原发性骨髓纤维化的骨髓形态及临床效果观察

张壮儒　林楚怀　杨永怀

[摘要] 目的 探析沙利度胺治疗原发性骨髓纤维化的骨髓形态及临床效果观察。 方法 临床选择2007年8月～2010年5月本院收治的原发性骨髓纤维化患者60例，根据随机数字表法分为对照组和观察组，每组30例，全部患者均予以羟基脲疗法，观察组在此基础上予以沙利度胺疗法，两组均治疗半年，比较两组治疗前后的脾脏大小、肝脏大小、血小板计数、血红蛋白计数、白细胞计数等指标变化水平；评估观察组的入院时骨髓象、治疗1年后骨髓象、治疗3年后骨髓象、治疗5年后骨髓象变化。 结果 两组治疗后的脾脏大小、肝脏大小、血小板计数、血红蛋白计数、白细胞计数等指标变化水平均有改善，但观察组治疗后的脾脏大小、肝脏大小、血小板计数、血红蛋白计数、白细胞计数等指标变化水平显著优于对照组，差异有统计学意义（P<0.05）。 结论 沙利度胺治疗原发性骨髓纤维化可作用于巨核细胞，可显著改善患者的临床状态，临床效果确切，值得临床推广。

[关键词] 临床观察；沙利度胺；原发性骨髓纤维化；骨髓形态

[中图分类号] R551.3 [文献标识码] B [文章编号] 2095-0616（2016）09-131-03

[Abstract] Objective To explore and analyze the clinical effect observation of thalidomide on treating the bone marrow morphology of primary myelofibrosis. Methods 60 patients with primary myelofibrosis in clinical from August 2007 to May 2010 in our hospital were divided into control group and observation group according to random number table method，30 cases in each group.The whole patients received hydroxyurea treatment，and the observation group also received thalidomide therapy.After 6 months' treatment of the two groups，the index change levels of the size of spleen，size of liver， platelet count，hemoglobin count， white blood cell count etc in before and after treatment were compared among the two groups.In the observation group，the myelogram changes of on admission， after 1 year's treatment，after 3 years' treatment and after 5 years' treatment were evaluated. Results After treatment，in the two groups，the index change levels of the size of spleen，size of liver，platelet count，hemoglobin count，white blood cell count etc all improved，but those index change levels of the observation group were significantly better than those of the control group，the differences had statistical significance （P<0.05）. Conclusion The thalidomide on treating primary myelofibrosis acted on megakaryocyte，which could greatly improve the patient's clinical state， have obvious clinical effect and be worthy of clinical promotion.

[Key words] Clinical observation；Thalidomide；Primary myelofibrosis；Bone marrow morphology

原发性骨髓纤维化属于骨髓增殖性肿瘤，是造血干细胞的克隆性疾病，与原发性血小板增多症、真性红细胞增多症、慢性粒细胞白血病等并列[1]。原发性骨髓纤维化存在肝脾肿大，可见泪滴样红血细胞，临床特征为髓外造血、骨髓纤维组织增生、贫血。大量研究表明，沙利度胺治疗原发性骨髓纤维化观察骨髓形态发现沙利度胺可作用于巨核细胞，可显著改善患者的临床状态，临床效果确切[2]。探析原发性骨髓纤维化应用沙利度胺治疗对骨髓形态改变的影响及临床效果十分重要，故临床选择2007年8月～ 2010年5月本院收治的原发性骨髓纤维化患者进行沙利度胺治疗，效果满意，现报道如下。……