骨髓增生异常综合征免疫表型的研究

Immunophenotyping in myelodysplastic syndromes

目的评价免疫表型测定在骨髓增生异常综合征（ＭＤＳ）诊断及预后判断中的价值。方法应用一组单克隆抗体采用免疫荧光法对３２例ＭＤＳ患者骨髓单个核细胞（ＭＮＣ）进行免疫表型检测。结果ＭＤＳ患者髓系抗原表达明显增高，淋巴细胞抗原表达相对减少，而且随ＭＤＳ恶化，ＦＡＢ亚型的抗原表达出现规律性变化，随ＲＡ／ＲＡＳ向ＲＡＥＢ再向ＲＡＢＥｔ转化，较早期的髓系抗原（如ＣＤ１３、ＣＤ３３）逐渐增加，较晚期出现的髓系抗原逐渐减少，同时伴有Ｔ淋巴细胞抗原表达减少；ＲＡ／ＲＡＳ阶段骨髓ＣＤ３４＋细胞与正常组相比无显著增高，ＲＡＥＢ和ＲＡＥＢｔ阶段ＣＤ３４＋细胞数明显增高；较早期骨髓细胞（即祖细胞）表面抗原ＣＤ３８、ＨＬＡＤＲ、ＣＤ９９Ｒ、ＣＤ９在ＭＤＳ表达明显增加。ＣＤ３４和其它早期抗原表达增高者，预后较差，易于转化为白血病。结论ＭＤＳ患者骨髓ＭＮＣ表面标记的检测有利于ＭＤＳ的诊断，也可协助预后判断。

Objective To evaluate the values of immunophenotyping in the diagnosis and prognosis of myelodysplastic syndromes(MDS). Methods Surface markers of mononuclear marrow cells were analyzed by indirect immunofluorescence for a panel of monoclonal antibodies in 32 patients with MDS. Results Expression of myeloid antigen increased significantly while lymphoid antigen decreased. The antigen expression was correlated with the FAB subtype of MDS, Immature myeloid cells (CD 13 +,CD 33 +) was being increased and the lymphoid antigen expression decreased with the RA/RAS evolving to RAEB and RAEB t.Compared with normal marrow, the number of CD 34 + cells was not significantly different in RA/RAS subtypes but significantly higher in RAEB/RAEB t subtypes. The expression of early marrow cell antigens(CD 38 ,HLA DR,CD 99R and CD 9) was significantly increased. The expression of CD 34 and other early antigen was predictive for transformation and poor survival. Conclusion Surface marker analysis of mononuclear marrow cells may be a useful tool for the diagnosis and prognosis of MDS.