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临床血液细胞学图谱与应用

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《临床血液细胞学图谱与应用》对广大临床医师,尤其对血液科医师、检验技术和科研人员、医学院校师生均是一本有价值的参考书,可起到推动我国医疗、教学、科研发展和提高的作用。
Content Description

《临床血液细胞学图谱与应用》以发热、贫血、全血细胞减少以及肝大、脾大、淋巴结大为主线,采用细胞形态学、细胞化学染色、血液病理学、血液免疫学、细胞和分子遗传学、分子生物学等技术,结合造血和淋巴组织肿瘤的WHO分类,以图文并茂的形式,将血液细胞诊断广泛应用于临床,为血液病的诊断、鉴别诊断、治疗观察和发病机制等方面提供科学依据。
目前,随着血液病及其相关疾病研究的不断深入,血液病诊断的准确性与诊断方法的应用显得尤为重要。
Author Description

熊树民,1967年毕业于原上海第一医学院(现复旦大学医学院)医疗系。现任上海交通大学医学院附属瑞金医院、上海血液学研究所骨髓细胞形态室主任、主任医师、教授;上海疑难血液病会诊专家组成员。
自1974年始从事血液学临床工作,对血液病的诊断和治疗有丰富的经验。1991年以来重点进行骨髓细胞形态学工作,并与免疫学、细胞遗传学、分子生物学的研究相结合,与研究生课题相结合。尤其在急性早幼粒细胞白血病(APL)细胞形态特点与基因关系的研究中,首先发现APL中M3a、M3b两种亚型分别与该病PMLRARa融合基因转录本L型和S型之问密切相关,为APL病理生理研究提供了有价值的资料;在上海血液学研究所研究氧化砷对APL的作用机制方面,最早提出了砷剂对细胞还有一定分化作用,以后研究证实了砷剂具有凋亡和分化双向作用机制。
主要研究成果有HOAP方案治疗急性非淋巴细胞白血病、氧化砷单用或联合全反式维A酸(all-trans-reetinoic acid,ATRA)治疗急性早幼粒细胞白血病临床及机制研究、白血病诱导分化研究奖等七项;主编及参编《血液肿瘤骨髓诊断图谱》、《白血病MICM分型诊断》等医学专著19种。在国内外医学杂志发表论文70篇。
Catalogue

第一篇 血液细胞检查的临床意义
第一章 造血组织形态学
第一节 血液细胞形态学
第二节 骨髓组织病理

第二章 细胞化学染色
第一节 过氧化物酶染色
第二节 中性粒细胞碱性磷酸酶染色
第三节 过碘酸-希夫染色
第四节 氯醋酸AS-D萘酚酯酶染色
第五节 醋酸AS-D萘酚酯酶染色
第六节 酯酶双染色
第七节 酸性磷酸酶染色
第八节 骨髓铁染色

第三章 血液免疫学
第一节 流式细胞术及其临床应用概述
第二节 骨髓细胞涂片免疫标记
第四章 细胞和分子遗传学
第五章 分子生物学

第二篇 贫血
第一章 造血原料缺乏
第一节 缺铁性贫血
第二节 巨幼细胞贫血

第二章 造血功能障碍
第一节 再生障碍性贫血
第二节 纯红细胞再生障碍
第三节 急性髓细胞白血病
第四节 急性混合细胞白血病

第三章 红细胞破坏过多
第一节 红细胞膜先天异常所致溶血性贫血
第二节 珠蛋白异常所致溶血性贫血
第三节 自身免疫性溶血性贫血
第四节 阵发性睡眠性血红蛋白尿症
第五节 微血管病性溶血性贫血

第四章 其他贫血
第一节 慢性肾性贫血
第二节 肝脏疾病所致贫血
第三节 化学物质所致贫血
第四节 物理因素所致贫血

第三篇 发热
第一章 感染性疾病
第一节 传染性单核细胞增多症
第二节 艾滋病
第三节 伤寒
第四节 全身性真菌病
第五节 疟疾
第六节 黑热病

第二章 肿瘤性疾病
第一节 恶性组织细胞病
第二节 多发性骨髓瘤
第三节 淋巴瘤
第三章 风湿病
第四章 噬血组织细胞综合征

第四篇 血细胞减少
第一章 粒细胞减少和粒细胞缺乏
第二章 血小板减少性紫癜
第三章 全血细胞减少
第一节 骨髓增生异常综合征
第二节 骨髓增生异常/骨髓增生性疾病
第三节 急性骨髓纤维化
第四节 癌细胞骨髓转移
第五节 脾功能亢进
第六节 免疫性全血细胞减少症
第七节 复合因素——阵发性睡眠性血红蛋白尿症

第五篇 肝大、脾大、淋巴结大
第一章 淋巴组织肿瘤
第一节 急性淋巴细胞白血病
第二节 慢性淋巴细胞白血病
第三节 幼淋巴细胞白血病
第四节 毛细胞白血病
第五节 伯基特(Burkitt)白血病/淋巴瘤
第六节 T细胞大颗粒性淋巴细胞白血病
第七节 侵袭性自然杀伤细胞白血病
第八节 成人T淋巴细胞白血病/淋巴瘤
第九节 肝、脾γδ淋巴瘤
第十节 脾边缘区B细胞淋巴瘤
第十一节 套细胞淋巴瘤
第十二节 问变性大细胞淋巴瘤——T/裸细胞,原发系统型
第十三节 血管免疫母细胞T细胞淋巴瘤
第四节 霍奇金淋巴瘤

第二章 骨髓增生性疾病
第一节 Ph染色体[t(9;22)(q34;q11),BCR-ABL]阳性的慢性髓细胞白血病
第二节 慢性中性粒细胞白血病
第三节 慢性嗜酸性粒细胞白血病/特发性高嗜酸性粒细胞综合征
第四节 真性红细胞增多症
第五节 慢性特发性骨髓纤维化
第六节 原发性血小板增多症

第三章 代谢性疾病
第一节 尼曼-匹克病
第二节 戈谢病
第三节 海蓝组织细胞病
Book Abstract

3.其他组织学图像
(1)混杂性浸润:母细胞呈不均匀性浸润,混杂在残留的造血组织中,后者为中幼粒细胞、嗜酸性粒细胞和幼稚红细胞,幼稚红细胞可聚集形成红细胞岛。一般不易见到巨核细胞。
(2)再障型骨髓:骨髓腔内大部分为结构脂肪。在脂肪空泡之间有各种细胞成分,一部分区域为造血成分,其中有典型的母细胞岛。“再障”型的骨髓、“正常”的骨髓和母细胞性骨髓三者的比例在各个病例各不相同。同一病例的不同部位取得的标本,表现也有差别。
(3)长期化疗后继发的白血病常表现为增生正常或增生低下性骨髓,其中有母细胞增多及成熟障碍现象。
4.急性白血病骨髓支架的变化多数急性白血病骨髓支架不受干扰,没有胶原纤维形成。在成片母细胞之间有时可勉强看到被挤压的网状纤维支架。在“再障”型,脂肪空泡之间可见到网状纤维支架。少数患者网状纤维增多,相互吻合。有的淹没在成片的母细胞之中,大多数围绕着扩张的血窦。
5.其他变化
(1)血管的改变:约1/4的活检标本可见到血窦的改变。在成片浸润的母细胞之间,血窦扩张,内层衬有单层肿胀的内皮细胞,这种图像使骨髓看上去很像海绵样。在血窦内可有个别散在的母细胞或成堆的母细胞。这表明血液循环活跃。这种变化与骨髓硬化时血窦扩张的发生机制不同,后者是由于被动牵拉所造成的扩张。
(2)出血和坏死:未经治疗的急性白血病的骨髓中,很少见到出血和坏死,白血病细胞的死亡被认为是启动细胞凋亡程序而进行的,因此缺少坏死的形态学变化。
(二)急性白血病化疗后的变化
急性白血病经化疗后骨髓的组织学变化过程大致如下:初起骨髓的造血组织明显增生,为紧密成片的母细胞,随后转变成完全“再障”型的骨髓图像,以后再恢复到正常图像。
骨髓的组织学变化在化疗后几小时即可见到。虽然各种不同的化疗药物对骨髓造成的影响有程度上的差别,但其基本变化都是坏死和增生低下或不增生。骨髓中成片的母细胞出现核碎裂的变化,最后表现为核溶解,整个细胞变成颗粒状均匀的嗜伊红碎屑。骨髓活检中仅见不均匀性、疏松散在的脂肪细胞、血管、间质成分和扩张的血窦。在治疗成功的病例,随后可见到脂肪组织再生,伴随造血细胞的再生。其中红系最早恢复,但常有异常表现,随后粒系及巨核系也恢复增生。当然不同的治疗方案对骨髓的整个变化过程可有不同的影响。
在部分缓解或治疗无效者,骨髓中有不同程度的残留白血病细胞。残留的白血病细胞与坏死区及再生的正常骨髓交杂存在。有些病例,残存的白血病细胞灶非常小,很难与再生的正常细胞灶相区别,特别是与原红细胞及早幼红细胞很难区别。这需要与治疗前活检中的白血病细胞进行仔细的比较。在治疗完全无效的病例,其骨髓组织学形态可与治疗前完全一样,或仅有散在少量的坏死区存在。
Introduction

血液细胞在血液病中的诊断价值毋庸赘述。血液细胞图谱在国内外已有多种版本,但由于技术的不断进步,对血液细胞的研究内容也在不断拓展,如从光学显微镜到电子显微镜、相差显微镜、干涉显微镜及共聚焦显微镜;“染色”方法从Romanowsky染色到各种酶的细胞化学;对蛋白质的特性多利用其抗原性(用单克隆或多克隆抗体)加以区别,对核酸则利用其序列杂交(原位杂交、原位PCR)或抽提后扩增检测。流式细胞仪的出现陡然使被检测的细胞呈指数级增加,而细胞旋转(cytospin)则可使细胞集中到小范围内。上述的种种方法,其结果均被综合到所谓的积分式诊断。
然而,正由于方法的纷呈复杂,初学者及非专业医师往往难以确定各项结果的“分量”,亦难以掌握取舍。有鉴于此,编者从临床实践出发,按照血液病的临床表现,以发热、贫血、全血细胞减少以及肝大、脾大、淋巴结大为经线,采用细胞形态学、细胞化学、血液病理学、血液细胞免疫学、细胞和分子遗传学、分子生物学等技术作横向联系,再结合造血和淋巴组织肿瘤WHO的最新分类,采用图文并茂的形式,在血液病的诊断、鉴别诊断和发病机制等方面提供了系统而简明的资料,以冀对读者有所帮助。
本书由上海交通大学医学院、上海血液学研究所、上海第二军医大学附属长征医院和长海医院、复旦大学医学院附属中山医院的多位专家共同参与编写。最后由陈赛娟院士、王鸿利教授审阅并修改。
本书从临床症状出发进行血液细胞形态学及其他内容的分析。此种结构的写作在国内外著作中比较少见,不少地方为本书稿新的探索。其目的不仅希望能给临床医师提供细胞学人门的钥匙、为实验室工作者联系临床提供捷径,而且希望有助于进一步推进血液学新技术更深入的开展。由于属初次尝试,不足及错误之处竭诚希望同道及前辈予以指正。

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Jingdong book

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About the brand

Jingdong book