CAJ | 학술논문

目的探讨新疆地区维吾尔族和汉族骨髓增生异常综合征(MDS)患者的细胞形态学和免疫表型特征.方法对已确诊的67例MDS患者骨髓涂片进行系统观察分型,记录各系病态造血细胞,并进行流式细胞术(FCM)免疫表型检测.结果 67例MDS患者骨髓细胞的粒、红、巨核三系有不同程度的病态造血,依次为粒系[52例(77.6％)]、巨核系[44例(65.7％)]、红系[36例(53.7％)],维吾尔族和汉族患者骨髓三系中出现病态造血表现的比例相近,两组差异无统计学意义(x2值分别为1.02、0.30、0.02,均P＞0.05).67例骨髓细胞病态造血改变类型的发生率依次为单圆核巨核细胞[36例(53.7％)]、假Pelger核异常粒细胞[36例(53.7％)]、红系巨幼样变[33例(49.3％)]、粒细胞颗粒减少或缺失[27例(40.3％)]等,维吾尔族和汉族患者发生率相似.67例MDS患者FCM免疫表型检测结果显示,随着MDS的难治性贫血/难治性贫血伴环形铁粒幼细胞向难治性贫血伴原始细胞过多(RAEB)/转化中的RAEB的进展变化,较成熟的CD15表达率逐渐降低,而较早期的CD34、CD117表达率逐渐升高(x2值分别为6.23、12.06,8.95、7.37,8.95、8.08,均P＜0.05),维吾尔族和汉族患者差异无统计学意义(x2值分别为0.715、0.024、0.146,均P＞0.05)；同时维吾尔族患者CD56表达增高,汉族MDS患者HLA-DR增高,两组比较差异有统计学意义(x 2值分别为3.91、3.90,均P＜0.05).结论维吾尔族和汉族MDS患者骨髓细胞形态学病态造血改变相同,多数MDS有两系以上的病态造血.维吾尔族和汉族MDS患者免疫表型抗原表达部分不同,免疫表型的检测对MDS的诊断、分型及预后具有重要意义.
목적 탐토신강지구유오이족화한족골수증생이상종합정(MDS)환자적세포형태학화면역표형특정.방법 대이학진적67례MDS환자골수도편진행계통관찰분형,기록각계병태조혈세포,병진행류식세포술(FCM)면역표형검측.결과 67례MDS환자골수세포적립、홍、거핵삼계유불동정도적병태조혈,의차위립계[52례(77.6％)]、거핵계[44례(65.7％)]、홍계[36례(53.7％)],유오이족화한족환자골수삼계중출현병태조혈표현적비례상근,량조차이무통계학의의(x2치분별위1.02、0.30、0.02,균P＞0.05).67례골수세포병태조혈개변류형적발생솔의차위단원핵거핵세포[36례(53.7％)]、가Pelger핵이상립세포[36례(53.7％)]、홍계거유양변[33례(49.3％)]、립세포과립감소혹결실[27례(40.3％)]등,유오이족화한족환자발생솔상사.67례MDS환자FCM면역표형검측결과현시,수착MDS적난치성빈혈/난치성빈혈반배형철립유세포향난치성빈혈반원시세포과다(RAEB)/전화중적RAEB적진전변화,교성숙적CD15표체솔축점강저,이교조기적CD34、CD117표체솔축점승고(x2치분별위6.23、12.06,8.95、7.37,8.95、8.08,균P＜0.05),유오이족화한족환자차이무통계학의의(x2치분별위0.715、0.024、0.146,균P＞0.05)；동시유오이족환자CD56표체증고,한족MDS환자HLA-DR증고,량조비교차이유통계학의의(x 2치분별위3.91、3.90,균P＜0.05).결론 유오이족화한족MDS환자골수세포형태학병태조혈개변상동,다수MDS유량계이상적병태조혈.유오이족화한족MDS환자면역표형항원표체부분불동,면역표형적검측대MDS적진단、분형급예후구유중요의의.
Objective To investigate the cell morphology and immune phenotypic characteristics in Uygur and Han patients with myelodysplastic syndrome (MDS) in Xinjiang Uygur Autonomous Region.Methods Bone marrow smears of 67 cases diagnosed as MDS were systematicly observed and recorded,flow cytometry (FCM) was used to test the immunophenotyping.Results There were abnormal hematopoiesis in different extent in granulocyte series,erythron series and megakaryocytic series of all patients.Occurence of pathological hematopoietic performance in Uygur patients with MDS was similar to that in Han,granulocyte series [52 cases (77.6 ％)] ＞megakaryocytic series [44 cases (65.7 ％)] ＞ erythrocyte series [36 cases (53.7 ％)],the differences in two groups were not significant (x2 values 1.02,0.30,0.02,respectively,all P ＞ 0.05).The changes type of pathological hematopoietic performance in two groups were similar,single garden nuclear megakaryocyte [36 cases (53.7 ％)],false Pelger nuclear anomaly granulocyte [36 cases (53.7 ％)],erythroid gigantic young cell change [33 cases (49.3 ％)],granulocyte cell particles reduced or absent [27 cases (40.3 ％)] etc.The result of FCM showed that along with the progressive change of RA/RAS to RAEB/RAEB-t,the expression ratios of mature CD15 were decreased,while the expression ratios of early stage CD117 and CD34 were raised gradually (x2 values 6.23,12.06,8.95,7.37,8.95,8.08,respectively,all P ＜ 0.05),the differences in two groups were not significant (x2 values 0.715,0.024,0.146,respectively,all P ＞ 0.05).Meanwhile,Uygur patients with MDS has great expression of CD56 and Han had HLA-DR,there were significantly differences in two groups (x2 values 3.91 and 3.90,respectively,both P ＜ 0.05).Conclusion Occurence of pathological hematopoietic performance in Uygur patients with MDS are similar to that in Han.Most MDSs has two or more levels of pathological hematopoietic performance.The differences of immunophenotype characteristics in two groups are partially significant and test of immunophenotype are helpful in the diagnosis,classification,prognosis of MDS.