骨髓增生异常综合征患者的实验室指标与预后相关性的初步探索

摘要

目前骨髓增生异常综合征(MDS)的预后评估在国际上主要依据MDS预后积分系统(IPSS),但此评分系统对于部分同群组患者的病情评估仍有差异.本研究旨在通过对IPSS不同分组患者的外周血平均红细胞体积( MCV)、血清乳酸脱氢酶(LDH)、β2-微球蛋白(β2 -MG)、铁蛋白(SF)、Vit B12比较分析,探讨上述指标与MDS预后的可能关系.将入选的116例MDS患者按IPSS评分系统分为低危(24例)、中危Ⅰ(43例)、中危Ⅱ(26例)、高危(23例)4组.测定各组患者治疗前及正常对照组(116例)MCV、空腹血清LDH、β2 -MG、SF、Vit B12水平,比较MDS患者与正常人以及各组MDS患者间上述指标是否存在差异.结果表明,MDS患者外周血MCV、血清LDH、β2 -MG、SF、Vit B12水平明显高于正常人(P＜0.05).低危组、中危Ⅰ组、中危Ⅱ组、高危组MDS患者血清LDH水平依次增高,4组之间的差异均有统计学意义(P＜0.05).β2 -MG水平在高危组明显高于低危、中危Ⅰ组、中危Ⅱ组(P＜0.05),后3组间无显著差别.外周血MCV、血清SF、Vit B12水平各组间两两比较无显著性差异.结论:MDS患者血清LDH、β2-MG水平与疾病的进展及预后似有一定相关性,监测上述指标对MDS患者预后可能具有一定的提示性,有可能作为IPSS评分系统补充的候选指标.%The myelodysplastic syndrome ( MDS) is a group of hematopoietic stem cell-clonal disease. TheInternational Prognostic Scoring System (IPSS) is mainly used for its prognostic classification, but still remains some unrepeatable results in the same group of patients with MDS. This study was aimed to compare the levels of peripheral blood mean corpuscular volume ( MCV), serum lactate dehydrogenase ( LDH) , |32-microglobulin ( p2-MG), ferroprotein (SF), Vit B12 in patients with MDS classified by IPSS and to explore the relationship between the prognosis and laboratory indexes above mentioned in MDS patients. 116 patients with MDS were divided into 4 group: low-risk, intermediate risk- I , intermediate risk- II and high-risk according to IPSS. The index of MCV, serum LDH, P2-MG, SF and Vit B12 in MDS patients prior treatment and in normal control group were detected. Data with normal group and each groups of MDS were compared. The results showed that the levels of MCV, LDH, p2-MG, SF were Vit B12 in patients with MDS were significantly higher than those in normal control group ( P < 0. 05). There were significant differences of serum LDH among the 4 groups of MDS (P < 0.05), and the levels of serum LDH increased in turn; low-risk, intermediate risk I , intermediate risk II and high-risk. Serum p2-MG level in the high-risk group was significantly higher than that in the groups of low risk, intermediate risk I and intermediate risk H (P < 0. 05) , the difference among the latter three groups was not statistically significant ( P > 0. 05 ). There were no significant differences in MCV, SF and Vit B12 levels of all groups compared with each other. It is concluded that the level of serum LDH and β2-MG seems to have a certain correlation with the progress and prognosis of the MDS, which may be useful for predicting the prognosis of the MDS besides IPSS scoring system.