目的：探讨骨髓活检采用乙二醇-甲基丙烯酸酯（glycol-methacrylate, GMA）塑胶包埋技术结合巨核细胞免疫标记方法在诊断以单纯血小板减少为表现的骨髓增生异常综合征（myelodysplastic syndrome, MDS）中的应用价值。方法：采用骨髓活检GMA塑胶包埋及巨核细胞免疫标记技术,对47例表现为单纯血小板减少患者的骨髓标本进行病理学分析。结果：8例患者被诊断为MDS,其中3例为MDS伴单系病态造血（myelodysplastic syndrome with single lineage dysplasia,MDS-SLD）,1例为5q-综合征,4例为MDS伴多系病态造血（myelodysplastic syndrome-multilineage dysplasia,MDS-MLD）。8例MDS患者的巨核细胞标志物均为阳性,其中6例的骨髓可见清晰的未成熟前体细胞异常定位（abnormal localization of immature precursors,ALIP）现象,且有3例患者检测到染色体异常。结论：采用骨髓活检塑胶包埋技术,细胞形态可清晰显示,有助于以单纯血小板减少为表现的MDS的诊断,有助于MDS的明确诊断及辅助分型;巨核细胞免疫标记有助于医师辨认小、微巨核细胞等特征性的巨核系病态造血表现,由此可以鉴别以单纯血小板减少为表现的MDS,故2种方法结合在诊断MDS方面具有应用价值。

Objective: To explorethe value of megakaryocyte immunolabeling performed on bone marrow biopsy section embedded in glycol-methacrylate (GMA) plastic in the diagnosis of myelodysplastic syndrome (MDS) with thrombocytopenia. Methods: Bone marrow biopsy samples acquired from 47 patients with thrombocytopenia were processed with glycol-methacrylate (GMA) embedding technique, and megakaryocyte immunolabeling were performed. Results: Bone marrow biopsy plastic embedded technology improved themorphologic diagnosis of MDS, and megakaryocyte immunolabeling enabled identification of the small or micor sized megakaryocyte. Out of the cases examined, 8 were diagnosed as myelodysplastic syndrome (MDS), including 3 cases of myelodysplastic syndrome-single lineage dysplasia (MDS-SLD), 1 case of 5q- syndrome and 4 cases of myelodysplastic syndrome-multilineage dysplasia (MDS-MLD). All of the 8 cases were positive for megakaryocyte markers, and 6 cases of them showed clear abnormal localization of immature precursor (ALIP) in the section, and 3 cases had chromosomal abnormalities detected. Conclusion: Combination of GMA plastic embedded technology and megakaryocyte immunolabeling facilitate the diagnosis of MDS with thrombocytopenia.