初发骨髓增生异常综合征患者血清铁蛋白水平变化及意义  

Changes and significance of serum ferritin level in patients with myelodysplastic syndrome

作　　者：刘超[1] 秦浩人 冀虹霞 刘姚姚 杨向东[2] 

机构地区：[1]天津中医药大学,天津300110 [2]天津中医药大学第一附属医院

出　　处：《山东医药》2017年第48期19-22,共4页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(81774048)

摘　　要：目的探讨初发骨髓增生异常综合征(MDS)患者血清铁蛋白(SF)水平变化及临床意义。方法选取初发MDS患者50例,其中RA型6例、RARS型4例、RCMD型20例、RAEB-1型13例、RAEB-2型7例,极低危3例、低危8例、中危20例、高危15例、极高危4例。患者分别于输血前及累计输注红细胞达10、20、30 U时取血,采用放射免疫法检测血清SF水平,计算SF变化量(SFΔ);分析血清SFΔ与患者输血量、临床分型、危险分层的关系。输注红细胞达30 U时,将患者分为SFΔ≥2 000 ng/m L组和<2 000 ng/m L组,比较两组预后。结果输血前RARS、RAEB-1、RAEB-2型患者血清SF水平均高于RA、RCMD型患者(P均<0.05),高危、极高危患者均高于极低危、低危及中危患者(P均<0.05)。RAEB-1、RAEB-2型患者在输注红细胞量为20、30 U时血清SFΔ均低于其他各型(P均<0.05)。高危、极高危患者输注红细胞达30 U时血清SFΔ均低于其他危险度患者(P均<0.05)。两组均随访至2016年6月,输注红细胞达30 U时SFΔ≥2 000 ng/m L组的MDS/急性髓系白血病(AML)转化率低于SFΔ<2 000 ng/m L组(P<0.01),中位总体生存时间长于SFΔ<2 000 ng/m L组(P<0.01)。结论初发RARS、REAB-1、RAEB-2型及高危、极高危MDS患者血清SF水平均高于其他分型及危险度者;随着输血量的增加,RAEB-1、RAEB-2型及高危、极高危患者铁过载程度均高于其他分型及危险度者;血清SF水平变化对MDS患者预后有一定的预测作用。Objective To investigate the changes and clinical significance of serum ferritin（ SF） level in patients with primary myelodysplastic syndrome（ MDS）. Methods Fifty cases of newly diagnosed MDS patients were selected,including different sub-types（ 6 cases of RA type,4 RARS,20 RCMD,13 RAEB-1,and 7 RAEB-2） and different IPSS-R classifications（ 3 cases of very low risk,8 cases of low risk,20 cases of intermediate risk,15 cases of high risk,and 4 cases of very high risk）. First of all,the blood samples were taken before and after transfusion of red blood cells at 10,20 and 30 U,respectively,then we measured SF level in each sample by radioimmunoassay and calculates the difference of SF（ SFΔ）. At last,we analyzed the relationship of SFΔ level with different blood transfusion volume,different sub-type and IPSS-R classification. When the infusion of red blood cells were up to 30 U,we divided the patients into the SFΔ≥2 000 ng/mL group and SFΔ〈 2 000 ng/mL group,and we compared the prognosis of patients between these two groups.Results The levels of SF in patients with RARS,RAEB-1,and RAEB-2 types were higher than those of patients with RA and RCMD types（ all P〈0. 05）; the levels of SF in the high-risk and very-high-risk patients were apparently higher than those in the very-low-risk,low-risk and intermediate-risk patients（ all P〈 0. 5）. Serum SFΔ levels were lower in patients with RAEB-1 and RAEB-2 types than those in the other types at the blood transfusion of 20 and 30 U（ all P〈0. 05）. Serum SFΔ levels in the high-risk and very-high-risk patients with erythrocytes up to 30 U were lower than those in the other risk patients（ all P〈0. 05）. All patients were followed up to June 2016. When the infusion of red blood cells were up to30 U,the transformation rate of MDS/AML in the SFΔ≥2 000 ng/ml group was lower than that in the SFΔ 〈2 000 ng/ml group,and the whole median survival time in the SFΔ≥2 000 ng/ml group was longer（ P 〈0. 01）. Conclusions The serum S

关 键 词：骨髓增生异常综合征 铁蛋白 变化量 输血 急性髓系白血病 

分 类 号：R551.3[医药卫生—血液循环系统疾病]