真性红细胞增多症患者内源性红系集落检测及其临床意义

Detection for endogenous erythroid colony in the patients with polycythemia vera and its clinical significance

目的 了解真性红细胞增多症 (PV)患者内源性红系集落 (EEC)生长情况及其临床意义。方法 应用半固体甲基纤维素培养体系培养 2 6例PV患者及 19名正常对照者骨髓单个核细胞中的EEC ,应用流式细胞术检测 8例PV患者及 10名正常对照者骨髓单个核细胞AnnexinⅤ并分析其与EEC之关系。结果 ① 2 6例PV患者中 2 5例 (96 .2 % )检测到EEC ,继发性红细胞增多症患者及正常对照组EEC检出率为 0。②PV患者的EEC数、EEC/Epo依赖CFU E(EEC率 )与患者血红蛋白水平呈正相关(r=0 .6 0 8,P =0 .0 1) ,EEC率与患者外周血白细胞和血小板计数及中性粒细胞碱性磷酸酶 (ALP)指数无明显相关性。③EEC与血清Epo水平无相关性 (r =0 .5 18,P =0 .12 5 )。④ 15例PV患者应用羟基脲(HU)和 (或 )干扰素 (IFN)治疗 ,治疗前EEC率与达完全缓解 (CR)所需治疗时间呈正相关 (r=0 .6 5 1,P=0 .0 0 9) ,与缓解持续时间呈负相关 (r=- 0 .5 92 ,P <0 .0 2 )。⑤ 7例应用HU和 (或 )IFN治疗的PV患者 ,血常规恢复正常后EEC及EEC率均减低。⑥EEC率与血栓栓塞发生率呈正相关 (r =0 .5 2 4 ,P =0 0 1)。⑦PV患者骨髓单个核细胞的凋亡率较正常对照组明显减低 ,PV患者中EEC与骨髓细胞凋亡率呈负相关 (r=- 0 .192 ,P <0 .0 4 5 )。

Objective To investigate the growth of endogenous erythroid colony(EEC) in polycythemia vera(PV) patients and its clinical significance. Methods Bone marrow mononuclear cells of 26 PV patients, 2 se-condary erythrocytosis(SE) and 19 normal controls were cultured by Marsh's method for EEC. Results ①EEC was present in 25/26 (96.2%) PV patients and was not found in 2 SE patients and 19 normal controls. ②The number of EEC and the ratio of EEC/ Epo-dependent CFU-E(EEC ratio) were positively correlated with the hemoglobin(Hb) levels ( r=0.608,P =0.01)in PV patients, but did not correlate with white blood cell(WBC) counts, platelet counts and neutrophil alkaline phosphatase scores. ③EEC did not correlate with PV patients’ serum Epo levels( r=0.518,P =0.125). ④Fifteen PV patients were treated with hydroxyurea and /or interferon-alpha. Their EEC ratio before treatment was correlated positively with the time required for complete remission (CR) ( r=0.651,P =0.009) and negatively with the time before relapsing ( r=-0.529,P <0.02). ⑤EECs of 7 PV patients treated with HU/IFN were decreased after their blood cell counts normalization. ⑥There was a positive correlation between the EEC ratio and the attacks of vascular thrombosis (r=0.524,P =0.01). ⑦ The apoptosis of bone marrow mononuclear cells of PV patients was less than that of normal controls. PV patients'EEC was negatively correlated with the apoptosis of their bone marrow mononuclear cells ( r=-0.192,P <0.045). Conclusion EEC is peculiarly present in PV patients, and is a sensitive parameter in reflecting the abnormal hematopoietic clone burden and in diagnosing and monitoring the disease.