铁过载对初诊骨髓增生异常综合征患者T淋巴细胞亚群及生存预后的影响

Effects of iron overload on T lymphocyte subsets and survival prognosis in patients with newly diagnosed myelodysplastic syndrome

目的 探讨铁过载对初诊骨髓增生异常综合征(MDS)患者T淋巴细胞亚群及生存预后的影响。方法 回顾性分析2018年1月至2023年12月山西医科大学附属运城市中心医院收治的58例MDS患者的临床资料,根据血清铁蛋白(SF)水平将其分为铁过载组(SF≥1 000 ng/mL,27例)和非铁过载组(SF<1 000 ng/mL,31例)。比较两组一般临床资料、淋巴细胞亚群及生存预后。结果 铁过载组SF、转铁蛋白饱和度水平高于非铁过载组,外周血CD3^(+) T淋巴细胞、CD4^(+) T淋巴细胞和CD8^(+) T淋巴细胞水平低于非铁过载组,差异有统计学意义(P<0.05)。铁过载组和非铁过载组中位生存时间分别为8个月和30个月,非铁过载组的总生存期显著优于铁过载组(log-rank检验:χ^(2)=5.368,P=0.020)。多因素Cox回归分析结果显示,铁过载[HR(95%CI)=3.50(1.46~8.39),P=0.005]、IPSS-R危险分类为极高危[HR(95%CI)=6.28(1.15~34.27),P=0.034]是影响MDS患者生存预后的独立危险因素(P<0.05)。结论 铁过载是MDS患者不良生存预后的危险因素,并可影响T淋巴细胞亚群水平,值得临床医师关注。

Objective To explore the effects of iron overload on T lymphocyte subsets and survival prognosis in patients with newly diagnosed myelodysplastic syndrome(MDS).Methods The clinical data of 58 patients with MDS who were admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from January 2018 to December 2023 were retrospectively analyzed,and the study subjects were divided into iron overload group[serum ferritin(SF)≥1000 ng/mL,27 cases]and non-iron overload group(SF<1000 ng/mL,31 cases)according to their SF levels.The general clinical data,lymphocyte subsets and survival prognosis were compared between the two groups.Results The levels of SF and transferrin saturation in the iron overload group were higher than those in the non-iron overload group,and the levels of peripheral blood CD3+T lymphocytes,CD4+T lymphocytes and CD8+T lymphocytes in the iron overload group were lower than those in the non-iron overload group,and the differences were statistically significant(P<0.05).The median survival time was 8 months in the iron overload group and 30 months in the non-iron overload group.The overall survival time of the non-iron overload group was significantly better than that of the iron overload group(log-rank test:χ2=5.368,P=0.020).The results of multivariate Cox regression analysis showed that iron overload[HR(95%CI)=3.50(1.46-8.39),P=0.005]and the Revised International Prognostic Scoring System(IPSS-R)risk classification at very high risk[HR(95%CI)=6.28(1.15-34.27),P=0.034]were independent risk factors affecting the survival prognosis of the patients with MDS(P<0.05).Conclusion Iron overload is a risk factor for poor survival prognosis in MDS patients,and iron overload can affect the level of T lymphocyte subsets,which deserves the attention of clinicians.