摘要
目的研究铁调素及其相关因素对骨髓增生异常综合征(MDS)患者铁过载水平的评估价值。方法选取64例MDS患者,采用ELISA法对患者的外周血和骨髓铁调素水平进行测定;Real-Time PCR法测定骨髓生长分化因子15(GDF15)和扭转原肠胚形成同系物1(TWSG1)mRNA的表达;流式细胞仪对T淋巴细胞亚型(CD4^+、CD19^+)和极化进行测定;采用磁共振成像T2~*(MRI T2~*)技术对心脏和肝脏铁沉积程度进行测定;结合患者的血清铁蛋白(SF)、C反应蛋白(CRP)和促红细胞生成素(EPO)资料,对数据进行分析。结果 64例MDS患者外周血与骨髓的铁调素表达水平无明显差异(P=0.134)。根据WHO 2008分型分组,难治性贫血伴环形铁粒幼细胞增多(RARS)亚型的骨髓铁调素表达水平最低[(105.40±5.13)ng/mL],难治性贫血伴原始细胞增多(RAEB)亚型的骨髓铁调素表达水平最高[(335.71±25.16)ng/mL],各组间比较差异有统计学意义(P=0.041)。根据IPSS积分和WPSS积分分组,低危组和高危组骨髓铁调素表达水平比较差异均有统计学意义(P<0.05和P<0.01);但与WPSS低危组相比,WPSS高危组的SF和GDF15 mRNA均明显高表达(P<0.05),而IPSS低危组与高危组比较差异无统计学意义(P>0.05)。根据T淋巴细胞亚型和极化分组,CD4^+高表达组骨髓铁调素水平较正常组高(P<0.05);CD19^+高表达和正常组间骨髓铁调素水平比较无统计学意义(P=0.206);Th1/Th2>70.6组骨髓铁调素水平高于Th1/Th2≤70.6组(P<0.001)。将铁调素与SF、心脏T2~*值、肝脏铁浓度(LIC)(由肝脏T2~*值换算得到)做逐步回归分析,仅有LIC水平与铁调素存在相关性(r=0.582,P<0.001)。结论炎症对于调节铁调素表达至关重要,T淋巴细胞的活化及极化趋势可能在其中起到部分作用。MRI T2~*对于评估MDS患者铁过载水平的效能优于SF。
Objective To determine the role of hepcidin and related factors in evaluation of iron overload in patients with myelodysplastic syndromes （MDS）. Methods Sixty-four patients with MDS were enrolled. The hepcidin levels in peripheral blood and bone marrow were measured by ELISA, the expression of growth differentiation factor 15 （GDF15） and twisted gastrulation 1 （TWSG1） mRNA was detected by Real-Time PCR, T lymphocyte subtypes （CD4~ and CD19＋ lymphocytes） and T lymphocyte polarization were determined by flow cytometry, the deposition of iron in heart and liver was examined through magnetic resonance imaging T2＂ （ MRI T2＂ ）, and serum ferritin （SF）, C-reactive protein （CRP） and erythropoietin （EPO） levels were measured. Results There was no significant difference between hepcidin level in peripheral blood and that in bone marrow （P = 0. 134）. Stratified according to WHO 2008 subtypes, the hepcidin level in patients with refractory anemia with ringed sideroblasts （RARS） was the lowest [ （ 105.40 ＋ 5.13） ng/mL], and that in patients with refractory anemia with excess blasts （RAEB） was the highest [ （335.71 ＋ 25.16） ng/mL], and there were significant differences among groups （P = O. 041）. Stratified according to IPSS and WPSS, there were significant differences in hepcidin levels between low-risk group and high-risk group in two systems respectively （P 〈 O. 05 and P 〈 0.01）. The SF level and expression of GDF15 mRNA in WPSS high-risk group were significantly higher than those in WPSS low-risk group （P 〈0.05）, while there was no significant difference between IPSS low-risk group and IPSS high-risk group （P 〉 0.05）.Stratified according to T lymphocyte subtype and polarization, than that in normal expression group （ P 〈 0, 05）, but there the hepcidin level in CD4 ~ high-expression group was higher was no significant difference in the hepcidin levels between CD19 ＊ high-expression group and normal expression group （P = 0. 206）
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2013年第1期56-61,66,共7页
Journal of Shanghai Jiao tong University:Medical Science
关键词
铁调素
炎症
磁共振成像T2＊
hepcidin
inflammation
magnetic resonance imaging T2＊
