免疫表型对骨髓增生异常综合征早期诊断应用研究

Study on immuno-phenotype in early diagnosis of myelodysplastic syndrome

目的探讨免疫异常表型对骨髓增生异常综合征（MDS）早期诊断价值。方法选用多种单克隆抗体，用流式细胞测定分析仪，对98例MDS、100例良性血液患者（贫血、粒细胞减少症、血小板减少性紫癜、感染等）的骨髓细胞免疫表型进行测定分析研究。结果MDS89．3％以上有二系或三系免疫表型异常，其中CD7、CDl9、CDl3、CDl4、CD33、CD34、HLA—DR免疫标志改变明显，明显高于正常对照组（P〈0．01）；髓系抗原表达明显增高，而且随MDS进展恶化，FAB亚型抗原表达出现规律性变化，RA—RAs—RAEB-向RAEB-T转化，较早期髓系抗原表达（如CDl3、CD33）逐渐增加，而较晚期髓系抗原表达（如CD15、CD24）逐渐减少；同时伴淋系抗原表达逐渐减少；骨髓干细胞／祖细胞表面抗原（如CD34、HLA-DR），随着MDS恶化发展，有逐渐明显增加异常表现，而且CD34、HLA-DR早期抗原表达增高者，常常预后较差，易于转化成白血病。结论MDS患者骨髓细胞免疫异常表型，有利于MDS早期诊断及鉴别诊断，并对治疗、预后判断有重要指导价值。

Objective To research the immuno-phenotype＇s significance in the classification and differentiation of myelodysplastic syndrome（MDS）. Methods The immuno-phenotype of bone marrow cells was detected in 98 patients with MDS and 100 patients with benign hematological disease. Results More than 89.3% MDS patients had anormality in 2 or 3 lineages of immuno-- phenotype,among which CD7,19,13,14,33, 34, HLA-DR changed most great- ly,higher than normal （P~ 0. 01 ）. Myeloid series antigens were significantly increased. They showed the relular change with the progress of illness. RA-RAS increased, CD15,24 and lympho-linaege antigen decreased step by step. High level CD34, HLA-DR indicated poor prognosis and such MDS tend to transfer into leukemia. Conclusion Anormal immnophetotype of MDS is valuable for diagnosis.