EB病毒编码的小RNA检测在噬血细胞综合征骨髓活检中的意义

目的 探讨噬血细胞综合征骨髓活检样本病理改变特点及与EB病毒(EBV)感染的关系，以及EBV编码的小RNA(EBER)检测技术在噬血细胞综合征骨髓样本检测中的价值。方法应用HE、免疫组织化学EnVision二步法、EBER原位杂交技术，观察51例噬血细胞综合征患者骨髓活检样本形态学改变及噬血现象，并检测EBV潜在膜蛋白1(LMP-1)、EBER及其他相关标志。结果51例噬血细胞综合征患者中，49.0％(25/51)可见骨髓腔内造血细胞丰富，27.5％(14/51)各系造血细胞增生情况与本年龄段相符，23.5％(12/51)造血细胞减少和分布稀疏，较相同年龄患者应有的骨髓造血细胞减少明显。43.1％( 22/51)可以见到噬血现象。91.4％(32/35)见增生细胞表达CD68/KP-1,89.5％( 17/19)增生细胞表达CD68/PG-M1，提示单核细胞增生明显。所有病例进行EBER检测，51.0％( 26/51)阳性，41例同时进行LMP-1和EBER检测，其中46.3％(19/41)EBER阳性，而LMP-1全部阴性(Fisher精确概率法，P= 0.000)。结论噬血细胞综合征患者骨髓活检组织可以见到造血细胞增生减低及噬血现象。病理形态学的噬血现象有时较难判定，借助于免疫组织化学检测组织细胞的增生很有意义。同时，采用EBER检测EBV对诊断的意义大于检测LMP-1。

Significance of detection of EBV-encoded mRNA on bone marrow biopsy tissues of hemophagocytic syndrome

Objective To investigate the diagnostic significance of different pathology techniques (Immunohistochemistry and ISH) to detect EBV on bone marrow biopsy tissues of hemophagocytic syndrome. Methods Histological,immunohistochemical and in situ hybridization were used to study the hemophagocytic features and expression of LMP-1, EBER and other markers. Results 25 out of 51 cases (49.0 ％) showed an active proliferation growth pattern while other 12 cases (23.5 ％) demonstrated a deterioration morphological character compared with their same age group. The left 14 cases (27.5 ％) showed a normal myeloproliferative pattern. 91.4 ％ (32/35) expressed CD68/KP-1 and 89.5 ％ (17/19) cases expressed CD68/PG-M1, which showed an abnormal increase of monocytes. 26 out of 51 cases (51.0 ％) were positive for EBER, while EBER and immunohistochemistry on LMP-1 were detected simultaneously in 41 cases. The EBER were positive in 19 cases (46.3 ％) but none for LMP-1 (P =0.000). Conclusion Hypoplasia or hemophagocytic features could be detected on bone marrow biopsy tissues of hemophagocytic syndrome, which might be slightly difficult to diagnose. So immunohistochemistry would be essential. Meanwhile, the detection of EBER is more helpful than LMP-1 for diagnosis.