骨髓增生异常综合征的生物学特性和预后因素的研究

Biological Characteristics and Risk Factors for Prognosis of Myelodysplastic Syndrome

目的:探讨骨髓增生异常综合征(MDS)的生物学特性和预后的危险因素,重点研究不同染色体核型及免疫表型与MDS预后的联系。方法:收集本院近5年60例MDS患者临床及实验室资料,建立详细资料档案,并采用骨髓短期培养和G显带技术对60例患者进行染色体核型分析;采用流式细胞术检测其免疫表型(CD10,CD13,CD15,CD7,CD34,CD117);应用SPSS 19.0软件包进行数据处理,结合WHO2008分型及IPSS-R积分对MDS进行分组。结果:60例MDS患者中极低危12例,极高危7例;染色体异常35例(58.33%),其中5号、7号、8号、20号、Y染色体异常及复杂核型染色体所占比例分别为22.89%、20.0%、17.14%、11.43%、5.71%及14.29%;转化为白血病的正常核型占8.0%,转化为白血病的异常核型分别为复合核型占80%、8号占66.67%、7号占71.43%、5号占75.0%;极高危组MDS患者的髓系细胞表面的非成熟抗原标记CD13、CD33及CD117表达明显比极低危组MDS患者的高(P<0.05),而髓系细胞表面的成熟抗原标记CD15表达率则明显比极低危组MDS患者的低(P<0.05),极高危组淋巴系细胞表面抗原标记CD7、CD10表达率明显低于极低危组(P<0.05)。结论:染色体核型及免疫表型对MDS患者的预后产生重要影响。

Objective： To investigate the biological characteristics and risk factors for prognosis of patients with myelodysplastic syndrome（ MDS）,to emphatically study the correlation of different chromosome karyotype and immune phenotype with the prognosis of MDS patients. Methods： All clinical data of 60 patients diagnosed as primary MDS over a period of 5 years were collected and compared. The bone marrow short-term culture and G banding technique were used to analyze the chromosome karyotypes of 60 patients,the flow cytometry was used to detect the immune phenotypes（ CD10,CD13,CD15,CD7,CD34,CD117）. SPSS 19. 0 software was applied to deal with all data,the WHO2008 classification and IPSS-R score were used for grouping of MDS. Results： There were 12 cases of low-risk,and 7 cases of high-risk in 60 patients with MDS; 35 out of 60 patients（ 58. 33%） showed karyotypic abnormalities. The proportion of 5,7,8,20,and Y chromosome abnormality were 22. 89%,20. 0%,17. 14%,11. 43% and 5. 71%,respectively,complex chromosome karyotype accounted for 14. 29%. The percentage of normal karyotype transformed into leukemia was 8. 0%,the percentage of other abnormal karyotype transformed into leukemia respectively was 80% for complex karyotype,66. 67% for 8 chromosome abnormality,71. 43% for 7 chromosome abnormality,75. 0% for 5 chromosome abnormality. The expression rate of immature myeloid cell surface antigen markers（ CD13,CD33,CD117） in high-risk group of patients with MDS significantly higher than that in low-risk group（ P〈0. 05）. And the expression rate of mature myeloid cell surface antigen markers（ CD15） in high-risk group was significantly lower than that in low-risk group（ P〈0. 05）. The expression rate of lymphoid cell surface antigen markers（ CD7,CD10） in high-risk group was lower than that in low-risk group（ P〈0. 05）. Conclusion： Chromosome karyotypes and immune phenotypes have great influence on the prognosis of patients with MDS.