抗凋亡治疗骨髓增生异常综合征

Patients with myelodysplastic syndrome in Anti-apoptosis treatment

目的：探讨抗凋亡治疗骨髓增生异常综合征（MDS）的疗效及疗效和骨髓细胞凋亡、TNF-α的关系。方法：采用形态学方法检测骨髓细胞凋亡；ELISA方法检测骨髓单个核细胞（BMMC）培养后上清液中TNF-α浓度。用己酮可可碱、环丙沙星和地塞米松（PCD）联合治疗MDS。结果：抗凋亡治疗MDS有效率48.15％（13/27），1例难治性贫血（RA）完全缓解（3.7％），3例RA（11．1％）血液学三系明显进步。3例PCD联合治疗持续10～54个月的RA，疗效维持10～36个月。抗凋亡治疗有效的患者治疗前TNF-α浓度和骨髓细胞凋亡指数较无效患者高，但这种差异无统计学意义（P〉0．05），有效的患者治疗后的TNF-α和骨髓凋亡细胞指数较治疗前下降。结论：抗凋亡治疗适用于BMMC上清液TNF-α浓度和骨髓凋亡细胞指数较高的MDS患者，尤其适用于低危MDS患者。

Objective：To evaluate the effect of anti apoptosis therapy on MDS patients and the correlation among the effect, TNF-α as well as bone marrow cells apoptosis. Method： BMMC of MDS patients were cultured for 4 hours in vitro, and then the apoptosis of the BMMC was detected by morphological analysis. The concentration of TNF-α in the supernatant of cultured BMMC from MDS patients was measured by ELISA. MDS patients were treated by pentoxifylline, ciprofloxacin and dexamethasone together. Result：The response rate of MDS treated by antiapoptosis therapy was 48.15%（13/27）, 1 case of RA （3.7%） showed complete remission. 3 cases of RA （11.1%） had trilingage major response in hematology. The three patients with RA who had persisted in the treat ment for 10～54 months had a response remained without relapse for 10～36 months. Responders had higher levels of TNF-α and higher numbers of apoptotic cell in bone marrow than nonresponders, but the difference had no statistical significance （ P 〉0.05）. After treatment the levels of TNF-α and the apoptotic rates declined in responders. Conclusion： Anti-apoptosis therapy is an effective treatment for the patients with MDS, especially for those who are in early stage with higher levels of TNF-α in BMMC supenatant and with higher rate of apoptosis.