骨髓增生异常综合征的临床特征及T淋巴细胞亚群分析

Clinical features and T lymphocyte subsets of myelodysplastic syndrome

目的探讨骨髓增生异常综合征伴多系病态造血(MDS-MLD)外周血常规和骨髓象特点,并分析T淋巴细胞亚群情况,为临床诊疗提供依据。方法选取中国中医科学院西苑医院2021-01-01-10-30确诊的MDS-MLD患者27例和健康体检者8名,用流式细胞仪检测外周血常规中Th1、Th2、Th17和Treg淋巴细胞比例,采用独立样本t、单因素方差和非参数检验分析2组之间T淋巴亚群差异,并收集MDS-MLD患者入组时骨髓形态学和细胞遗传学信息。结果(1)MDS-MLD患者外周血三系减少,平均红细胞体积(MCV)和红细胞分布宽度(RDW-CV)增高,骨髓粒系24例(88.89%)、红系18例(66.67%)和巨核细胞改变9例(33.33%)均可见形态异常,有3例(11.11%)染色体异常;(2)MDS-MLD患者Th1细胞(t=2.931,P=0.006)、Th17细胞(Z=-2.848,P=0.004)和Th1/Th2水平(Z=-2.556,P=0.011)均高于健康人群;(3)MDS-MLD较低危组Th1细胞(Hc=9.169,P=0.007)、Th17细胞(Hc=8.171,P=0.027)和Th1/Th2水平(Hc=7.484,P=0.019)高于健康人群,较高危组Th17细胞(Hc=8.171,P=0.033)高于健康人群,而2个危度层相比各T淋巴亚群间差异均无统计学意义;(4)MDS-MLD患者中有输血依赖的10例(37.04%),较其他患者这类患者Th17细胞(t=-2.870,P=0.008)和Th17/Treg水平(Z=-3.616,P<0.001)增高,Treg细胞水平减低,t=2.503,P=0.019;(5)低增生性MDS 5例(18.52%),较其他患者Th17细胞(Z=-3.059,P=0.002)和Th17/Treg水平(Z=-2.466,P=0.014)增高;(6)再生障碍性贫血(AA)继发MDS-MLD 13例(48.15%),较原发性MDS-MLD Th17细胞增高,Z=2.241,P=0.034。结论MDS-MLD患者中T淋巴细胞亚群失衡,免疫亢进在疾病发病中具有重要作用。此外,对于输血依赖性MDS、低增生性MDS及AA继发MDS的临床诊疗,Th17细胞淋巴亚群具有一定意义。

Objective To investigate blood routine and the bone marrow morphology of myelodysplastic syndrome-multilineage dysplasia(MDS-MLD),and analyze the clinical characteristics of T lymphocyte subsets,so as to provide basis for clinical diagnosis.Methods Twenty-seven patients with MDS-MLD and eight health persons in Xiyuan Hospital from January 1to October 30,2021were selected.The proportions of Th1,Th2,Th17and Treg lymphocytes in peripheral blood were detected by flow cytometry,comparing the test results of the two groups by independent sample t test,one-way ANOVA and non-parametric test.Bone marrow morphological and cytogenetic information were collected to investigate the clinical characteristics of MDS-MLD.Results(1)The patients with MDS-MLD decreased in three series of peripheral blood,but increased in mean corpuscular volume(MCV)and red blood cell distribution width(RDW-CV).There were88.89%of patients with abnormal morphology in neutrophile granulocytexi,66.67%in erythroid system and 33.33%in megakaryocytes,and 3patients were abnormal in chromosome,accounting about 11.11%.(2)The levels of Th1(t=2.931,P=0.006),Th17(Z=-2.848,P=0.004)and Th1/Th2(Z=-2.556,P=0.011)in patients with MDS-MLD were higher than those in healthy people.(3)Compared with the healthy counterpart,the low-risk MDS-MLD group was higher in Th1(Hc=9.169,P=0.007),Th17(Hc=8.171,P=0.027)and Th1/Th2(Hc=7.484,P=0.019),while the high-risk MDS-MLD group was higher in Th17(Hc=8.171,P=0.033),but there was no statistical difference between the two risk-groups in any T lymphoid subgroups.(4)There were 10patients(37.04%)with MDS-MLD dependent on blood transfusion,and these patients was higher in Th17(t=-2.870,P=0.008)and Th17/Treg(Z=-3.616,P<0.001)than other patients,but decreased in Treg(t=2.503,P=0.019).(5)Compared with other patients,there were5patients(18.52%)with hypo-MDS-MLD,who were increased in Th17(Z=-3.059,P=0.002)and Th17/Treg(Z=-2.466,P=0.034).(6)There were 13patients(48.15%)with aplastiv anemia(AA)secondary to MDS-MLD,who were higher in Th17than those with primary MDS-MLD(Z=2.241,P=0.034).Conclusions Immune hyperactivity plays an important role in the pathogenesis of MDS-MLD,causing imbalance in T lymphocyte subsets.In addition,Th17has certain significance in clinical diagnosis of transfusion-dependent MDS,hypo-MDS-MLD and AA secondary to MDS-MLD.