血清铁蛋白与骨髓增生异常综合征危险度分层和预后的关系分析

Clinical Significance of Serum Ferritin in Risk Stratification and Prognosis Evaluation of Patients with Myelodysplastic Syndromes

目的 探讨血清铁蛋白水平在骨髓增生异常综合征（MDS）患者中危险度分层及预后评估的临床意义。方法 对41例初诊MDS患者和30名健康对照者采用电化学发光免疫法测量血清铁蛋白（SF）,观察MDS患者SF水平及与国际预后评分系统（IPSS）的关系。对MDS患者进行随访,根据铁蛋白水平和IPSS评分的数值绘制ROC曲线,并将患者分组分为相对低危组（SF〈577ng/m L）和相对高危组（SF≥577ng/m L）,比较两组间白血病转化率和生存时间。结果 MDS组患者铁蛋白水平明显高于健康对照组（P〈0.05）,相对低危组与相对高危组之间铁蛋白水平差异有统计学意义（P〈0.05）,随访的39位患者中共12人转化为急性白血病,两组转化率分别为10.5%和45.5%,向白血病转化的中位时间分别为18.5（4~46）个月和30.0（6~48）个月,差异有统计学意义（P〈0.05）,两组间生存时间差异无统计学意义（P〉0.05）。结论 铁蛋白在MDS患者中高于正常水平,初诊未输血的患者存在铁过载,高危类型MDS患者的SF水平较高,SF水平与其不良预后有一定的相关性。

Objective To explore the clinical significance of serum ferritin （SF） in risk stratification and prognosis evaluation in patients with myelodysplastic syndromes （MDS）. Methods SF was measured by electrochemiluminescence immunoassay in 41 MDS patients and 30 healthy subjects. The relationship between SF level and the International Prognostic Scoring System （IPSS） was investigated. All patients were followed up and divided into two groups （ SF 〈 577ng/mL and S ~〉 F577ng/mL） according to the receiver operating characteristic curve （ROC curve）, which is drawn according to the relationship between SF level and the International Prognostic Scoring System （IPSS）. The conversion ratio of MDS transformed into leukemia and the survival time were compared between the two groups. Results The SF level of MDS patients was significantly higher than that of healthy subjects （ P 〈 0. 05 ）, and the SF level showed statistical significance between the relatively low-risk group and the relatively high-risk group （ P 〈 0.05 ）. Twelve cases progressed to acute leukemia out of 39 followed up MDS patients. The leukemic conversion rates were 10.5% and 45.5% of the two groups. The median times of leukemic conversion were 18.5 （4-46） months and 30 （6-48） months （P 〈 0.05 ）. But the survival time between the relatively low-risk group and the relatively high-risk group had no significant difference （ P 〉 0. 05 ）. Conclusion MDS patients without transfusion have iron overload. The level of serum ferritin in the high-risk group is higher than that of the low-risk group and the control group. The level of serum ferritin is indicated to be correlated with prognosis to some degree.