病态造血特点在骨髓增生异常综合征预后评估中的价值

摘要

目的 探讨病态造血特点在骨髓增生异常综合征(MDS)向急性白血病转化及预后评估中的价值.方法 以2008 WHO MDS分类标准为诊断金标准,选择2008年2月至2014年3月98例MDS患者,分别进行细胞形态学、细胞遗传学及流式细胞术等检测,分析患者病态造血特点在MDS向急性白血病转化及预后评估中的意义.结果 98例MDS患者经随访,27例转化为急性髓系白血病,其中转化为M215例、M410例、M62例.67例存在Pelger-Hu(e)t异常者中23例转化为急性白血病,31例无Pelger-Hu(e)t异常者中4例转化为急性白血病,转化率差异有统计学意义(x2=4.87,P=0.030);37例存在Auer小体者中19例转化为急性白血病,61例无Auer小体者中8例转化为急性白血病,转化率差异有统计学意义(x2=16.87,P=0.000);52例小巨核病态改变者中21例转化为急性白血病,46例无小巨核病态改变者中6例转化为急性白血病,转化率差异有统计学意义(x2=9.14,P=0.003).98例MDS患者中,37例死亡,存在Pelger-Hu(e)t异常、Auer小体、小巨核病态改变患者的中位生存时间分别为26个月(95％CI13～38)、19个月(95％CI11～26)、13个月(95％CI6～19),差异均有统计学意义(x2值分别为11.05、13.04、21.05,P值分别为0.001、0.000、0.000).结论 形态学异常是MDS患者在细胞学上的外在表现,Pelger-Hu(e)t异常、Auer小体、小巨核病态改变与转化为急性白血病及其预后有相关性,对指导预后有一定意义.%Objective To analyze the characteristics of dysplasia in patients with myelodysplastic syndromes (MDS),and identify the risk factors for evolution of MDS to acute leukemia.Methods According to the WHO criterion 2008 of MDS,98 cases were included.As the characteristics of dysplasia,cell morphology,cytogenetics and flow cytometry were analyzed in these patients.Results To the last follow-up,27 of 98 patients transformed to acute myeloid leukemia,including M2 (15 cases),M4 (10 cases),M6 (2 cases).Patients with abnormal Pelger-Hu(e)t had significantly higher risk for evolution of MDS to leukemia,when compared to those without Pelger-Hu(e)t (23/67 vs 4/36,x2 =4.87,P =0.03).Auer corpuscle and small nuclear pathological were also the risk factors of developing to leukemia (19/37 vs 8/61,x2 =16.87,P =0.000; 21/57vs 6/46,x2 =9.14,P =0.003,respectively).37 patients died,the median suvival time was 26 months (95 ％ CI 13-38) for patients with abnorrnal Pelger-Hu(e)t,19 months (95 ％ CI 11-26) for patients with Auer corpuscle,13 months (95 ％ CI 6-19) for patients with small nuclear pathology,respectively (x2 =11.05,13.04,21.05,P =0.001,0.000,0.000).Conclusion Abnormal Pelger-Hu(e)t,Auer corpuscle and small nuclear pathology are indentified as the risk factors for evolution of MDS to leukemia,and they are the infavorable predictors of survival.