摘要
目的:探讨再生障碍性贫血(AA)、AA继发骨髓增生异常综合征伴多系病态造血(MDS-MLD)和原发性MDS-MLD外周血常规及骨髓像特点,并分析T淋巴细胞亚群情况,为临床诊疗提供依据。方法:选取2021年1月1日至2021年10月30日就诊的AA、AA继发MDS-MLD和原发性MDS-MLD患者各15例,用流式细胞仪检测外周血常规中Th1、Th2、Th17和Treg淋巴细胞比例,分析2组间T淋巴亚群差异,并收集所有患者入组时骨髓形态学和细胞遗传学信息。结果:①AA继发MDS-MLD相较于原发性MDS-MLD病程更长(P<0.01);②AA相较于AA继发MDS-MLD外周血常规中淋巴细胞百分比明显升高(P<0.05);③骨髓中AA继发MDS-MLD相较于AA红系增加(P<0.05)、淋系减少(P<0.01),原发性MDS-MLD相较于AA红系增加(P<0.01)、淋系(P<0.01)和粒红比(P<0.05)减少,原发性MDS-MLD相较于AA继发MDS-MLD淋系减少(P<0.05);④外周血中AA继发MDS-MLD相较于AA Th2细胞(P<0.01)减低,Th17细胞(P<0.01)、Th1/Th2(P<0.05)和Th17/Treg(P<0.01)增高;原发性MDS-MLD相较于AA Th2细胞(P<0.05)减低,Th1/Th2水平(P<0.05)增高;AA继发MDS-MLD相较于原发性MDS-MLD Th17细胞(P<0.01)和Th17/Treg(P<0.01)增高。结论:外周血常规和骨髓像中各系占比和细胞形态在AA和MDS-MLD鉴别中有重要作用,同时3组间T淋巴细胞各亚群存在差异,有助于临床诊疗。
Objective:To investigate the characteristics of peripheral blood and bone marrow images of aplastic anemia(AA),AA secondary MDS-MLD and primary MDS-MLD,and analyze the T lymphocyte subsets,so as to provide evidence for clinical diagnosis and treatment.Methods:Fifteen patients diagnosed as AA,AA secondary MDS-MLD and primary MDS-MLD in each group from Xiyuan Hospital,China Academy of Chinese Medical Sci-ences from January 1,2021to October 30,2021were selected.The proportion of Th1,Th2,Th17and Treg lymphocytes in peripheral blood images were detected by flow cytometry.The differences in T lymphocyte subsets between the two groups were analyzed,and bone marrow morphological and cytogenetic information of all patients at enrollment was collected.Results:①AA secondary MDS-MLD had a longer course of disease than primary MDS-MLD(P<0.01);②Compared with AA secondary MDS-MLD,the percentage of lymphocytes in AA was significantly increased(P<0.05);③In bone marrow,AA secondary MDS-MLD compared with AA the erythrocytes increased(P<0.05)and lymphocyte decreased(P<0.01);primary MDS-MLD compared with AA the erythrocytes increased(P<0.01),lymphocyte decreased(P<0.01)and the granulocyte to erythrocyte ratio decreased(P<0.05);primary MDS-MLD compared with AA secondary MDS-MLD lymphocyte decreased(P<0.05);④In the peripheral blood,AA secondary MDS-MLD compared with AA the Th2decreased(P<0.01),while Th17(P<0.01),Th1/Th2(P<0.05)and Th17/Treg(P<0.01)levels increased;primary MDS-MLD compared with AA Th2decreased(P<0.05)and Th1/Th2levels increased(P<0.05);AA secondary MDS-MLD compared with pri-mary MDS-MLD the Th17(P<0.01)and Th17/Treg levels(P<0.01)increased.Conclusion:The proportion of each line and cell morphology in peripheral blood and bone marrow images might play an important role in the identification of AA and MDS-MLD.At the same time,there were differences in T lymphocyte subsets among the three groups,which may be helpful for clinical diagnosis and treatment.
作者
王文儒
杜宇
许勇钢
王洪志
唐旭东
WANG Wenru;DU Yu;XU Yonggang;WANG Hongzhi;TANG Xudong(Department of Hematology,Xiyuan Hospital Affiliated to China Academy of Chinese Medical Sciences,Beijing,100091,China)
出处
《临床血液学杂志》
CAS
2022年第10期710-716,共7页
Journal of Clinical Hematology
基金
国家自然基金面上项目(No:81673819,No:82074258)
中国中医科学院科技创新工程重大攻关项目(No:CI2021A01701)。
