血清学指标联合骨髓形态学分析对骨髓增生异常综合征的预后判断价值

Prognostic Values of Serological Index Combined with Marrow Morphology in Myelodysplastic Syndrome

目的 探讨骨髓增生异常综合征（MDS）患者外周血平均红细胞体积（MCV）、血清乳酸脱氢酶（LDH）、β2-微球蛋白（β2-MG）、铁蛋白、维生素B12（VitB12）联合骨髓形态学分析对疾病预后的判断价值.方法 回顾性分析我院2006年9月-2012年7月收治的152例MDS患者初诊时的血清学指标和骨髓形态学的特点,采用单因素和多因素分析检验上述指标与生存期的关系,进一步联合应用筛选出的影响因素对152例患者重新进行预后评价.结果 152例MDS患者死亡68例（44.7%）,中位生存期12个月.单因素分析显示,血清LDH、β2-MG、铁蛋白水平,骨髓3系病态造血及多核红细胞、假pelger核、淋巴样小巨核细胞、单圆核巨核细胞的病态造血表现为生存期的影响因素.外周血MCV、VitB12及其他病态造血表现与生存期无关（P＞0.05）.多因素Cox回归分析显示铁蛋白、假pelger核、淋巴样小巨核细胞为MDS国际预后评分系统（IPSS）预后分组的独立危险因素.联合应用上述生存期影响因素对本组患者进行预后积分（独立危险因素积1.0分,其余生存期影响因素积0.5分）,积分分值与IPSS预后分组呈正相关（r=0.626,P＜0.001）.根据积分（0～1.5分,2.0～3.5分,≥4.0分）将患者分为3组,各组生存曲线比较,差异有统计学意义（Log-rankχ2=101.870,P＜0.001）.结论 联合应用血清 LDH、β2-MG、铁蛋白水平与骨髓3系病态造血、多核红细胞、假pelger核、淋巴样小巨核细胞、单圆核巨核细胞的骨髓病态造血形态学分析对MDS患者预后判断有较高的临床价值.

Objective To study the prognostic value of laboratory parameters including mean corpuscular volume （MCV）, serum lactate dehydrogenase （ LDH）, 2 - microglobulin （ β2 - MG）, serum ferritin （ SF）, Vitamin B,2 （ VitB, ） combined with marrow morphological analysis in patients with myelodysplastic syndrome （MDS）. Methods The serological in- dexes and features of marrow morphology of 152 MDS patients visiting this hospital from September 2006 to July 2012 were ana- lyzed retrospectively. Univariate and multivariate analyses were used to study the relationship between the above indexes and sur- vival, and further the screened prognostic indexes used to reassess patients＇ prognoses. Results Sixty - eight MDS patients died （44. 7% ）, with a median survival of 12 months. By univariate analysis, the levels of serum LDH, β2 - MG and SF, tri - line- age myelodysplasia and multinucleated erythrocytes, false pelger nucleus, lymphoid small megakaryocytes, single round nuclear megakaryocyte dysplasia were influencing factors of survival. Peripheral MCV, serum VitB12 and other dysplasias were not related to survival （P 〉 O. 05 ）. By multivariate Cox regression analysis, SF, false pelger nucleus, lymphoid small megakaryocytes were independent risk factors of MDS International Prognostic Scoring System （IPSS） prognoses. The above survival influencing factors were used combinedly to score patients＇ prognoses （ independent risk factors scored 1.0 point, the other factors scored O. 5 points）, the scores were positively correlated with IPSS （ r = 0. 626, P 〈 0. 001 ）. The patients were divided, based on the scores, into 3 groups （0 - 1.5 points, 2.0 -3.5 points, 4. 0 points）, there was significant difference in survival in 3 groups（ Log - rank 2 = 101. 870, P 〈 0. 001 ）. Conclusion Combined use of LDH, 132 - MG, SF and marrow morphology analysis is of great clinical value for prognostic judgment of MDS patients.