高铁负荷对免疫相关性全血细胞减少症骨髓造血功能影响的研究

Study of the effect of iron overload on the bone marrow hematopoietic function in immuo-related pancytopenia patients

目的了解高铁负荷对免疫相关性全血细胞减少症(IRP)骨髓造血功能的影响。方法抽取天津医科大学总医院2009年7月至2010年2月收治的46例IRP患者骨髓4～5mL,进行红细胞集落生成单位、爆式红细胞集落生成单位、粒细胞-单核细胞集落生成单位骨髓祖细胞培养,并将其按血清铁蛋白高低分成2组,比较2组骨髓祖细胞培养情况、血象、骨髓象、输血情况及疗效。结果高铁组IRP患者3类集落数[(43.33±17.74)/105BMMNC、(1.50±2.20)/105BMMNC、(11.06±5.83)/105BMMNC]均显著低于铁正常组[(77.43±40.64)/105BMMNC、(9.57±7.99)/105BMMNC、(21.25±11.41)/105BMMNC](P<0.01);高铁组外周血红蛋白、红细胞[(65.0±18.67)g/L、(1.97±0.55)×109/L]、骨髓粒系、红系所占比例[(29.69±9.57)%、(18.44±17.18)%]以及骨髓增生程度、治疗后总有效率(44.4%)均显著低于铁正常组[(84.25±27.56)g/L、(2.41±0.77)×109/L、(42.30±15.76)%、(34.14±19.64)%、75.0%](P<0.05),而红细胞和血小板输注量(P<0.05)明显高于铁正常组。结论高铁负荷可能降低IRP患者骨髓造血功能,临床上应动态监测血清铁蛋白。

Objective To study the effect of iron overload on the bone marrow hematopoietie function on immuo-related pancytopenia（IRP） patients by hematopoietic progenitor cell （ HPC ） culture of bone marrow （ BM ）. Methods BM liquid 4 - 5 mL was taken from 46 IRP patients of General Hospital Tianjin Medical University from July 2009 to February 2010 to detect colany-forming-unit of erythroeyte, blast-forming-unit of erythrocyte and colony-forming-unit of granulocyte-monocyteby HPC culture of BM. And according to the serum ferritin（SF） level, these patients were classified into 2 groups to compare HPC proliferation, blood cell counts, BM proliferation, blood transfusion and treatment effects. Results The mean values of 3 different colonies of IRP patients with high SF level [ （ 43. 33 ±17.74 ）, （ 1.50 ± 2. 2 ）, （ 11.06± 5.83 ）/10^5 BMMNC ] were significantly lower than those of the patients with normal SF level [ （77.43±40. 64）, （9. 57 ±7.99）, （21.25 ± 11.41 ）/10^5BMMNC] （ P 〈0. 01 ）. And the Hb, RBC in peripheral blood [ （ 65.0 ± 18. 67 ） g/L, （ 1.97 ± 0. 55 ）× 10^9/L ], granuloeytes and erythrocytes in BM [ （ 29.69 ± 9. 57 ） %, （ 18.44 ± 17. 18 ） % ], the bone marrow cellularity and the total effective rate （44. 4% ） of IRP patients with high SF level were also lower than those of the patients with normal SF level [ （84. 25±27.56）g/L, （2.41±0. 77 ） × 10^9/L, （42. 30 ± 15.76）%, （34. 14 ± 19. 64）% ,75% ] （P 〈0. 05 ）. However, the units of RBC and PLT transfused of high SF level patients（ P 〈 0. 05 ） were significantly higher than those of the patients with normal SF level. Conclusion Iron overload can reduce the bone marrow hematopoietie function of IRP patients and we should test the SF level dynamically.