真性红细胞增多症患者伴骨髓纤维增生的可能危险因素分析

Possible Risk Factors for Bone Marrow Fibroplasia in Patients with Polycythemia Vera

目的:了解伴有骨髓纤维增生的真性红细胞增多症(PV)患者的生物学特征,并进一步分析影响PV患者骨髓纤维增生的危险因素,为预测PV患者骨髓纤维增生发生提供思路。方法:收集中国中医科学院西苑医院血液科收治的PV患者40例,将患者根据是否伴有骨髓纤维增生分为增生和非增生两组,比较两组患者基础临床特征、血常规、生化、骨髓细胞、凝血功能等指标的差异,进一步多因素回归分析影响PV患者骨髓纤维组织增生的独立危险因素。结果:与非增生组比较,增生组PV患者的JAK2突变率明显升高(95%vs70%,P=0.037),嗜酸细胞计数(0.19vs0.11,P=0.047)及嗜酸性粒细胞占比(1.84vs1.27,P=0.001)均显著升高,甘油三酯(1.55vs1.91,P=0.038)与低密度脂蛋白(1.50vs3.08,P=0.000)均明显降低,骨髓造血容量(0.85vs0.6,P=0.001)、粒红比(3.40vs1.89,P=0.033)、淋红比(0.60vs0.42,P=0.033)及粒细胞+淋细胞/红细胞比值(3.72vs2.37,P=0.026)均显著升高,凝血酶时间(18.84vs18.12,P=0.043)明显延长。进一步对上述因素进行多因素回归分析,提示,外周血嗜酸性粒细胞占比≥2%及低密度脂蛋白≤2 mmol/L是PV患者骨髓纤维组织增生的独立危险因素(P<0.05)。结论:外周血嗜酸性粒细胞占比增加及低密度脂蛋白降低是PV患者骨髓纤维组织增生的危险因素。

Objective:To understand the biological characteristics of polycythemia vera(PV)patients with myeloid fibroplasia,and further analyze the risk factors affecting myeloid fibroplasia in PV patients,so as to provide ideas for predicting the occurrence of myeloid fibroplasia in PV patients.Methods:Forty patients with PV in the Department of Hematology,Xiyuan Hospital of China Academy of Chinese Medical Sciences were collected and divided into two groups,with(hyperplasia group)and without(Non-proliferative group)hyperplasia of bone marrow fibers.The differences of basic clinical characteristics,blood routine,biochemistry,bone marrow cells,coagulation function and other indicators between the two groups were compared,and the independent risk factors affecting the proliferation of bone marrow fibrous tissue in PV patients were further analyzed by multivariate regression.Results:Compared with Non-proliferative group,the JAK2 mutation rate(95% vs70%,P= 0.037),eosinophilic cell count(0.19vs0.11,P= 0.047)and eosinophilic percentage(1.84vs1.27,P= 0.001)in PV patients with hyperplasia were significantly increased,triglycerides(1.55vs1.91,P= 0.038)and low-density lipoprotein(1.50vs3.08,P= 0.000)were significantly reduced,bone marrow hematopoietic volume(0.85vs0.6,P= 0.001),granulocyte/erythrocyte ratio(3.40vs1.89,P= 0.033),lymphocyte/erythrocyte ratio(0.60vs0.42,P= 0.033),and granulocyte+lymphocyte/erythrocyte ratio(3.72vs2.37,P= 0.026)were significantly increased,thrombin time(18.84vs18.12,P= 0.043)was significantly prolonged.Multivariate regression analysis results showed that peripheral blood eosinophil≥2% and low-density lipoprotein≤2mmol/L were independent risk factors for bone marrow fibrous tissue hyperplasia in PV patients(P<0.05).Conclusion:Increased proportion of peripheral blood eosinophils and decreased low density lipoprotein are risk factors for bone marrow fibrous tissue hyperplasia in PV patients.