细胞发育异常在骨髓增生异常综合征患者预后评估中的价值

目的:探讨骨髓细胞病态造血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:回顾性分析82例MDS患者骨髓细胞形态学、细胞遗传学及流式细胞术等相关资料，分析患者骨髓细胞病态造血特点及患者预后转归。结果:82例MDS患者中，25例转化为急性髓系白血病(AML)，其中45例存在原始细胞增多中20例转化为急性白血病，37例无原始细胞增多中5例转化为急性白血病，转化率差异有统计学意义(P=0.002)；20例存在Auer小体者中13例转化为急性白血病，62例无Auer小体者中12例转化为急性白血病，两组转化率差异有统计学意义(P=0.000 1)；31例小巨核病态改变者中15例转化为急性白血病，51例无小巨核病态改变者中10例转化为急性白血病，转化率差异有统计学意义(P=0.006)。其余病态造血未发现与转化为急性白血病有相关性(均P>0.05)。82例MDS患者中，27例死亡。其中存在原始细胞增多、Auer小体以及小巨核者，其生存时间较短。结论:原始细胞增多、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。

The prognostic value of dysplasia features in the patients of myelodysplastic syndromes

Objective:To investigate the characteristics of cell dysplasia in the patients of myelodysplastic syndromes (MDS)，and analyze the risk factors for evolution of MDS to acute leukemia.Methods:The characteristics of dysplasia，cytogenetics and flow cytometry of 82 MDS patients were retrospectively analyzed.Results:Of the 82 MDS patients，25 were converted to acute myeloid leukemia (AML).20 of 45 patients with increased primitive cells were developing to acute leukemia.13 of 20 patients with Auer's body were developing to acute leukemia，15 of 31 patients with nucleus pathology were developing to acute leukemia.The difference was statistically significant in the conversion rate (P=0.002，P=0.000 1，P=0.006).The survival time were shorter in the patients with increased primitive cells，Auer body and small nucleus pathology.Conclusion:Increased primitive cells，Auer body，small nucleus pathology were identified as the risk factors for evolution of MDS to acute leukemia.