骨髓细胞免疫表型分析在低幼稚细胞骨髓增生异常综合征诊断中的价值

Diagnostic Significance of Immunophenotyping of Bone Marrow Cells in Myelodysplastic Syndrome without an Increase of Marrow Blasts

本研究旨在探讨低幼稚细胞骨髓增生异常综合征(MDS)患者细胞免疫表型特征,确定其在诊断中的价值。应用流式细胞术(FCM)检测222例血细胞减少伴骨髓病态造血、骨髓幼稚细胞数<5%的患者的细胞免疫表型;测定成熟粒细胞群和单核细胞群的抗原跨阶段表达(粒系或单核系CD34或CD117表达或成熟粒细胞群HLADR的表达),抗原跨系列表达(粒系或单核系CD7或CD56表达),CD45/SSC异常(成熟粒细胞群或单核细胞群),分化抗原表达(粒细胞群CD13/CD16和单核细胞群HLA-DR表达缺失);确定阳性结果的敏感性与特异性。结果表明:在222例患者中经临床检测及鉴别诊断,有127例确定诊断为MDS,95例为非MDS(药物性粒细胞减少,自身免疫性血细胞减少及特发性血小板减少)。在成熟粒细胞群抗原跨阶段、跨系列表达,CD45/SSC及抗原分化异常的敏感性分别为31.5%、30.7%、49.6%和60.6%,其特异性分别为100%、100%、88.4%和52.6%。单核细胞群抗原跨阶段、跨系列表达、CD45/SSC及抗原分化异常的敏感性分别为2.3%、11%、37%和12.6%。特异性均为100%。在如上观察的粒细胞群和单核细胞群的8个项目中,≥2项异常的敏感性为77.9%,特异性为95.8%,阳性结果预测值为96.1%。结论:抗原的跨阶段表达、跨系列表达及CD45/SSC异常具有较高的特异性,但敏感性差;而分化抗原异常虽敏感性较高但特异性差。多项表达异常对于MDS的诊断具有较高的诊断特异性及敏感性。

This study was aimed to investigate the characteristics of immunophenotypes in the patients with myelodysplastic syndrome （MDS） without an increase of marrow blasts, and to confirm their diagnostic significance. Marrow cells from 222 patients with pancytonia, dysplastic changes in one or more hematopoietic lineages and blast cells less than 5% were analyzed by multiparametric flow cytometry（FCM）. The abnormal immunophenotypes were evaluated in asynchronous antigen expression （ CD34 or CD117 in mature granulocytes or mature monocytes, HLA-DR in mature granulocytes）, in cross-lineage antigen expression （CD7 or CD56 in granulocytes or monocytes ）, in aberrant light-scatter （CIM5/SSC in mature granulocyte or monocyte） and in abnormal expression of differentiation antigen （CD13/CD16 pattern in granulocytes and HLA-DR under-expression in monocytes）. The sensitivity and specificity of abnormal immunophenotypes were determined on diagnosis. Among 222 cases, 127 cases were diagnosed as MDS by traditional diagnostic method and 95 cases were non-MDS （drug-related neutropenia, autoimmune cytopenia and idiopathic thrombocytopenia）. In mature granulocyte gate, the sensitivity of asynchronous, cross-lineage antigen expression, aberrant lightscatter of CD45/SSC and abnormal expression of differentiation antigen were 31.5% ,30.7% ,49.6% and 60. 6% respectively, and the specificity were 100%, 100% ,88.4% and 52.6% respectively. In monocyte gate, the sensitivity of asynchronous, cross-lineage antigen expression, aberrant light-scatter of CD45/SSC and abnormal expression of differentiation antigen were 2.3% ,11% ,37% and 12.6% respectively. The specificity was 100% in all of them. Among 8 above mentioned items, sensitivity of more than 2 abnormalities was 77.9%, and specificity was 95.8%. The positive predictive value was 96.1%. It is concluded that the abnormal expression of asynchronous, cross-lineage antigen expression, aberrant light-scatter of CD45/SSC have a high specificity and a low sensitivity for diagnosis of MDS. The abnormal expressions of differentiation antigens have a high sensitivity and a low specificity; however, the detection of multiple expression abnormalities possesses the high sensitivity and specificity for diagnosis of MDS.