BCR-ABL阴性骨髓增殖性肿瘤患者的肝脾硬度及其临床意义

Liver and spleen stiffness measurements in patients with BCR-ABL-negative myeloproliferative neoplasms and their clinical significance

目的:探讨BCR-ABL阴性骨髓增殖性肿瘤(myeloproliferative neoplasms,MPN)患者的肝脾硬度情况,并分析其临床意义。方法:河北中石油中心医院2018年6月至2020年6月用肝硬度检测仪(fibroScan 502)对健康志愿者15例及BCR-ABL阴性MPN患者27例进行肝脏硬度(liver stiffness measurement,LSM)、脾脏硬度(spleen stiffness measurement,SSM)进行检测,并进一步分析其临床相关性。结果:MPN组LSM、SSM、SSM-LSM均高于健康组(6.34±2.22)kPa比(5.07±1.27)kPa,(26.00±10.66)kPa比(13.61±5.64)kPa,(19.65±10.37)kPa比(8.54±5.33)kPa,差异均有统计学意义(t=-2.01、-4.30、-4.06,均P<0.05)。PLT与LSM、SSM呈负相关(r=-0.39、-0.42);WBC与SSM-LSM呈负相关(r=-0.40);尿酸与LSM呈负相关(r=-0.54),而与SSM呈正相关(r=0.41);B淋巴细胞百分比与SSM、SSM-LSM呈负相关(r=-0.56、-0.56);病态巨核细胞百分比与SSM呈正相关(r=0.40),铁粒幼细胞百分比与LSM呈负相关(r=-0.44),差异均有统计学意义(均P<0.05)。结论:MPN患者SSM、LSM与白细胞、血小板、尿素、B淋巴细胞百分比、病态巨核细胞、铁粒幼细胞百分比等临床指标密切相关,动态监测LSM、SSM,将来或可联合骨髓检查对MPN患者进行病情评估。

Objective To measure liver and spleen stiffness in patients with BCR-ABL-negative myeloproliferative neoplasms and analyze their clinical significance.Methods Fifteen healthy volunteers and 27 patients with BCR-ABL-negative myeloproliferative neoplasms underwent liver and spleen thickness measurements using FibroScan 502 Touch medical device between June 2018 and June 2020 in Hebei Petro China Central Hospital and they were included in this study.Liver and spleen stiffness was correlated with clinical laboraty indicators.Results Liver stiffness,spleen stiffness,and the difference between spleen stiffness and liver stiffness in patients with BCR-ABL-negative myeloproliferative neoplasms were significantly greater than those in healthy controls[(6.34±2.22)kPa vs.(5.07±1.27)kPa;(26.00±10.66)kPa vs.(13.61±5.64)kPa;(19.65±10.37)kPa vs.(8.54±5.33)kPa,t=-2.01,-4.30,-4.06,all P<0.05].Platelet count was negatively correlated with liver and spleen stiffness(r=-0.39,-0.42).White blood cell count was negatively correlated with the difference between spleen stiffness and liver stiffness(r=-0.40,P<0.05).The uric acid level was negatively correlated with liver stiffness(r=-0.54,P<0.05),but it was positively correlated with spleen thickness(r=0.41,P<0.05).The percentage of B lymphocytes among lymphocytes was negatively correlated with spleen stiffness and the difference between spleen stiffness and liver stiffness(r=-0.56,-0.56,both P<0.05).The percentage of diseased megakaryocytes was positively correlated with spleen stiffness(r=0.40,P<0.05).The percentage of sideroblasts was negatively correlated with liver stiffness(r=-0.44,P<0.05).Conclusion Spleen stiffness and liver stiffness are closely related to clinical indicators in patients with BCR-ABL-negative myeloproliferative neoplasms,including white blood cell count,platelet count,uric acid level,percentage of B lymphocytes,diseased megakaryocytes and sideroblasts.Dynamic monitoring of liver and spleen stiffnesses or in combination with bone marrow examination in future can help evaluate the condition of patients with BCR-ABL-negative myeloproliferative neoplasms.