【摘要】 目的　探讨骨髓增生异常综合征 (MDS)患者骨髓细胞凋亡及髓内肿瘤坏死因子α(TNFα)水平 ,初步揭示MDS无效造血机制。方法　采用TUNEL法检测 2 6例MDS及 10例正常健康对照组新鲜骨髓单个核细胞 (BMMNC)凋亡 ,RT PCR探讨BMMNC中TNFαmRNA表达 ,ELISA法测定骨髓上清液TNFα蛋白水平。结果　早期MDS(RA +BM原始细胞 <10 %RAEB)患者的骨髓细胞凋亡率明显增加 ,进展期MDS(BM原始细胞 >10 %RAEB +RAEB t)骨髓细胞凋亡率与对照组无显著差异 ,凋亡累及各阶段幼稚粒细胞及有核红细胞。早期MDS细胞凋亡程度与骨髓增殖程度有关。 5 8% (15 / 2 6 )MDS表达TNFαmRNA ,77% (2 0 / 2 6 )MDS髓内TNFα蛋白升高 ,早期MDS髓内TNFα水平与凋亡呈正相关 ,并于外周血血红蛋白 (Hb)量呈负相关。结论　早期MDS骨髓细胞凋亡增加 ,随病情演变 ,凋亡逐渐下降 ,这可能与异常克隆逃逸凋亡有关 ,髓内TNFα增加是骨髓细胞发生凋亡的机制之一。更多还原

【Abstract】 Objective To investigate apoptosis of hematopoietic cells and levels of TNFα in the marrow of patients with myelodysplastic syndromes(MDS), to preliminarily elucidate the mechanism of ineffective hematopoiesis of MDS. Methods Apoptosis of bone marrow mononuclear cells(BMMNC) was demonstrated using TUNEL method in 26 MDS patients and 10 normal controls,expression of TNFα by BMMNC was detected using RT PCR, intramedullary levels of TNFα protein were measured using ELISA. Results Apoptosis was significantly increased in early MDS compared with advanced MDS and normal controls. There was a direct correlation between the degree of BM proliferation and the incidence of apoptosis in early MDS. An enhanced expression of the mRNA for TNFα was observed in 58% patients, TNFα protein was increased in 77% patients. Further a significant direct relationship was found between the TNFα levels and the degree of apoptosis in early MDS, there was also a negative correlation between the TNFα levels and peripheral blood hemoglobin. Conclusion Apoptosis is significantly increased in early MDS and falls with disease progression. TNFα may be responsible for apoptosis,and it might be produced by both hematopietic cells and stromal cell.更多还原