骨髓增生异常综合征(MDS)免疫表型研究

Study of immuno-phenotype of myelodysplastic syndrome

[目的]探讨免疫异常表型对骨髓增生异常综合征(MDS)分型诊断及鉴别诊断价值。[方法]选用多种单克隆抗体,用流式细胞测定分析仪,对79例MDS、70例良性血液病人(贫血、粒细胞减少症、血小板减少性紫癜、感染)的骨髓细胞免疫表型进行测定分析。[结果]MDS 89.3%以上有二系或三系免疫表型异常,其中CD19、CD13、CD14、CD33、CD34、HLA-DR免疫标志变化最大,明显高于正常对照组(P<0.01)。髓系抗原表达明显增高,而且随MDS进展恶化。FAB亚型抗原表达出现规律性变化:RA→RAS→RAEB→向RAEB-T转化。较早期髓系抗原表达(如CD13、CD33)逐渐增加,而较晚期髓系抗原表达(如CD15)逐渐减少;同时伴淋系抗原表达逐渐减少;骨髓干细胞/祖细胞表面抗原(如CD34、HLA-DR),随着MDS恶化发展,有逐渐明显增加异常表现,而且CD34、HLA-DR早期抗原表达增高者,常常预后较差,易于转化成白血病。[结论]MDS病人骨髓细胞免疫异常表型,有利于MDS诊断、分型诊断及鉴别诊断,并对治疗、预后判断有重要指导价值。

[ Objective ] This work is to research the immuno -phenotype significance in the classification and differentiation of Myelodysplastic Syndrome （MDS）. [ Methods ] The immuno - phenotype of bone marrow cells was detected in 79 patients with MDS and 70 patients with benign hematological disease. [ Results] More than 89.3% MDS patients had abnormality in 2 or 3 lineages of immuno - phenotype, among which CD19, 13, 14, 33, 34, HLA - DR were changed most greatly （P 〈 0.01 ）. Myeloid series antigens were significantly increased. They showed the regular change with the progress of illness. From RA to RAS, from RAS to RAEB, from RAEB to RAEB -T . CD15 and lympho -linaege antigen decreased step by step. High level CD34, HLA - DR indicated poor prognosis and such MDS tended to convert into leukemia. [ Conclusion] Abnormal immuno - phenotype is valuable for diagnosis of classification and differentiation of MDS. It is important to test abnormal immuno - phenotype to guide the treatment and predict prognosis of MDS.