骨髓增生异常综合征患者骨髓CD34＋细胞亚群及其表面造血因子受体的表达

Differentiation and expression of membrane hemopoietic cytokine receptors on CD34＋ bone marrow cells in patients with myelodysplastic syndromes

目的探讨骨髓增生异常综合征（MDS）患者骨髓CD34＋细胞亚群及其表面干细胞因子受体（SCF－R）、红细胞生成素受体（EpoR）、粒细胞集落刺激因子受体（G－CSFR）及血小板生成素受体（TpoR）的表达情况及其意义。方法采用流式细胞术检测2008年7月至2010年3月天津医科大学总医院新诊断的45例MDS患者（17例低危患者、28例高危患者）及30名对照组原代骨髓CD34＋CD38＋及CD34＋CD38＋细胞亚群及其表面SCF－R、EpoR、G．CSFR及Tp0R的表达率。结果高危组CD34＋细胞比例[0．53％（0．10％～1．68％）]明显高于对照组[0．13％（0．08％～0．32％），P〈0．01]，其他2组问比较差异无统计学意义。低危组和高危组CD34＋CD38＋细胞比例（86．3％±8．5％、82．6％±11．1％）显著低于对照组（92．3％±3．4％，均P〈0．05），而CD34＋CD38＋细胞比例（13．7％±8．5％、17．4％±11．0％）显著高于对照组（7．7％±3．4％，均P〈0．05）。对照组骨髓CD34＋CD38＋细胞亚群EpoR表达率（18．7％±18．3％）显著低于CD34＋CD38＋细胞亚群（63．6％±20．O％，P〈0．01），两亚群之间SCF－R、G－CSFR及TpoR表达率差异无统计学意义。在CD34＋CD38＋细胞亚群中，3组间SCF－R和TpoR表达率差异无统计学意义，而低危组和高危组EpoR的表达率[9．0％（1．4％～12．7％）、5．2％（1．1％～14．1％）]明显低于对照组[9．6％（5．1％～30．1％），均P〈0．05]，G—CSFR的表达率（29．8％4-19．1％、28．7％±21．1％）明显低于对照组（44．4％4-23．4％，均P〈0．05）；在CD34＋CD38＋细胞亚群中，3组间SCF－R和G－CSFR表达率差异无统计学意义，低危组和高危组EpoR的表达率（42．2％±21．9％、25．7％±15．6％）明显低于对照组（63．6％±20．O％，均P〈0．01），TpoR的表达率（5．4％±4．7％、4．1％±4．0％）明显低于对照组（10．1％±8．3％，均P〈0．05）。MDS患者骨髓CD34＋CD38＋和CD34＋CD38＋细胞亚群表面受体表达率低的患者其外周血血红蛋白水平、中性粒细胞及血小板计数减低的发生率明显高于受体表达率不低的患者（均P〈0．05）。结论MDS患者的原代骨髓CD34’细胞亚群分化异常，膜表面部分造血细胞因子受体表达减低，这可能与MDS患者血细胞减少有关，有望用于辅助诊断MDS。

Objective To detect the abnormalities of differentiation and expression of membrane hemopoietic cytokine receptors on CD34＋ bone marrow cells in patients with myelodysplastic syndromes （MDS）. Methods Forty-five newly diagnosed MDS cases from July 2008 to March 2010 in our hospitaland 30 normal controls were enrolled. There were 17 low-risk and 28 high-risk patients. The CD34 ＋ CD38 ＋ and CD34 ＋ CD38- bone marrow cells and the expressions of stem cell factor receptor （SCF-R）, erythropoietin receptor （ EpoR ）, granuloeyte colony-stimulating factor receptors （ G-CSFR ） and thrnmbopoietin receptor （TpoR） on those cells were measured by flow eytnmetry. Results The mean percentage of CD34＋ in karyocyte of MDS eases in high-risk patients [0. 53% （0. 10% - 1.68% ） ] was significantly higher than that of control group [ 0. 13% （0. 08% - 0. 32% ）, P 〈 0. 01 ]. The mean percentages of CD34 ＋ CD38 ＋ cells were significantly lower in low and high-risk groups （86. 3% ± 8.5% and 82. 6% ± 11. 1% ） than those in control group （92. 3% ± 3.4% ）. And the percentage of CD34 ＋ CD38- cells was significantly higher in either low-risk or high-risk group （ 13.7% -＋ 8. 5% and 17.4% -＋ 11.0% ） than that in control group （7.7% ± 3.4% , both P 〈 0. 05 ）. In control group, the mean percentage of antigen expression of EpoR was significantly lower in CD34＋ CD38 ＋ cells than that in CD34＋ CD38＋ cells （ 18.7%± 18.3% vs 63.6% ± 20. 0% , P 〈 0. 01 ）. The expressions of SCF-R, G-CSFR and TpoR were not significantly different between two cell populations. The expressions of EpoR on CD34 ＋ CD38 ＋ cells of low and high-risk MDS groups [9. 0% （ 1.4% - 12. 7% ）, 5.2% （ 1.1% - 14. 1% ） ] were significantly lower than those of control group [9. 6% （5.1% -30. 1% ）, both P 〈0. 05]. The expressions of G-CSFR on CD34＋CD38＋ cells of low and high-risk MDS groups （29. 8% ± 19. 1% , 28. 7%± 21. 1%） were significantly lower than those of control group （44. 4%±23.4%, both P 〈0. 05）. The quantities of EpoR on CD34 ＋CD38＋ cells of low and high-risk MDS groups （42.2% ±21.9%, 25.7%± 15.6%） were significantly lower than those of control group （63.6% ±20. 0% , both P 〈0. 01 ）. The expressions of TpoR on CD34 ~ CD38- cells of low and high-risk MDS groups （5.4% ± 4.7%, 4. 1% ± 4. 0%） were significantly lower than those of control group （ 10. 1% ±8.3% , both P 〈 0. 05 ） . The incidence of cytopenia with low expression rates of hemopoietic cytokine receptors on CD34＋ cells was higher than that of MDS with high expression rates. Conclusion The abnormalities of differentiation and membrane hemopoietie cytokine receptors expression of CD34＋ bone marrow cells in MDS are associated with MDS cytopenia and may be useful for the diagnosis of MDS.