骨髓增生异常综合征病态造血的流式细胞术检测

摘要

骨髓增生异常综合征(MDS)是一组异质性疾病,以病态造血及无效造血为主要表现,病态造血在MDS的诊断中具有重要作用,但骨髓细胞形态学异常并不只出现在MDS中,且当形态学以及细胞遗传学评估不能提供足够的MDS诊断信息时,流式细胞术(FCM)对MDS免疫表型的分析所提供的信息就显得尤为重要.通过多参数评估髓系和单核系细胞成熟和抗原表达模式有助于识别MDS中髓系形态异常情况;以免疫表型评价红系的病态造血存在困难,但评价胞浆内铁代谢相关蛋白,MDS红系显示出“铁超负荷”,表现为铁蛋白含量增加而转铁蛋白受体下降,与红系的病态造血紧密相关联;CD34+细胞比例增高,表面抗原异常表达亦很有意义.本文就应用流式细胞术检测骨髓增生异常综合征病态造血的研究进行综述.%Myelodysplastic syndrome (MDS) is a heterogeneous disease characterized by dysplasia and ineffective hematopoiesis.The dysplasia is crucial in the diagnosis of MDS,but the morphologic abnormalities of bone marrow cells are not specific for MDS.When the morphological evaluation of marrow dysplasia and cytogenetics can not give enough informations,for diaguosis of MDS,the application of flow cytometrey (FCM) for immunophenotyping in MDS will become particularly important.Multiparametric evaluation of myeloid,monocytic maturation and antigen expression pattern contribute to the identification of two or more aberrancies in MDS cases.FCM evaluation of erythroid dysplasia is particularly difficult,because of the limited availability of specific markers.By analyzing the proteins involved in cellular iron metabolism,MDS erythroid cells present an "iron-loaded" phenotype characterized by increased ferritin contents and reduced transferrin receptor,which reflects the degree of dysplasia assessed by morphology.The proportion of CD34 + cells increased,abnormal expression of surface antigen is also important.The application of flow cytometry in detecting dysplasia of myelodysplastic syndrome is discussed in this article.