维吾尔族和汉族骨髓增生异常综合征患者细胞形态学及免疫表型的对比分析

 【摘要】　目的　探讨新疆地区维吾尔族和汉族骨髓增生异常综合征（MDS）患者的细胞形态学和免疫表型特征。方法　对已确诊的67例MDS患者骨髓涂片进行系统观察分型，记录各系病态造血细胞，并进行流式细胞术（FCM）免疫表型检测。结果　67例MDS患者骨髓细胞的粒、红、巨核三系有不同程度的病态造血，依次为粒系[52例（77.6 %）]、巨核系[44例（65.7 %）]、红系[36例（53.7 %）]，维吾尔族和汉族患者骨髓三系中出现病态造血表现的比例相近，两组差异无统计学意义（χ2值分别为1.02、0.30、0.02，均P＞0.05）。67例骨髓细胞病态造血改变类型的发生率依次为单圆核巨核细胞 [36例（53.7 %）]、假Pelger核异常粒细胞 [36例（53.7 %）]、红系巨幼样变[33例（49.3 %）]、粒细胞颗粒减少或缺失[27例（40.3 %）]等，维吾尔族和汉族患者发生率相似。67例MDS患者FCM免疫表型检测结果显示，随着MDS的难治性贫血／难治性贫血伴环形铁粒幼细胞向难治性贫血伴原始细胞过多（RAEB）／转化中的RAEB的进展变化，较成熟的CD15表达率逐渐降低，而较早期的CD34、CD117表达率逐渐升高（χ2值分别为6.23、12.06，8.95、7.37，8.95、8.08，均P＜0.05），维吾尔族和汉族患者差异无统计学意义（χ2值分别为0.715、0.024、0.146，均P＞0.05）；同时维吾尔族患者CD56表达增高，汉族MDS患者HLA-DR增高，两组比较差异有统计学意义（χ2值分别为3.91、3.90，均P＜0.05）。结论　维吾尔族和汉族MDS患者骨髓细胞形态学病态造血改变相同，多数MDS有两系以上的病态造血。维吾尔族和汉族MDS患者免疫表型抗原表达部分不同，免疫表型的检测对MDS的诊断、分型及预后具有重要意义。

Comparison analysis of cellular morphology and immune phenotypic in Uygur and Han patients with myelodysplastic syndrome

【Abstract】　Objective　To investigate the cell morphology and immune phenotypic characteristics in Uygur and Han patients with myelodysplastic syndrome (MDS) in Xinjiang Uygur Autonomous Region. Methods　Bone marrow smears of 67 cases diagnosed as MDS were systematicly observed and recorded, flow cytometry (FCM) was used to test the immunophenotyping. Results　There were abnormal hematopoiesis in different extent in granulocyte series, erythron series and megakaryocytic series of all patients. Occurence of pathological hematopoietic performance in Uygur patients with MDS was similar to that in Han, granulocyte series [52 cases (77.6 %)] >megakaryocytic series [44 cases (65.7 %)] > erythrocyte series [36 cases (53.7 %)], the differences in two groups were not significant (χ2 values 1.02, 0.30, 0.02, respectively, all P > 0.05). The changes type of pathological hematopoietic performance in two groups were similar, single garden nuclear megakaryocyte [36 cases (53.7 %)], false Pelger nuclear anomaly granulocyte [36 cases (53.7 %)], erythroid gigantic young cell change [33 cases (49.3 %)], granulocyte cell particles reduced or absent [27 cases (40.3 %)] etc. The result of FCM showed that along with the progressive change of RA/RAS to RAEB/RAEB-t, the expression ratios of mature CD15 were decreased, while the expression ratios of early stage CD117 and CD34 were raised gradually (χ2 values 6.23, 12.06, 8.95, 7.37, 8.95, 8.08, respectively, all P < 0.05), the differences in two groups were not significant (χ2 values 0.715, 0.024, 0.146, respectively, all P > 0.05). Meanwhile, Uygur patients with MDS has great expression of CD56 and Han had HLA-DR, there were significantly differences in two groups (χ2 values 3.91 and 3.90, respectively, both P < 0.05). Conclusion　Occurence of pathological hematopoietic performance in Uygur patients with MDS are similar to that in Han. Most MDSs has two or more levels of pathological hematopoietic performance. The differences of immunophenotype characteristics in two groups are partially significant and test of immunophenotype are helpful in the diagnosis, classification, prognosis of MDS.