无幼稚分界膜和致密颗粒，2例偶见。11例中5例细胞直径在20-40μm之间，PPO阳性率16%-80%，大细胞表面有不规则突起，核质比不等，核不规则，异染色质多，核仁不明显，胞质有成熟分界膜结构、管道系统和成熟α颗粒。结论：大部分患者巨核细胞以Ⅰ期分化阶段为主，少数病例伴有少量Ⅱ、Ⅲ期细胞；相同或不同患者骨髓中未成熟巨核细胞的发育程度存在差异。【关键词】急性巨核细胞白血病UltrastructuralCharacteristicsofMegakar

3、yocytesin11PatientswithAcuteMegakaryocyticLeukemiaAbstractThepurposeofstudywastoinvestigatetheultrastructuralfeaturesofleukemicmegakarocyte(LMK)inpatientswithacutemegakaryocyticleukemia(M7).AnalyzingtheultrastructurecharacteristicsofLMKandpositiveratioofplateletperoxi

4、des(PPO)in11patientswithM7wereanalyzedonbasisoftransmissionelectronmicroscopicobservationretrospectively.TheresultsshowedthatthediameterofLMKin7outof11caseswaslessthan20μm,in2casesofthem,theLMKdiameterwasfrom10to15μmandtheirPPOpositiveratiowasmorethan50%,mostLMKdispla

5、yedregularshape,lessprotrusions,irregularnucleus,highnuclear/cytoplasmratio,tinygranules,undevelopeddemarcationmembranesystem(DMS)andirregulartubulesincytoplasm;in5outofthose7casesthediameterofLMKwasabout20μm,PPOpositivecellcountwasfrom8%to22%,mostshowingroundorhorses

6、hoenuclei,moreorlessheterochromatin,noDMSandgranuleswerefoundinLMKin3casesand2casesoccasionally.Inother5outof11cases,thediameterofLMKwasfrom20to40μmandPPOpositiveratiowasfrom16%to80%,inwhichsmallerLMKsweresimilartothoseinformercasesinshape,andthelargerLMKhadirregularp

7、rotrusions,5variednuclear/cytoplasmratio,moreheterochromatin,prominentnucleolus,someofthemcontaineddevelopedDMS,tubulesandαgranules.ItisconcludedthatmostpatientswithM7arepredominantofLMKinstageIandminoritycontainedLMKinIIorIIIstagesimultaneously.Thedifferentiationde

8、greesofLMKaredifferentinindividualandvariouscases.Keywordsultrastructure;acutemegakaryocyticleukemia;differentiationJExpHema