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To investigate the expression of CD47 molecules in patients with newly diagnosis of adult acute myeloid leukemia (AML) and its correlation with clinical prognosis.20 patients with acute myeloid leukemia diagnosed in Shanghai Fengxian District Central hospital from April 2020 to October 2021 and 5 cases with non malignant hematological diseases in the control group were collected, and the expression of CD47 in single nuclear cells of bone marrow and peripheral blood was detected by real-time fluorescence quantitative polymerase chain reaction (qPCR). Combined with the blood image, bone marrow smears, flow cytometry, chromosome and gene detection, ECOG score, etc. during the patient's initial diagnosis, the relationship between the patient's prognosis and CD47 was evaluated.The expression of CD47 in bone marrow (P=0.0115) and peripheral blood mononuclear cells (P=0.0069) in new diagnosis AML patients was significantly higher than that of controls. In bone marrow mononuclear cells, the total survival time of patients with high CD47 expression was less than that of CD47 low expression patients (P=0.036). There was statistical significance in difference stratification group (P=0.012), but there was no statistical significance between CD47 expression and survival time in peripheral blood mononuclear cells (P=0.116). There were no statistical significance between bone marrow mononuclear cell CD47 expression and gene mutation fusion genes related to leukemia , CD34The high expression of bone marrow mononuclear cell CD47 in AML patients indicates poorer survival and higher risk of recurrence.CD47分子在初诊成人急性髓系白血病患者中的表达及与临床预后的相关性.探讨CD47分子在初诊成人急性髓系白血病（AML）患者中的表达及其与临床预后的相关性.选择2020年4月-2021年10月上海市奉贤区中心医院诊断明确的AML患者20例，另5例非恶性血液病患者作为对照组。实时荧光定量聚合酶链式反应（qPCR）检测骨髓、外周血单个核细胞CD47的表达。结合患者初诊时血象、骨髓涂片、流式细胞术、染色体及基因检测、ECOG评分等情况，评价患者预后与CD47表达的关系.与对照组比较，初诊AML患者骨髓（P=0.0115）及外周血单个核细胞（P=0.0069）中CD47表达明显升高。在骨髓单个核细胞中，CD47高表达患者总的生存时间短于CD47 低表达患者（P=0.036），不同危险分层患者的生存率差异有统计学意义（P=0.012），但在外周血单个核细胞中CD47表达高、低的患者生存时间比较差异无统计学意义（P=0.116）。骨髓单个核细胞CD47表达高低组在白血病相关基因突变、存在融合基因、CD34骨髓单个核细胞CD47在AML患者中表达升高，提示更差的生存和更高的复发风险.

To analyze the clinical characteristics, diagnosis and prognostic factors of bone marrow necrosis (BMN) patients, aim to avoid misdiagnosis, missed diagnosis or delayed treatment.The clinical data of 51 BMN patients treated in the Affiliated Hospital of Xuzhou Medical University from January 2010 to December 2017 were retrospectively analyzed. The types of primary disease, etiology, clinical manifestations, laboratory tests, radiological findings, treatment outcomes and prognostic factors were summrized, and the reasons for misdiagnosis were analyzed.Among 51 BMN patients, the hematologic tumor was detected out in 32 patients; solid tumors caused- BMN was detected out in 14 patients, benign lesions for 5 patients. The time of interval from the appearance of symptoms to the confirmation of BMN was 7 days to 6 months, with a median of 35 days. Misdiagnosis and missed diagnosis occurred in 25.5% of the BMN patients. Anemia was found in all of the 51 BMN patients, fever accounted for 58.8%, systemic bone pain for 52.9%, bleeding for 29.4%, lymphadenectasis for 37.3%, and hepatosplenomegaly for 19.6%. Leukoerythroblastic anemia accounted for 84.3%, bicytopenia for 51.0%, pancytopenia for 25.5%, and monocytopenia for 23.5%. The serologic test revealed no specific results. The first bone marrow aspiration were 38 patients and multi-site puncture were 7 patients. The diagnostic coincidence rate of bone marrow smear was 88.2%. Among 51 BMN patients, 41 patients received bone marrow biopsy, and the diagnostic coincidence rate of bone marrow biopsy was 75.6%. The abnormal signals were found in multiple vertebral bodies by spinal/pelvic MRI scan in 13 BMN patients; PET-CT scan revealed a diffuse pattern of low FDG uptake in the bone marrow in 16 patients, with a local increase in FDG uptake accompanied by bone marrow involvement. For 46 patients with BMN combined with malignancies, among which 35 patients died (76.1%) and the median survival time was 25 days. Among the 32 patients with hematologic tumors, early death occurred in 12 patients, BMN disappeared in 11 out of 20 patients received active chemotherapy for the primary disease, 9 patients died within 1 week to 3 months. Fourteen patients combined with bone marrow metastatic carcinoma died within 2 weeks to 3 months. Focal necrosis disappeared in 4 out of 5 BMN patients secondary to non-malignant diseases after symptomatic supportive treatment and still alived. Multiple logistic regression was performed to analyze factors affecting the prognosis of BMN patients, the result showed that the prognosis of BMN was closely related to the factors of primary disease (benign and malignant). The reasons for misdiagnosis and missed diagnosis were as follows: hidden onset of the primary disease, nonspecific symptoms, insufficient understanding and alertness of the physicians regarding the primary clinical characteristics and hematological abnormalities, and failure to receive multiple sites bone marrow punctures or bone marrow biopsies.BMN usually occurs concomitantly to hematologic tumors and bone marrow metastases from solid tumors. Its prognosis is closely related to the nature and severity of the primary disease and its own severity. In the clinic, BMN should be suspected in patients with severe bone pain, fever, hepatosplenomegaly, hemocytopenia, lymphadenectasis and leukoerythroblastic anemia. Bone marrow puncture at multiple positions and bone marrow biopsy can compensate for each other in the diagnosis of BMN. The combined use of the two methods can improve the diagnostic coincidence rate of BMN, and the positive rate of the etiological diagnosis of BMN.骨髓坏死患者的临床特点、预后因素及误诊分析.分析骨髓坏死（BMN）患者的临床特征、诊断及预后，避免误诊、漏诊或延误治疗。.回顾性分析2010年1月至2017年12月徐州医科大学附属医院收治的51例BMN患者的临床资料，总结其原发病种类、病因、临床表现、实验室检查及影像学表现、治疗转归及预后影响因素，并对误诊原因进行分析。.51例BMN患者中，原发病为血液肿瘤32例，实体肿瘤所致骨髓转移癌14例，良性病变者5例。患者从出现症状到确诊BMN的时间为7 d-6 个月，中位时间为35 d。25.5% BMN患者存在误诊和漏诊。51例BMN患者中，贫血占100%，发热占58.8%，全身骨痛占52.9%，出血占29.4%，淋巴结肿大占37.3%，肝脾肿大占19.6%。幼红-幼粒细胞贫血占84.3%，二系细胞减少占51.0%，全血细胞减少占25.5%，单系细胞减少占23.5%。血清学检查无特异性。1次骨髓穿刺确诊者38例，多部位穿刺确诊者7例，骨髓涂片的诊断符合率为88.2%。51例患者中，41例行骨髓活检，骨髓活检的诊断符合率为75.6%。13例BMN患者脊柱/骨盆MRI显示多发椎体异常信号，16例患者的PET-CT显像示骨髓弥漫性摄取FDG低下，骨髓浸润时伴局部摄取增高。46例合并BMN恶性疾病的患者中，35例死亡（76.1%），中位生存期为25 d。32例血液肿瘤患者中，12例早期死亡，20例针对原发病积极化疗后，11例BMN消失，9例于1周-3个月内死亡。14例骨髓转移癌合并BMN患者于2周-3个月内死亡。5例继发于非恶性疾病的BMN患者，4例经对症支持治疗，坏死灶消失，现仍存活。对BMN患者预后的影响因素进行多因素Logistic回归分析，结果显示，BMN预后与原发病因素（良恶性）密切相关。 误、漏诊主要原因：原发病隐匿，症状无一定规律，对主要临床特点和血液学异常缺乏认识和警惕性，未及时行多部位骨髓穿刺和骨髓活检等。.BMN主要伴发于血液肿瘤及实体瘤骨髓转移，其预后与原发病性质及本身危重性密切相关，临床上对剧烈骨痛、发热、肝脾淋巴结肿大、血细胞减少伴幼红-幼粒细胞贫血者，应高度警惕BMN的存在。多部位骨髓穿刺和骨髓活检可相互弥补各自不足，二者联合检查可以提高BMN诊断符合率和病因诊断阳性率。.