细胞免疫表型对确定骨髓增生异常综合征髓系病态的作用

The Significance of Immunophenotype on the Evaluation of Myeloid Dysplasia in MDS Patients

目的探讨细胞免疫表型分析在确定骨髓增生异常综合征(MDS)患者是否存在髓系细胞异常中的价值。方法以具有外周血一系以上血细胞减少、且骨髓原始细胞数<5%的患者为研究对象,以免疫性血小板减少患者为对照,回顾性分析流式细胞术中患者骨髓髓系细胞的免疫表型,观察粒细胞群和单核细胞群SSC强度是否异常,是否存在抗原跨阶段表达、抗原跨系列表达和分化抗原表达异常,并与细胞形态学粒系病态造血的结果进行比较。结果在符合研究条件的255例患者中,有127例确定诊断为低危MDS、95例为非MDS,另有33例为意义未明血细胞减少(ICUS)。在MDS患者中,髓系免疫表型异常的检出率(85.8%)显著高于形态学病态造血检出率(57.5%)(P=0.000);在非MDS患者中,具有髓系免疫表型异常的比例(1.1%)显著低于形态学病态造血比例(4.2%)(P=0.042);ICUS患者虽然形态学无病态造血,但48.5%的患者具有髓系免疫表型异常。结论细胞免疫表型分析对髓系异常的确定,有助于MDS的早期诊断和鉴别诊断。

Objective To investigate the significance of immunophenotype on the evaluation of myeloid dysplasia in patients with myelodysplastic syndromes （MDS）. Methods Immunophenotype of myeloid cells in bone marrow of patients with cytopenia（s） and blast cells less than 5% were retrospectively analyzed by flow cytometry. Immunophenotype of patients with immune thromboytopenia were selected as the control. The abnormal myeloid immunophenptypes included abnormal sideward light scatter intensity, asynchronous antigen expression, cross-lineage antigen expression and abnormal pattern of the differentiation antigens. The results of immunophenotype were compared with morphology of myeloid cells. Results Among the total 255 cases, 127 patients were diagnosed as low-risk MDS ,95 patients were non-MDS ,and 33 patients were idiopathic cytopenia of undetermined significance （ICUS）. In MDS patients, the rate of abnormal immunophenotype （85.8%）was significantly higher than morphological dysplasia （57.5%） （P = 0. 000）. In non-MDS patients, the rate of abnormal immunophenotype （1. 1% ） was significantly lower than morphological dysplasia （4.2%） （P = 0.042）. In ICUD patients without morphological dysplasia, abnormal immunophenotype could be detected in 48.5% patients. Conclusion Abnormal immunophenotype of myloid cells is helpful to early diagnosis anddifferential diagnosis of MDS.