骨髓增生异常综合征患者血脂代谢特点分析

Serum lipid profile in patients with myelodysplastic syndromes

目的明确骨髓增生异常综合征(MDS)患者血脂代谢特点,并探究血脂水平与疾病类型、危险度分层及疾病状态之间的相关性。方法收集2017年1月至2020年12月在中南大学湘雅医院血液科住院的初诊MDS患者133例、初诊急性髓系白血病(MDS转化)患者13例为疾病组,收集同时期体检健康者140例为对照组。回顾性分析所有研究对象的空腹血脂水平,进行组间和组内对比分析。结果MDS患者的甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)水平明显低于对照组(P<0.05)。不同WHO-MDS分型患者间的TG、TC、HDL及LDL差异无统计学意义(P>0.05)。根据国际预后积分系统(IPSS)、WHO预后积分系统(WPSS)及修正的国际预后积分系统(IPSS-R)进行危险度分层,其中TG水平在不同危险度分层组间差异无统计学意义(P>0.05),而TC、LDL及HDL水平在高危组或极高危组中明显减低(P<0.05),除了LDL在WPSS极高危组中有下降趋势,但差异无统计学意义(P>0.05)。通过去甲基化治疗缓解后的患者的TC及LDL水平较治疗前明显增高(P<0.05);HDL水平较治疗前呈上升趋势,但差异无统计学意义(P>0.05);TG水平较治疗前无明显差异(P>0.05)。结论血脂代谢异常是MDS的典型特征,MDS患者血脂水平降低,且高危患者胆固醇水平低于低危患者。血脂水平的恢复可间接反映治疗效果。

[Objective]To study the serum lipid profile in patients with myelodysplastic syndromes(MDS),and explore the correlations between lipids level and disease type,risk stratification and disease status.[Methods]All patients were admitted to our center during January 2017 to December 2020.A total of 133 cases were newly diagnosed as MDS and 13 cases were diagnosed as acute myelogenous leukemia(AML)transformed from MDS.Meanwhile,140 healthy people were included as controls.We analyzed and compared their fast serum lipid levels.[Results]Compared to healthy people,the TG,TC,HDL and LDL levels were significantly lower in MDS patients(P<0.05).There was no significant difference in TG,TC,HDL and LDL level among different WHO-MDS types(P>0.05).Patients were classified into low,intermediate and high-risk group based on IPSS,WPSS and IPSS-R scales.TG level showed no significant difference between low and high-risk groups (P>0.05).However,TC,LDL and HDL level were significantly lower in high-risk group.Patients who achieved remission after demethylation therapy showed increased TC and LDL levels than baseline(P=0.0021 and 0.0015).HDL level tended to increase after remission(P=0.091),while TG level was not significantly altered.[Conclusion]MDS patients had significantly lower lipid levels.Compared with low-risk patients,high risk MDS patients had much lower cholesterol levels.The TC and LDL levels increased in patients who accepted demethylation agent treatments and achieved remission.