原位检测细胞凋亡率及增殖率对骨髓增生异常综合征的诊断意义

观察原位检到骨髓细胞凋亡率及增殖细胞核抗原(PCNA)表达率在MDS临床鉴别、疗效观察及向白血病转化中的诊断作用。采用原位末端转移酶介导标记(TUNEL)法和免疫组化ABC法对60例MDS，30例AML，21例CAA，16例溶血性贫血，15例巨幼细胞性贫血以及30例正常对照进行检到，统计凋亡细胞阳性率及PCNA表达率。结果发现，骨髓有核细胞凋亡率及PCNA表达率在各类疾病的表达有显差异，低增生MDS可与其他疾病相鉴别，MDS转化的白血病与原发白血病的骨髓有核细胞凋亡率及PCNA表达率无差异，临床治疗对MDS组，CAA组，AML组骨髓有核细胞凋亡率及PCNA表达率有显影响。结论：原位检测骨髓有核细胞凋亡率及PCNA阳性表达率可作为MDS临床诊断、鉴别诊断的有效方法，临床治疗对凋亡率及PCNA表达率有明显影响，可作为疗效判断指标之一。

Significance of In Situ Identification of Apoptosis and Proliferation Rates in Diagnosis of Myelodysplastic Syndromes

In order to investigate the significance of apoptosis and proliferation rates in differential diagnosis, evaluating curative effect and leukemia transformation in myelodysplastic syndromes, apoptosis index (AI) and proliferating index (PI) were assayed in marrow smears from 60 cases of MDS, 30 AML, 21 chronic aplastic anemia (CAA), 16 hemolytic anemia, 15 megaloblastic anemia and 30 normal controls. The apoptotic cells were assayed with TUNEL technique and proliferating cell nuclear antigen (PCNA) by immunohistochemical method in situ. The results showed that average AI in marrow smears from 39 cases with MDS prior therapy was (11.2 +/- 8.8)% and PI was (17.3 +/- 8.7)%, significant differences were observed in MDS group and normal control group, as well as in AML, CAA, megaloblastic anemia and hemolytic anemia groups. Hypoplastic MDS can be distinguished from CAA by AI and PI. Clinical therapy induced significant alteration of AI and PI in MDS, AML and CAA. After therapy of MDS, the AI dropped from (11.2 +/- 8.8)% to (6.6 +/- 0.7)%. It was concluded that examination of AI and PI of marrow cells in situ may provide valuable prognostic information, also can contribute to evaluate therapeutic effectiveness.