摘要目的:总结弥漫大B细胞淋巴瘤（DLBCL）细胞形态特征，探讨该特征和骨髓中瘤细胞数量对疾病预后的影响。方法:回顾性研究。收集2020年1月1日至2022年8月26日于郑州大学第一附属医院初诊确诊为DLBCL且骨髓涂片形态学资料完整者79例。筛选本院同期30例未侵犯骨髓的初诊DLBCL患者作为对照，年龄58（30，82）岁。采用涂片法、活检法、流式细胞术等对患者的骨髓进行检测，比较3种方法对于骨髓中DLBCL的检出率，研究涂片中DLBCL形态特征与患者临床特征、流式细胞术参数之间的关系，并分析骨髓涂片中检出DLBCL及其数量在预后中的价值。采用Logistic回归分析骨髓涂片是否检出DLBCL细胞与患者年龄、临床分期、结外受累器官数的相关性，多因素Cox回归分析DLBCL及其数量对患者预后的影响。结果:（1）初诊侵犯骨髓时，DLBCL细胞在骨髓活检、骨髓涂片、流式细胞术中的阳性率分别为4.86%（87/1 790）、5.14%（92/1 790）和9.27%（166/1 790）。（2）初诊DLBCL骨髓涂片形态特征为：多见胞体≥2倍体积的淋巴细胞，形态各异、圆形或类圆形或不规则形，可见伪足或突起；胞浆量多中等，可见空泡、少部分可见核周淡染区；胞核形态各异，圆形或类圆形或不规则形，以1个为主、少部分可见多核，染色质细致疏松，多数核仁中等或大而明显，核仁以1~2个为主，少部分3个以上；部分DLBCL可见浆质体和噬血现象，少部分可见瘤细胞聚集现象，偶见病理性分裂象。（3）骨髓涂片是否检出DLBCL细胞与患者年龄、临床分期、结外受累器官数呈正相关（β=2.012、2.754、2.028， P<0.05）；骨髓涂片中瘤细胞大小与CD4/CD8比值呈正相关（β=2.545， P<0.05），瘤细胞胞浆空泡与其表达CD38呈负相关（β=-2.465， P<0.05），瘤细胞伪足与其表达CD38呈负相关（β=-3.045， P<0.05）。（4）骨髓涂片存在DLBCL细胞是影响无进展生存期的独立危险因素（ RR=7.059， P<0.05），也是影响总生存期的独立危险因素（ RR=5.409， P<0.05）。 结论:DLBCL细胞形态各异，骨髓涂片中出现DLBCL细胞可作为预后判断的指标，其瘤细胞数量变化可用于临床分期。

abstractsObjective:To summarize the morphological characteristics of diffuse large B-cell lymphoma (DLBCL) cells and investigate the prognosis value of the characteristics and the number of DLBCL cells in bone marrow.Methods:Retrospective study. We collected 79 cases newly diagnosed with DLBCL in the First Affiliated Hospital of Zhengzhou University from January 2020 to August 2022. 30 cases newly diagnosed without bone marrow involvement were selected as controls, whose mean age 58 years (30-82 years). The DLBCL cells were evaluated by the bone marrow smear, biopsy and flow cytometry separetely.The detection rate of DLBCL cells in the bone marrow was compared, to analyse the relationship between the morphological characteristics of DLBCL in the smear, clinical characteristics and flow cytometry parameters, and the prognostic value of DLBCL detected in the bone marrow smear and its quantity was analyzed. Logistic regression was used to analyze the correlation between the detection of DLBCL cells in bone marrow smears and the age, clinical stage, and the number of extraderules involved organs. Multivariate Cox regression was used to analyze the influence of DLBCL cells detection and its number on the prognosis of patients.Results:(1) The positive rates of DLBCL cells in bone marrow biopsy, bone marrow smear and flow cytometry were 4.86%, 5.14% and 9.27% respectively. (2) The morphological characteristics of 79 cases in bone marrow smears were described: more than 2 times the volume of the cell body of the lymphocyte, the shape was different, round or quasi-round or irregular shape, can be seen pseudopodia or protrusion; The volume of cytoplasm was moderate, vacuoles were visible, and a few perinuclear areas were visible. The nucleus were different in shape, round or quasi-round or irregularly shaped, with a majority of them having multiple nuclei and a few of them having delicate and loose chromatin. Most nucleoli were medium or large obviously, with a majority of them having 1-2 nucleoli and a few having more than 3.Sergiosomes and hemophagocytosis were observed in some DLBCL cases, tumor cell aggregation phenomenon was observed in a few DLBCL cases, occasionally pathological mitosis.(3) DLBCL cells in bone marrow smear was positively related to the age of patients, clinical stage and the number of extranodal organs involved(regression coefficient were 2.012, 2.754, 2.028, P<0.05);The volume of DLBCL cells in bone marrow smear was positively correlated with the ratio of CD4 and CD8(regression coefficient is 2.545, P<0.05);The vacuoles in cytoplasm and the pseudopod of tumor were both negative relationship with the quantity of CD38 expressed on DLBCL cells(regression coefficient was -2.465, -3.045, P<0.05); (4) DLBCL cells in bone marrow smear was an independent risk factor for PFS and OS( RR=7.059, P<0.05); RR=5.409, P<0.05). Conclusion:The appearace of DLBCL cells in bone marrow smear with prognosis, and could be used for clinical staging.