平均红细胞体积≤100 fl是骨髓原始细胞<5%骨髓增生异常综合征患者的独立预后因素  

Mean corpuscular volume≤100 fl was an independent prognostic factor in patients with myelodysplastic syndrome and bone marrow blast<5 percent

作　　者：史仲珣 秦铁军 徐泽锋 黄慧君 李冰 曲士强 胡耐博 潘丽娟 刘丹 蔡亚楠 张喻堤 肖志坚 Shi Zhongxun;Qin Tiejun;Xu Zefeng;Huang Huijun;Li Bing;Qu Shiqiang;Hu Naibo;Pan Lijuan;Liu Dan;Cai Ya’nan;Zhang Yudi;Xiao Zhijian(Institute of Hematology and Blood Diseases Hospital,CAMS&PUMC,the State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Tianjin 300020,China)

机构地区：[1]中国医学科学院、北京协和医学院血液病医院(血液学研究所),实验血液学国家重点实验室,国家血液病临床医学研究中心,天津300020

出　　处：《中华血液学杂志》2020年第1期28-33,共6页Chinese Journal of Hematology

摘　　要：目的探讨平均红细胞体积(MCV)对骨髓增生异常综合征(MDS)预后的影响。方法收集2009年12月至2017年12月我中心新诊断、无红细胞输注史的321例原发性MDS患者,回顾性分析MCV水平对整体及不同骨髓原始细胞水平患者总生存(OS)期的影响。结果全部患者按照MCV水平高低分为MCV≤100 fl组(148例)和MCV>100 fl组(173例)。MCV≤100 fl组患者中位OS时间为27(95%CI 19~35)个月,MCV>100 fl组患者中位OS时间为72(95%CI 5~139)个月,差异有统计学意义(P<0.001)。亚组分析示,在骨髓原始细胞<5%的患者中,MCV≤100 fl患者的中位OS期较MCV>100 fl者显著缩短(P=0.002);而在骨髓原始细胞≥5%的患者中,MCV水平对OS的影响不显著(P=0.078)。在纳入其余临床指标及基因突变校正后,MCV≤100 fl仍为骨髓原始细胞<5%患者的独立不良预后因素(HR=1.890,95%CI 1.007~3.548,P=0.048)。对不同MCV水平骨髓原始细胞<5%的MDS患者的临床及实验室指标进行分析,结果显示MCV≤100 fl组患者外周血HGB高于MCV>100 fl组[90(42~153)g/L对78.5(28~146)g/L,P=0.015],IPSS-R高危/极高危组比例及IPSS-R染色体核型分组差/很差比例明显高于MCV>100 fl组,差异有统计学意义(28.8%对10.8%,P=0.003;24.7%对12.9%,P=0.049)。MCV≤100 fl组患者平均基因突变数目较MCV>100 fl组多(0.988个对0.769个,P=0.064),SF3B1突变较MCV>100 fl组少见(4.7%对15.4%,P=0.018)。结论MCV≤100 fl为骨髓原始细胞<5%的MDS患者独立于基因突变及其他临床指标的预后不良因素。Objective To explore the prognostic effects of mean corpuscular volume(MCV)in patients with myelodysplastic syndromes(MDS).Methods 321 newly diagnosed,untransfused primary MDS patients who administered from December 2009 to December 2017 were enrolled.The association of MCV with prognosis and several clinical features and genetic mutations were analyzed.Results Patients were divided into MCV≤100 fl(n=148)and MCV>100 fl(n=173)cohorts.Median overall survival of patients with MCV≤100 fl was shorter than their counterparts(27 months vs 72 months,P<0.001).In subgroup analysis,MCV≤100 fl patients had worse survivals in bone marrow blast<5%cohort(34 months vs not reached,P=0.002),but not so in≥5%cohort(17 months vs 20 months,P=0.078).MCV≤100 fl was still an independent adverse variable(HR=1.890,95%CI 1.007-3.548,P=0.048)after adjusting for clinical and laboratory variables and mutation topography in bone marrow blasts<5%cohort.In bone marrow blasts<5%cohort,patients with MCV≤100 fl had higher hemoglobin levels[90(42-153)g/L vs 78.5(28-146)g/L,P=0.015].The proportions of Revised International Prognostic Scoring System(IPSS-R)high/very high risks and poor/very poor IPSS-R karyotypes were higher in MCV≤100 fl cohort(28.8%vs 10.8%,P=0.003;24.7%vs 12.9%,P=0.049).MCV≤100 fl cohort had more genetic mutations than those with MCV>100 fl though without significance(0.988 vs 0.769,P=0.064).Mutated SF3B1 was less frequently in MCV≤100 fl cohort(4.7%vs 15.4%,P=0.018).Conclusion MCV≤100 fl was an independent adverse variable after adjusting for clinical and laboratory variables and mutation topography in MDS patients with bone marrow blasts<5%.

关 键 词：骨髓增生异常综合征 平均红细胞体积 基因突变 预后 

分 类 号：R5[医药卫生—内科学]