再生障碍性贫血和骨髓增生异常综合征患者骨髓CD34^+细胞及其粒细胞集落刺激因子受体的研究

Study on the ratio of CD34 positive cells and granulocyte colony stimulating factor receptor on CD34 positive cells in bone marrow of the patients with aplastic anemia and myelodysplastic syndrome

目的:检测再生障碍性贫血(AA)和骨髓增生异常综合征(MDS)患者CD34+细胞占骨髓单个核细胞(BMMNC)的比率及其表面粒细胞集落刺激因子受体(G-CSFR)的表达率。方法:用流式细胞术(FCM)检测13例AA、22例MDS及12例非血液病患者CD34+细胞占BMMNC的比率及其表面G-CSFR的表达率。结果:AA组与对照组、AA组与MDS组、MDS-难治性贫血(RA)组与难治性贫血伴原始细胞增多(RAEB)组BMMNC中CD34+细胞的比率比较差异有统计学意义(P<0.05),但G-CSFR的表达率差异无统计学意义(P>0.05)。多数重型AA(SAA)患者(3/4)及少数慢性AA(CAA)患者(1/9)BMMNC中的CD34+细胞少于0.1%。多数G-CSFR表达率低(<14%)的患者(7/9)外周血中性粒细胞减少;而表达率正常(14.0%~28.9%)的患者(1/6)很少见;表达率高(>28.9%)的患者(3/7)也可存在中性粒细胞减少。结论:造血干细胞减少是AA的主要发病机制之一,其表面G-CSFR的表达率不是影响AA的主要因素;MDS患者CD34+细胞比率升高是一个预后不良的指标,G-CSFR的检测可部分解释MDS患者外周血中性粒细胞减少的原因。

Objective：To detect the ratio of CD34 positive cells in bone marrow mononuclear cells and the expressive rate of granulocyte colony-stimulating factor receptor（G-CSFR） on CD34 positive cells in bone marrow of the patients with aplastic anemia （AA） and myelodysplastic syndrome（MDS）. Method：The ratio of CD34 positive cells in bone marrow mononuclear cells and the expressive rate of C,-CSFR on cells of 13 AA patients, 22 MDS patients and 12 normal subjects were detected by flow cytometry（FCM）. Result：There was significant difference according to the ratio of CD34 positive cells in mononuclear cells of bone marrow between AA group and control group, AA group and MDS group, MDS-RA group and MDS-RAEB group （P〈0.05） but there was no significant difference according to the expressive rate of G-CSFR on CD34 positive cells. The ratio of CD34 positive cells in mononuclear cells of bone marrow was less than 0.1% in the majority of SAA patients（3/4） while it was seldom less than 0.1% in CAA patients. Most MDS patients（7/9） with low G-CSFR expression had neutropenia of the peripheral blood. Neutropenia was less common in the normal expression group（1/6）, but also occurred in the high expression group（3/7）. Conclusion：The reduction of hematopoletic stem cells is one of the principal pathogenesis of AA , but the expressive rate of G-CSFR on CD34 positive cells in bone marrow isn＇t a main factor. The in- creased ratio of CD34 positive cells in bone marrow of MDS patients may be a poor prognostic indicator. The determination of G-CSFR on CD34 positive cells in bone marrow can partly explain why MDS patients have neutropenia of the peripheral blood.