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G-CSFR、GM-CSFR的表达和意义

Expression of G-CSF and GM-CSF Receptors on CD34 Positive Cells in Aplastic Anemia and Myelodysplastic Syndrome patients and Its Significance

本研究探讨再生障碍性贫血(AA)和骨髓增生异常综合征(MDS)患者骨髓CD34+细胞表面粒细胞集落刺激因子受体(G-CSFR)和粒-巨噬细胞集落刺激因子受体(GM-CSFR)的表达。分离27例AA患者、45例MDS患者和20例正常对照者的骨髓单个核细胞(BMMNC),用流式细胞术观察BMMNC中CD34+细胞比率和CD34+细胞表面G-CSFR、GM-CSFR表达率与外周血中性粒细胞数的关系。结果发现,CD34+细胞比率在AA组显著低于对照组,MDS组显著高于对照组,AA组显著低于MDS组,骨髓增生异常综合征-难治性贫血伴原始细胞增多(MDS-RAEB)组显著高于骨髓增生异常综合征-难治性贫血(MDS-RA)组或对照组,MDS-RA组显著高于AA组(p均<0.05);MDS-RA组与对照组无显著性差异(p>0.05)。各组BMMNC中CD34+细胞表面G-CSFR表达率在AA组、对照组、MDS组、MDS-RA组及MDS-RAEB组均无显著性差异(p均>0.05)。各组BMMNC中CD34+细胞表面的GM-CSFR的表达率在AA组与对照组无显著性差异(p>0.05),MDS组显著高于对照组或AA组(p均<0.05),MDS-RA组与MDS-RAEB组无显著性差异(p均>0.05)。SAA患者BMMNC中CD34+细胞的比率显著低于CAA患者(p<0.05),AA患者CD34+细胞表面的G-CSFR和GM-CSFR表达率与诊断时外周血中性粒细胞计数均无相关性(r=0.058和r=0.044);MDS患者BMMNC中的CD34+细胞的比率与诊断时外周血中性粒细胞数没有相关性(r=-0.335),其CD34+细胞表面的G-CSFR和GM-CSFR表达率与诊断时外周血中性粒细胞数亦无相关性(r=0.064和r=0.051)。结论:AA及MDS患者骨髓CD34+细胞占BMMNC的比率及其表面G-CSFR、GM-CSFR的表达率的测定有助于二者的诊断和鉴别诊断。

This study was aimed to detect the ratio of CD34^＋ cells in bone marrow mononuclear cells （BMMNCs） and the expression rate of G（M）-CSFR on CD34^＋ cells in bone marrow of the patients with aplastic anemia （AA） and myelodysplastic syndrome （MDS）. The ratio of CD34^＋ cells in BMMNCs and the expression rate of G （M）-CSFR on cells of 27 AA patients, 45 MDS patients and 20 controls were detected by flow cytometry （FCM）. The results showed that the ratio of CD34^＋ cells in BMMNCs of AA patients reduced and was significantly different from controls （p 〈 0.05 ）, the ratio of CD34^＋ cells in MDS patients elevated and was significantly different from controls （p 〈 0.05）. Compared with controls and MDS-RA patients, the ratio of CD34^＋ cells in MDS-RAEB patients significantly elevated （p 〈 0.05）, but there was no significant difference between MDS-RA patients and controls （p 〉 0.05 ）. The ratio of CD34^＋ cells in MDS-RA patients was significantly higher than that in AA patients （p 〈 0.05）. There was no significant difference in expression rate of G-CSFR on CD34^＋ cells between AA patients and controls, MDS patients and controls,AA patients and MDS patients, MDS-RA patients and MDS-RAEB patients （p 〉 0.05）. The expression rate of GMCSFR in MDS patients was significantly higher than that in AA patients and controls （p 〈 0.05 ）, but there was no significant difference between AA patients and controls, MDS-RA patients and MDS-RAEB patients （p 〉 0.05）. In APt patients, the ratio of CD34^＋ cells in BMMNCs was less than 0.1% accounts for 6/8 SAA patients, compared with 2/19 in CAA （p 〈 0. 05 ）. There was no correlation between the expression rate of either G-CSFR or GM-CSFR and neutrophil count at diagnosis （r = 0. 058 and r = 0. 044 ）. In MDS patients, there was no correlation between bone marrow CD34^＋ cells ratio and peripheral neutrophil count at diagnosis （ r = - 0. 335 ）. And there was no correlation between the expression of either G-CSFR or GM-CSFR and neutrophil count on diagnosis （ r =0. 064 and r =0. 051 ）. It is concluded the detection of CD34^＋ cells and their surface expression rate of G（M） -CSFR in AA and MDS is useful in diagnosis and differentiatial diagnosis of these two diseases.