骨髓增生异常综合征多指标综合诊断的前瞻性研究  

Prospective study on the multi-parameter diagnosis for myelodysplastic syndromes

作　　者：曹燕然[1] 邵宗鸿[2] 施均[1] 王化泉[2] 刘鸿[1] 付蓉[2] 赵明峰[1] 何广胜[1] 白洁[1] 涂梅峰[1] 邢莉民[2] 崔振珠[1] 孙娟[1] 贾海蓉[1] 杨天楹[1] 

机构地区：[1]中国医学科学院中国协和医科大学血液学研究所血液病医院,天津300020 [2]天津医科大学总医院,天津300052

出　　处：《中国实用内科杂志》2006年第8期1145-1147,共3页Chinese Journal of Practical Internal Medicine

基　　金：天津市自然科学基金重点项目(013111111);天津市自然科学基金(023609311)

摘　　要：目的建立多指标综合诊断骨髓增生异常综合征(MDS)诊断标准。方法以前瞻性方法验证从回顾性研究中得出的综合诊断MDS的8项指标。观察中国医学科学院血液病医院2000年1月至2004年6月住院MDS患者,其中多指标诊断组38例,同期对照组79例,既往对照组123例,对比分析3组患者转化为白血病的情况。结果随访期间多指标诊断组18例转化为白血病,转白率为47.37%,中位转白时间6(1～33)个月。同期对照组18例转化为白血病,转白率为22.78%(与多指标诊断组相比,P<0.01),中位转白时间6(1～33)个月。既往对照组16例转化为白血病,转白率为13.01%(与多指标诊断组相比P<0.01),中位转白时间5(1～23)个月。多指标转白的相对危险度:骨髓原始粒细胞和单核细胞≥0.020的相对危险度(RR)为9.11,髓系细胞分化指数≥1.8的RR为6.50,有淋巴样微巨核RR=4.55,外周血中出现幼稚粒、单核细胞RR=4.40,骨髓有核红细胞糖原染色阳性RR=4.26,染色体核型异常RR=2.87,骨髓细胞体外培养粒、单核细胞系集簇与集落比值≥4.0的RR为2.14。结论多指标综合诊断较全面反映MDS恶性造血克隆的生物学本质,能更准确地诊断MDS患者。Objective To establish a multi - parameter diagosls criteria for Myelodysplastie syndromes （MDS）. Methods Eight diagnostic parameters for MDS obtained from our retrospective study were prospectively studied. From Jan. 2000 to June 2004, leukemic transformations in 38 MDS patients diagnosed according to the multi - parameter criteria plus WHO criteria were dynamically followed up, and compared with that in 79 MDS cases who were diagnosed only according to WHO criteria contemporaneously and that in 123 MDS cases historially who fit in with WHO criteria. Results Eighteen of the 38 MDS patients transferred into leukemia. Among the 79 MDS patients diagnosed only according to the WHO criteria, 18 transferred （P 〈0. 01 ） ; among the 123 MDS patients diagnosed according to the WHO criteria historially, 16 transferred （P 〈0. 01 ）. The relative risk to leukemia of the 8 index： myeloblasts in the bone marrow≥ 0. 020 （9. 11 ）, myeloid differentiation index ≥ 1.8 （6. 50）, lymphocytoid micromegakaryocytes in the bone marrow （4.55）, immature granulocytes in the peripheral blood （4.40）, positive periodic acid schiff stained nucleated erythrocytes （4. 26 ）, typical colonal karyotypic abnormalities （2.87）, cluster/colony ratio of granuloeyte - macrophage colo- nyforming units ≥4. 0 （2. 14 ）. Conclusion The multi -parameters reflect the pathological nature of MDS better and the criteria based on them is more helpful to catch true MDS eases.

关 键 词：骨髓增生异常综合征 白血病 

分 类 号：R5[医药卫生—内科学]