MDS-RA/RARS/RCMD患者外周血循环CD34+细胞计数的临床价值

doi:10.3969/j.issn.1673-8640.2018.05.003

摘要/Abstract

摘要：

目的探讨骨髓增生异常综合征（MDS）-难治性贫血（RA）/难治性贫血伴环形铁粒幼细胞增多（RARS）/难治性贫血伴多系异常（RCMD）患者外周血循环CD34⁺细胞计数的临床价值。方法采用流式细胞仪检测19名造血干细胞供者（正常对照者）、52例MDS-RA/RARS/RCMD患者外周血循环CD34⁺细胞百分比和计数。根据国际预后积分系统（IPSS）及世界卫生组织（WHO）分型预后积分系统（WPSS）,将MDS-RA/RARS/RCMD患者分为低危、中危Ⅰ、中危Ⅱ、高危及极低危、低危、中危、高危、极高危。评价外周血循环CD34⁺细胞计数与MDS-RA/RARS/RCMD患者临床特点的相关性。结果 MDS-RA/RARS/RCMD患者外周血循环CD34⁺细胞百分比和计数均高于正常对照者（P<0.01）,外周血循环CD34⁺细胞计数与患者性别、年龄、外周血血细胞减少程度、白细胞计数下降、幼稚前体细胞异常定位（ALIP）现象均无相关性（r<0.625,P>0.05）,而与染色体核型异常、IPSS预后积分、WPSS预后积分、骨髓纤维化相关（r>0.995,P<0.01）。外周血循环CD34⁺细胞计数>10.00×10⁶/L的16例MDS-RA/RARS/RCMD患者中,有12例伴有复杂染色体核型异常,其中10例伴有7号染色体核型异常;有12例IPSS预后积分为中危Ⅱ;有13例WPSS预后积分为高危;9例伴有骨髓纤维化。36例外周血循环CD34⁺细胞计数<10.00×10⁶/L的患者均不伴有复杂染色体核型异常及7号染色体核型异常;所有患者IPSS预后积分均为低危或中危Ⅰ;除1例患者WPSS预后积分为高危外,其余患者的WPSS预后积分均为极低危、低危或中危;除1例患者伴有骨髓纤维化外,其余患者均不伴有骨髓纤维化。结论 MDS-RA/RARS/RCMD患者外周血循环CD34⁺细胞计数可出现异常增加,外周血循环CD34⁺细胞计数检测有助于对MDS患者疾病危险度的进一步分层。

关键词: 循环CD34⁺细胞, 外周血, 骨髓增生异常综合征

Abstract:

Objective To evaluate peripheral blood circulating CD34⁺ cell count in patients with myelodysplastic syndrome（MDS）-refractory anemia（RA）/refractory anemia with ring siderblasts（RARS）/refractory cytopenia with multilineage dysplasia（RCMD）. Methods A total of 52 MDS-RA/RARS/RCMD patients and 19 hematopoietic stem cell donors （healthy controls） were enrolled,and their peripheral blood circulating CD34⁺ cell percentages and counts were determined by flow cytometry. They were classified into low risk, intermediate-Ⅰ risk,intermediate-Ⅱ risk,high risk subgroups and very low risk,low risk, intermediate risk,high risk, very high risk subgroups according to the International Prognostic Scoring System （IPSS） and World Health Organization （WHO）-Based Prognostic Scoring System （WPSS）,respectively. The correlation of peripheral blood circulating CD34⁺ cell count with the clinical characteristics of MDS-RA/RARS/RCMD patients was analyzed. Results MDS-RA/RARS/RCMD patients had higher percentage and count of peripheral blood circulating CD34⁺ cells compared with healthy controls（P<0.01）. There was no correlation between peripheral blood circulating CD34⁺ cell count in MDS-RA/RARS/RCMD patients and patients' sex,age,cytopenia degree,white blood cell count decreasing and abnormal localization of immature precursor （ALIP）（r<0.625,P>0.05）,and there was correlation between peripheral blood circulating CD34⁺ cell count and abnormal karyotype,IPSS score, WPSS score and myelofibrosis（r>0.995,P<0.01）. There were 16 MDS-RA/RARS/RCMD patients with peripheral blood circulating CD34⁺ cell count >10.00×10⁶/L. Among them, there were 12 patients with complex karyotype abnormalities （10 patients with chromosome 7 abnormalities）. A total of 12 and 13 patients belonged to IPSS intermediate-Ⅱ risk and WPSS high risk subgroups,respectively. There were 9 patients with myelofibrosis. Among 36 MDS-RA/RARS/RCMD patients with peripheral blood circulating CD34⁺ cell count <10.00×10⁶/L,no patient had complex karyotype abnormalities or chromosome 7 abnormalities. Except for 1 patient in WPSS high risk subgroup,other patients were in IPSS low,intermediate-Ⅰ risk subgroups and WPSS very low,low and intermediate risk subgroups. Only 1 patient had myelofibrosis. Conclusions The count of peripheral blood circulating CD34⁺ cells increases in MDS-RA/RARS/RCMD patients,which can be further used for the classification of MDS risk.

Key words: Circulating CD34⁺ cell, Peripheral blood, Myelodysplastic syndrome

中图分类号:

R446.1

董海波, 曾慧, 张启国, 周敏, 袁翠英, 陈兵. MDS-RA/RARS/RCMD患者外周血循环CD34⁺细胞计数的临床价值[J]. 检验医学, 2018, 33(5): 388-392.

DONG Haibo, ZENG Hui, ZHANG Qiguo, ZHOU Min, YUAN Cuiying, CHEN Bing. Peripheral blood circulating CD34⁺ cell count in patients with MDS-RA/RARS/RCMD[J]. Laboratory Medicine, 2018, 33(5): 388-392.

图/表 3

参考文献 15

[1]	WAGNER-SOUZA K,DIAMOND H R,ORNELLAS M H,et al.Rhodamine 123 efflux in human subpopulations of hematopoietic stem cells:comparison between bone marrow,umbilical cord blood and mobilized peripheral blood CD34+ cells[J]. Int J Mol Med,2008,22(2):237-242.
[2]	CHICHA L,FEKI A,BONI A,et al.Human pluripotent stem cells differentiated in fully defined medium generate hematopoietic CD34- and CD34+ progenitors with distinct characteristics[J]. PLoS One, 2011,25(6):14733.
[3]	ALCHALBY H,LIOZNOV M,FRITZSCHE-FRIEDLAND U,et al.Circulating CD34(+) cells as prognostic and follow-up marker in patients with myelofibrosis undergoing allo-SCT[J]. Bone Marrow Transplant,2012,47(1):143-145.
[4]	关朝阳,张启国,欧阳建,等. 骨髓增生异常综合征和急性白血病患者外周血中CD34+水平的研究[J]. 南京医科大学学报(自然科学版),2010,30(6):847-849.
[5]	曾慧,张启国,欧阳建,等. 骨髓增殖性肿瘤患者外周血CD34+细胞水平及临床意义[J]. 江苏医药,2014,40(13):1550-1552.
[6]	CESANA C,KLERSY C,BRANDO B,et al.Prognostic value of circulating CD34+ cells in myelodysplastic syndromes[J]. Leuk Res,2008,32(11):1715-1723.
[7]	FUCHIGAMI K,MORI H,MATSUO T,et al.Absolute number of circulating CD34+ cells is abnormally low in refractory anemias and extremely high in RAEB and RAEB-t;novel pathologic features of myelodysplastic syndromes identified by highly sensitive flow cytometry[J]. Leuk Res,2000,24(2):163-174.
[8]	曾慧,张启国,欧阳建,等. 骨髓增生异常综合征患者外周血循环CD34+细胞计数的临床研究[J]. 临床肿瘤学杂志,2012,17(9): 832-835.
[9]	PONCHIO L,EAVES C,HOGGE D,et al.Both cycling and noncycling primitive progenitors continue to be mobilized into the circulation during the leukapheresis of patients pretreated with chemotherapy and G-CSF[J]. Br J Haematol,1997,99(2): 394-402.
[10]	曾慧,张启国,欧阳建,等. 全血细胞减少患者外周血循环CD34+细胞计数的临床意义[J]. 中华临床医师杂志(电子版),2013,7(11):5071-5073.
[11]	KNIPP S,STRUPP C,GATTERMANN N,et al.Presence of peripheral blasts in refractory anemia and refractory cytopenia with multilineage dysplasia predicts an unfavourable outcome[J]. Leuk Res,2008,32(1):33-37.
[12]	KAWANKAR N,VUNDINTI B R.Cytogenetic abnormalities in myelodysplastic syndrome: an overview[J]. Hematology,2011,16(3): 131-138.
[13]	HUSSAIN F T,NGUYEN E P,RAZA S,et al.Sole abnormalities of chromosome 7 in myeloid malignancies: spectrum,histopathologic correlates,and prognostic implications[J]. Am J Hematol,2012,87(7): 684-686.
[14]	JONAS B A,GREENBERG P L.MDS prognostic scoring systems-past, present, and future[J]. Best Pract Res Clin Haematol, 2015,28(1) :3-13.
[15]	江凤,王元元,岑建农,等. 骨髓增生异常综合征中CD34(+)细胞自噬活性及临床意义[J]. 中国实验血液学杂志,2016,24(3):779-783.