【摘要】 目的探讨骨髓增生异常综合征(MDS)患者染色体核型异常细胞负荷及其与病情和细胞免疫的关系。方法选取26例伴有非随机染色体异常的MDS患者,以骨髓异常染色体核型细胞数量占总分裂相细胞的百分比作为MDS患者核型异常细胞负荷。MDS患者骨髓核型异常细胞负荷与病情轻重作相关分析,病情指标包括白细胞计数、血红蛋白浓度、网织红细胞计数、血小板计数、乳酸脱氢酶水平、骨髓原始细胞比例、髓系分化指数、集丛/集落比值、淋巴样小巨核细胞数量以及输红细胞和血小板数量。将MDS患者骨髓核型异常细胞负荷与细胞免疫功能作相关分析,细胞免疫功能的指标包括CD4+细胞数量、CD8+细胞数量、血清IL-2和TNF水平。根据骨髓核型异常细胞负荷将患者分为低负荷组和高负荷组(以50%为分界点)。比较两组患者的病情指标和细胞免疫指标。结果MDS患者骨髓核型异常细胞负荷为(67.4±36.2)%。骨髓核型异常细胞负荷与骨髓原始细胞比例呈正相关(r=0.483,P<0.05);与血红蛋白浓度呈负相关(r=-0.445,P<0.05)。高负荷组和低负荷组骨髓原始细胞分别为0.0778±0.0551和0.0345±0.0334,红细胞计数分别为(1.82±0.48)×1012/L和(2.32±0.66)×1012/L,血红蛋白浓度分别为(56.06±14.28)g/L和(76.40±24.44)g/L,差异均有统计学意义(P<0.05)。伴有染色体异常的MDS患者外周血CD4+细胞绝对数为(274.18±71.85)×106/L,正常对照组为(454.82±205.88)×106/L(P<0.05)。两组CD8+细胞绝对数分别为(240.45±150.01)×106/L和(305.27±145.14)×106/L(P>0.05)。伴有染色体异常的MDS患者外周血IL-2水平为(6.29±3.58)μg/L,正常对照组为(3.11±1.40)μg/L(P<0.01)。两组TNF水平分别为(2.42±1.79)μg/L和(1.68±0.69)μg/L(P>0.05)。高负荷组CD4+/CD8+细胞比值为1.90±0.52,低负荷组CD4+/CD8+细胞比值为0.97±0.44(P<0.05)。结论骨髓染色体核型异常细胞负荷是影响MDS患者病情的重要指标,且与T细胞免疫功能相对不足有关,对于疾病的进展有重要意义。更多还原

【Abstract】 Objective To investigate the abnormal hematopoietic clone burden of the patients with myelodysplastic syndromes（MDS） and its clinical implication. Methods The ratio of the metaphase with abnormal karyotypes to the total was regarded as the index of MDS clonal burden. Thirteen parameters were assayed and the correlations between these parameters and MDS clone burden were analysed. Results The clonal burden of MDS patients was （67.4±36.2）%. It correlated positively with bone marrow blasts（r =（0.483）, P<0.05）, negatively with hemoglobin level（r =-0.445, P<0.05）. The number of blasts, hemoglobin and erythocytes in high clonal burden（>50%） and low clonal burden （≤50%） groups were significantly different （P<0.05）. CD4⁺ T lymphcytes of MDS patients and normal controls were （274.18±（71.85））×10⁶/L and （454.82±205.88）×10⁶/L（P<0.05）respectively. CD8⁺ T lymphocytes between MDS patients and normal controls had no difference. The serum level of IL-2 of MDS patients and normal con-trol groups were （6.29±3.58）μg/L and （3.11±1.40）μg/L （P<0.05） respectively; but no difference in the serum level of TNF between MDS and control groups. The ratio of CD4⁺ to CD8⁺ in high clonal burden patients was 1.90±0.52,and in low clonal burden patients was 0.97±0.44（P<0.05）. Conclusion The clonal bunden and deficient T cell immunity are the indicators for predicting MDS patients clinical progression.更多还原