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本研究探讨骨髓增生异常综合征(MDS)中WHO亚型难治性贫血伴原始细胞增多II型(RAEB-II)的免疫学特征,并筛选出与MDS预后相关的免疫学指标。采用CD45/SSC双参数散点设门,应用三色流式细胞术对35例原发MDS患者骨髓标本进行流式细胞术检测,并对其进行随访。另外,选择同时期47例AML-M1、51例AML-M2及38例ALL初诊患者作为对照。对免疫分型结果结合随访应用SPSS13.0软件包进行数据处理。结果显示:RAEB-II患者高表达HLA-DR(100%),有较高的灵敏度及特异性。在RAEB-II中表达相对较高的还有CD13(94.74%)、CD33(84.21%)和CD117(78.95%)。与MDS其它亚型相比,CD13在REAB-II中的表达高于RCMD(p<0.01)及REAB-I(p<0.05);CD33、CD117(p<0.05)及干细胞抗原CD34(p<0.01)在RAEB-II中的表达高于RC-MD,但与RAEB-I的表达没有显著性差异(p>0.05)。与AML-M1和AML-M2相比,RAEB-II中CD13和CD117的表达无显著差别(p>0.05);CD33(p<0.01)和CD34(p<0.05)表达均低于AML-M1,而与AML-M2表达无显著差别(p>0.05);CD15(p<0.01)和CD11b(p<0.05)表达低于AML-M2,而与AML-M1相比表达无显著差别(p>0.05);RAEB-II中MPO的表达低于AML-M1和AML-M2(p<0.05);HLA-DR表达高于AML-M2(p<0.05),与AML-M1表达无显著差别(p>0.05)。与T-ALL相比,RAEB-II不表达CD2、CD3、CD5和CD8(阳性率为0%,p<0.01);CD4(p<0.05)和CD7(p<0.01)表达均低于T-ALL。与B-ALL相比,CD19和CD20在RAEB-II中不表达(阳性率为0%,p<0.01);CD10、CD22和cCD79a表达均低于T-ALL(p<0.05)。CD117(p=0.0197)及MPO(p=0.0085)是影响本组MDS总存活期(OS)的主要免疫学标志;Cox回归显示CD117(p=0.003)为OS最主要影响因素。结论:RAEB-II以髓系抗原表达为主,基本不表达或者低表达淋巴系抗原,似乎有着自己较独特的免疫表型特征。HLA-DR可作为RAEB-II的特异性指标与MDS其它亚型相鉴别。CD117有望成为判断MDS预后的独立指标。
This study was aimed to investigate the immunological characteristics of WHO subtype refractory anemia with rheumatoid arthritis II (RAEB-II) in patients with myelodysplastic syndrome (MDS) and to screen out the immunological parameters associated with the prognosis of MDS. Three-color flow cytometry was used to detect the bone marrow samples of 35 patients with primary MDS using CD45 / SSC double-parameter scatter gate. The patients were followed up. In addition, select the same period 47 cases of AML-M1, 51 cases of AML-M2 and 38 cases of newly diagnosed patients as a control. The results of immunophenotyping combined with follow-up application SPSS13.0 software package for data processing. The results showed that: RAEB-II patients with high expression of HLA-DR (100%), with high sensitivity and specificity. Relatively high expression in RAEB-II was also CD13 (94.74%), CD33 (84.21%) and CD117 (78.95%). The expression of CD13 in REAB-II was significantly higher than that of RCMD (p <0.01) and REAB-I (p <0.05) compared with other MDS subtypes; CD33, CD117 (p <0.05) and stem cell antigen CD34 ) Was higher in RAEB-II than in RC-MD, but not in RAEB-I (p> 0.05). The expression of CD13 and CD117 in RAEB-II had no significant difference compared with that of AML-M1 and AML-M2 (p> 0.05). The expression of CD33 (p <0.01) and CD34 (P> 0.05), while the expression of CD15 (p <0.01) and CD11b (p <0.05) was not significantly different from that of AML-M2 ); The expression of MPO in RAEB-II was lower than that of AML-M1 and AML-M2 (p <0.05); The expression of HLA-DR was higher than that of AML-M2 0.05). RAEB-II did not express CD2, CD3, CD5 and CD8 (0%, p <0.01), but both of CD4 (p <0.05) and CD7 (p <0.01) ALL. Compared with B-ALL, CD19 and CD20 were not expressed in RAEB-II (positive rate was 0%, p <0.01); CD10, CD22 and cCD79a expression were lower than T-ALL (p <0.05). CD117 (p = 0.0197) and MPO (p = 0.0085) were the main immunological markers affecting the overall survival (OS) of this group. Cox regression showed that CD117 (p = 0.003) was the most important factor for OS. Conclusion: The expression of myeloid antigen (RAEB-II) is predominant in myeloid antigen (RAIB-II), and lymphoid lineage antigen (RAIB-II) does not express or express low level. It seems that RAEB-II has its own unique immunophenotype. HLA-DR can be used as a specific indicator of RAEB-II and other subtypes of MDS. CD117 is expected to be an independent prognostic indicator for MDS.