老年患者骨髓增生异常综合征不同亚型与染色体核型异常及预后的关系分析

Analysis of the relationship between different subtypes of myelodysplastic syndrome and abnormal chromosome karyotypes and prognosis in the elderly patients

目的 探讨老年骨髓增生异常综合征(MDS)不同亚型与染色体核型异常及预后的关系。方法 回顾性分析2019年1月—2021年6月于内蒙古医科大学附属医院收治的MDS老年患者144例,按照WHO标准进行分型,分为SLD亚型组27例,RS-SLD亚型组6例,MLD亚型组62例,EB-Ⅰ亚型组24例,EB-Ⅱ亚型组25例,均进行G显带计数染色体核型分析,并进行预后分析。结果 144例MDS老年患者中,染色体核型异常共68例(47.22%);SLD组、 RS-SLD组、 MLD组、 EB-Ⅰ组和EB-Ⅱ组的染色体核型异常率分别为33.33%、 16.67%、 46.77%、 51.17%及64%,其中EB-Ⅱ组染色体核型异常率显著高于SLD组和RS-SLD组(P<0.05);68例染色体核型异常患者中,染色体数目异常27例(39.70%),染色体结构异常27例(39.70%),染色体数目与结构同时异常14例(20.59%);单一染色体异常43例(63.23%),2种染色体异常12例(17.65%),3种或以上染色体异常13例(19.12%),且EB-Ⅱ组数目与结构同时异常的比例显著高于MLD组(P<0.05),MLD组单一异常比例显著高于EB-Ⅱ组(P<0.05),而EB-Ⅱ组3种及以上异常比例显著高于MLD组(P<0.05);68例染色体核型异常患者中,预后低危31例(45.59%),预后中危23例(32.35%),预后高危14例(22.06%),染色体核型异常的MDS不同亚型者预后整体比较,差异无统计学意义(P>0.05),但两两比较显示,EB-Ⅱ组预后高危率高于MLD组(P<0.05)。结论 染色体核型异常与MDS患者亚型及预后密切相关,EB-Ⅱ型MDS老年患者染色体核型复杂异常率更高,预后更差。

Objective To investigate the relationship between different subtypes of myelodysplastic syndrome(MDS) and abnormal chromosome karyotypes and prognosis in elderly patients.Methods A total of 144 elderly patients with MDS admitted to Affiliated Hospital of Inner Mongolia Medical University from January 2019 to June 2021 were retrospectively analyzed.According to WHO classification criteria,the patients were divided into SLD subtype group(n=27),RS-SLD subtype group(n=6),MLD subtype group(n=62),EB-I subtype group(n=24) and EB-Ⅱ subtype group(n=25).G-banding count chromosome karyotype analysis and prognosis analysis were performed in all patients.Results Among 144 elderly patients with MDS,68 ones(47.22%) had abnormal chromosome karyotypes.The abnormal rate of chromosome karyotype in the SLD group,RS-SLD group,MLD group,EB-Ⅰ group and EB-Ⅱ group was 33.33%,16.67%,46.77%,51.17% and 64%,respectively.The abnormal rate of chromosome karyotype in the EB-Ⅱ group was significantly higher than that in the SLD group and RS-SLD group(P0.05),but the high-risk prognosis rate of the EB-Ⅱ group was higher than that of the MLD group(P<0.05).Conclusion Abnormal chromosome karyotypes are closely related to the subtypes and prognosis of patients with MDS.Elderly patients with MDS of EB-Ⅱ subtype have a higher rate of complex abnormal karyotype and a worse prognosis.