骨髓增生异常综合征患者染色体核型及两种治疗方案的比较分析

摘要

目的：探讨骨髓增生异常综合征（myelodysplastic syndromes，MDS）患者的细胞遗传学特点及其对预后的影响，观察地西他滨3 d 和5 d 方案治疗骨髓增生异常综合征（MDS）的临床疗效及安全性。方法回顾性分析48例 MDS 患者的临床资料，探讨所有患者的染色体核型与预后的关系。观察比较两组方案各完成2个疗程治疗的 MDS 患者的疗效与不良反应。其中3 d 方案患者20例，地西他滨每天45 mg・ m mg・ m－2，QD，静脉滴注，连用3 d，28 d 为一个疗程。5 d 方案患者28例，地西他滨每天20－2，QD，静脉滴注，连用5 d，28 d 为一个疗程。结果48例患者中20例检出异常染色体核型，占所有患者的41．67％，其中难治性贫血伴原始细胞增多1型及2型异常染色体核型检出率较高。据 IPSS －R 积分系统分组，危险分层越高，异常染色体核型检出率越高（P ＜0．05），转化为急性白血病的概率越高。3 d 方案组总反应率为30％，5 d 方案组总反应率为46．43％，差异无统计学意义（P ＞0．05）。不良反应主要表现为骨髓抑制、感染、出血，其中3 d 方案组和5 d 方案组比较，差异有统计学意义（P ＜0．05），前者均高于后者。结论染色体核型分析对 MDS 的诊断及预后判断具有重要价值。5 d 方案较3 d 方案治疗 MDS 具有相似的有效率，但其具有明显较低的不良反应发生率，5 d 方案更值得推广。%Objective To investigate the relationship between cytogenetic markers and prognosis in cases with primary myelodysplastic syndromes(MDS).To observe the clinical safety and efficacy of decitabine in the 3 -day regimen and the 5 -day regimen for patients with myelodysplastic syndromes(MDS).Methods The clinical data of 48 patients (3 day 20,5 day 28) with MDS were retrospective-ly analyzed.The relationship between karyotype and prognosis was analyzed.The adverse effect and efficacy of the two regimens were observed and compared.Results Twenty -one out of 48 patients (41.67%) showed karyotypic abnormalities.The rates of abnormal karyotype in RAEB -1, RAEB -2 were much higher than others MDS.An analysis based on IPSS -R Scoring System showed that ad-vanced risk stratification gradually enhanced the incidence of karyotypic abnormalities (P <0.05).In addition, the probability of evo-lution to leukemia increased with the higher IPSS -R score (P <0.05).There was no significant difference between the two regimens in the overall response rates (3 day 30% vs 5 day 46.43%, P >0.05).Adverse events including myelosuppression,infection and bleeding were mainly caused by decitabine, and the incidences of adverse effect in 5 -day regimen were significantly lower than 3 -day regimen (P <0.05).Conclusion Karyotype analysis has a great value for the diagnosis and prognosis of MDS.The efficacy of 3 -day regimen and 5 -day regimen was similar, and the incidences of adverse effect in 3 -day regimen were significantly higher than 5 -day regimen, which is valuable for popularization.