骨髓增生异常综合征患者舌象与骨髓象相关性研究  

Correlation of Tongue Manifestations with Bone Marrow Smear Manifestations in Patients with Myelodysplastic Syndrome

作　　者：黄晓华 杨洪涌[2] 邹小秋 刘增慧 HUANG Xiaohua;YANG Hongyong;ZOU Xiaoqiu;LIU Zenghui(Guangzhou University of Chinese Medicine,Guangzhou Guangdong China 510405;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou Guangdong China 510405)

机构地区：[1]广州中医药大学,广东广州510405 [2]广州中医药大学第一附属医院,广东广州510405

出　　处：《中医学报》2021年第2期399-405,共7页Acta Chinese Medicine

基　　金：国家自然科学基金项目(81903973);广州中医药大学第一附属医院创新强院二期工程之青年科研基金项目(2019QN03)。

摘　　要：目的:比较骨髓增生异常综合征(myelodysplastic syndromes,MDS)患者不同舌象下的骨髓象差异,探索其舌象与骨髓象的相关性及舌象的MDS预后评估价值。方法:回顾325例住院第一诊断为MDS的患者病历资料,收集并记录入组MDS患者的舌象资料(舌色、舌体、苔色、苔质、舌苔干腻情况)及骨髓检查资料(原粒细胞比例、早幼粒细胞比例、总单核细胞比例及环形铁粒幼红细胞比例、形态异常情况以及幼稚前体细胞异常定位(abnormal localization of immature precursor,ALIP)发生情况。以不同舌象特点为分组依据,利用独立样本非参数Mann-Whitney U检验和卡方检验比较各舌象特点下的骨髓原粒细胞、早幼粒细胞、总单核细胞、环形铁粒幼红细胞比例及ALIP和其他形态异常的发生率,若基线不齐则再使用二元Logistic回归、最优尺度回归、Mantel-Haenszel分层方法控制基线水平后进一步分析。结果:本研究共入组200例MDS患者,其中142例(71.0%)患者进行了铁染色,133例(66.5%)患者进行骨髓活检病理检查。经检验,舌色暗红、舌色淡、黄苔患者骨髓原粒细胞比例分别高于非暗红舌患者(中位比例11.00%vs 2.50%,P=0.001)、非舌色淡者(中位比例4.00%vs 1.75%,P=0.001)、白苔患者(中位比例5.25%vs 2.00%,P=0.024),淡暗或淡紫舌患者骨髓原粒细胞比例、早幼粒细胞比例高于非淡暗或淡紫舌患者(中位比例5.00%vs 2.50%,P=0.038,2.50%vs 1.00%,P=0.023),干苔患者早幼粒细胞比例高于腻苔患者(中位比例9.00%vs 1.50%,P=0.042),骨髓原粒细胞比例的最优尺度回归显示舌色暗红患者评分高于其他舌色患者(2.752分)。暗红舌、干苔患者中ALIP的发生率高于非暗红舌患者(发生率50.00%vs 21.49%,P=0.028)及腻苔患者(发生率100.00%vs 12.20%,P=0.001)。Logistic回归亦提示,控制年龄的影响后,舌色暗红患者ALIP发生率高于非暗红舌患者。骨髓有ALIP患者其原粒细胞比例亦高于无ALIP患Objective:The research is to study the differences of bone marrow smear manifestations under different tongue manifestations of myelodysplastic syndromes(MDS)patients,and to explore the correlation between them and the prognostic value of tongue manifestations in MDS.Methods:The medical records of 325 hospitalized patients with the first diagnosis of MDS were reviewed,the tongue manifestation data(tongue color,tongue body,coating color,coating quality,dry and greasy tongue coating)and bone marrow smear manifestation data[proportion of myeloblasts,proportion of promyelocytic cells,proportion of total monocytes and proportion of ring sideroblasts,abnormal morphology and abnormal localization of immature precursor(ALIP)occurrence]were collected.Results:A total of 200 patients with MDS were enrolled in this study,of which 142(71.0%)patients underwent iron staining,and 133(66.5%)patients underwent bone marrow biopsy pathological examination.After inspection,the proportion of bone marrow myeloblasts in patients with dark red tongue,light tongue,and yellow fur was higher than that of non-dark red tongue(median ratio 11.00%vs 2.50%,P=0.001)and non-light tongue(medium).Proportion of bone marrow myeloblasts,promyelocytic granulocytes in patients with pale or lavender tongue in patients with white fur(median ratio 5.25%vs 2.00%,P=0.024)The proportion is higher than that of non-dark or lavender tongues(median proportion 5.00%vs 2.50%,P=0.038,2.50%vs 1.00%,P=0.023),and the proportion of promyelocytic cells in patients with dry fur is higher than that in patients with greasy fur(median ratio 9.00%vs 1.50%,P=0.042),the optimal scale regression of the ratio of bone marrow myeloblasts proportion showed that the score of dark red tongue was higher than other tongue colors(2.752 points).The incidence of ALIP in patients with dark red tongue and dry fur is higher than that in patients with non-dark red tongue(incidence 50.00%vs 21.49%,P=0.028)and greasy fur patients(incidence 100.00%vs 12.20,P=0.001).Logistic regression also suggest

关 键 词：骨髓增生异常综合征 舌象 骨髓象 ALIP 预后 

分 类 号：R273.33[医药卫生—中西医结合]