Comparison of clinical features and T lymphocyte subsets between myelodysplastic syndrome and aplastic anemia
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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 ① AA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。Abstract: 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 Sciences from January 1, 2021 to October 30, 2021 were selected. The proportion of Th1, Th2, Th17 and 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 ① AA 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 Th2 decreased(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 Th2 decreased(P< 0.05) and Th1/Th2 levels increased(P< 0.05); AA secondary MDS-MLD compared with primary 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.
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表 1 3组一般情况
例，X±S 项目 AA
(15例)AA继发MDS
(15例)原发性MDS
(15例)性别 男 9 7 7 女 6 8 8 年龄/岁 30.40±18.72 33.93±12.60 43.40±20.43 病程/年 5.00±3.93 9.07±7.88 2.00±1.41 输血 否 10 7 13 是 5 8 2 
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表 2 3组外周血常规结果
X±S 项目 AA(15例) AA继发MDS(15例) 原发性MDS(15例) F/HC P WBC/(×109·L-1) 2.69±0.90 2.49±1.09 3.03±2.65 0.932 0.628 RBC/(×1012·L-1) 2.77±1.02 2.67±1.06 2.39±0.94 1.580 0.454 HGB/(g·L-1) 90.33±33.72 86.60±36.46 77.20±24.19 0.675 0.514 PLT/(×109·L-1) 38.87±30.22 31.80±35.99 62.07±67.14 2.510 0.285 GR/% 33.61±15.41 49.12±22.78 46.27±19.67 2.672 0.081 LY/% 60.31±15.03 43.21±18.21 47.34±18.40 3.999 0.026
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表 3 3组骨髓像结果
例(%)，X±S 项目 AA
(15例)AA继发MDS
(15例)原发性MDS
(15例)增生度 Ⅰ级 0 0 1(6.67) Ⅱ级 0 2(13.33) 6(40.00) Ⅲ级 2(13.33) 8(53.33) 7(46.67) Ⅳ级 9(60.00) 1(6.67) 1(6.67) Ⅴ级 4(26.67) 4(26.67) 0 粒系形态 异常 0 10(66.67) 14(93.33) 未见异常 15(100.00) 5(33.33) 1(6.67) 红系形态 异常 0 12(80.00) 14(93.33) 未见异常 15(100.00) 3(20.00) 1(6.67) 巨核形态 异常 0 3(20.00) 6(40.00) 未见异常 15(100.00) 12(80.00) 9(60.00) 粒系/% 26.73±10.38 38.33±15.97 36.67±15.36 红系/% 8.37±12.64 28.07±16.44 47.07±18.36 粒红比 7.33±9.86 2.55±5.29 1.06±0.95 淋系/% 63.23±17.43 31.57±20.17 15.20±11.30
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表 4 3组T淋巴亚群结果
X±S 项目 AA(15例) AA继发MDS(15例) 原发性MDS(15例) F/HC P Th1细胞/% 7.39±2.38 8.81±2.85 9.78±3.28 2.646 0.083 Th2细胞/% 22.15±5.20 15.17±4.31 17.97±6.25 6.554 0.003 Th1/Th2 0.35±0.15 0.70±0.52 0.62±0.35 10.204 0.006 Th17细胞/% 4.80±2.36 7.49±2.74 5.07±1.97 5.848 0.006 Treg细胞/% 3.05±1.02 2.51±0.72 3.31±0.90 3.142 0.054 Th17/Treg 1.68±0.85 3.21±1.49 1.54±0.41 12.430 < 0.001
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