69例骨髓增生异常综合征病态造血特征对预后意义的研究  

Prognostic Significance of Morbidly Hematopoietic Characteristics in 69 Patients with Myelodysplastic Syndrome

作　　者：伍俞霓[1] 罗治彬[1] 王琛[1] 李静[1] 罗辉燕[1] 何代英[1] 

机构地区：[1]重庆市第三人民医院肿瘤科,重庆400000

出　　处：《中国实验血液学杂志》2015年第1期150-154,共5页Journal of Experimental Hematology

摘　　要：目的:本研究分析骨髓增生异常综合征(myelodysplastic syndrome,MDS)病态造血特点对预后的影响。方法:回顾性分析69例MDS患者的性别、年龄、MDS类型、诊断时的白细胞、血红蛋白、血小板水平,以及骨髓细胞学检查中病态造血特征与生存期的关系。结果:69例MDS患者中位生存期为29.90个月,不同性别、诊断时不同血小板水平患者的中位生存期差异无统计学意义(P>0.05);不同年龄组间,诊断时不同白细胞水平,不同血红蛋白水平患者的中位生存期差异有统计学意义(P<0.05);不同MDS类型患者的中位生存期差异有显著统计学意义(P<0.01);诊断时骨髓涂片中粒系含有核浆发育不平衡、微核、异常核分裂,红系含有巨幼样变、细胞体积大小悬殊、核出芽、核碎裂;巨核系含有微巨核、细胞核分叶过多的MDS患者,其中位生存期差异有统计学意义(P<0.05);骨髓活检中出现ALIP、纤维化的M DS患者的中位生存期差异有显著统计学意义(P<0.01)。结论:年龄、M DS类型、诊断时患者血红蛋白和白细胞水平均为影响预后的指标,粒系病态造血表现中核浆发育不平衡、微核、异常核分裂;红系的巨幼样变、细胞体积大小悬殊、核出芽、核碎裂;巨核系的微巨核、细胞核分叶过多,骨髓活检中出现ALIP、纤维化对预后评估有重要价值。Objective：This study was to investigate the influence of morbidly hematopoietic characteristics on the prognosis of patients with myelodysplastic syndrome （ MDS ）. Methods： A total of 69 cases of MDS were analyzed retrospectively on ralatienship between sex, age, MDS types, WBC count, hemoglobin （Hb） level, platelet （Plt） count at diagnosis, morbidly cytologic features of bone marrow and survival time of MDS patients. Results： The median survival time of 69 cases of MDS was 29.90 months. The patients of different sexes and Pit level at diagnosis did not display statistically significant difference in median survival time （ P 〉 0.05 ） ; the patients with different ages , WBC count and Hb level showed statistically significant difference in median survival time （ P 〈 0.05 ） ; the median survival time of patients with different MDS types was significant different （ P 〈 0.01 ） ; the MDS patients with myeloid lineage containing nuclear plasma development imbalance, micronuclei, abnormal mitotic figures, with erythroid lineage containing megaloblastic degeneration, cell size disparity, nuclcar budding and muclear fragmentation, and with megakaryocyte lineage containing micromegaryocytes, excessive muclear leaves, displayed significant difference in median survival time （ P 〈 0.05 ）. The MDS patients with ALIP positive, fibrosis in bone marrow blopsy showed significant difference in median survival time. Conclusion：The age, MDS types, Hb level and WBC count at diagnosis are indicators influencing the prognosis. The unbalanced development of muclear plasma, micronuclei, abnormal mitotic figures in myeloid morbid hematopoiesis, the megaloblastic degeneration, cell size disperity, muclear budding, nuclear fragmentation in erythroid morbid hematopoiesis, the micro-megakaryocytes, excessive nuclear leaves in megakaryocytic morbid hematopoiesis, and existance of ALIP posstive and fibrosis in bone marrow biopsy indicate important values for evaluation of MDS prognosis.

关 键 词：骨髓增生异常综合征 病态造血 预后因素 

分 类 号：R733.3[医药卫生—肿瘤] R551.3[医药卫生—临床医学]