| Objective:Myelodysplastic syndrome is a heterogeneous group of clonal hematopoietic stem great cell disease.Analysis of the good risk group, peripheral blood, bone marrow morphology typing characteristics of Myelodysplastic syndrome,serum ferritin, lactate dehydrogenase,β2 - microglobulin, bone marrow morphology typing, cytogenetics and other characteristics of myelodysplastic syndrome to investigate prognostic factors and comparison of IPSS, WPSS, MDACC prognostic scoring system. To help clinicians determine the disease more effectively and choose the right treatment.Methods:We retrospectively analyzed 212 cases data of newly diagnosed Primary MDS in the First Affiliated Hospital of Nanchang University from January 2004 to December 2010.98 cases have followed up information.Type the myelodysplastic syndrome according to the WHO classification criteria, summarize and comparison survival rate of the main clinical manifestations, blood, bone marrow routine, bone marrow biopsy, chromosome and the characteristics of treatment options. Because of the number of cases happened to acute myeloidleukemia is small, and thus no longer analysis prognostic factors with acute myeloidleukemia. Compareing the IPSS, WPSS, MDACC line prognostic scoring system based on survival.All the data were analysised by SPSS 16.0 statistical software, measurement data as mean±standard deviation (x±s),indicated that more than three and the number of samples were compared using analysis of variance, if the statistical significance, then use LSD method analysis between two comparison; variety of non-normal data using the rank sum test; count data using Chi-square test, statistical analysis of the level of significance were selected a = 0.05, P<0.05 was considered statistically significant, the survival rate estimated by Kaplan-Meier method and compare survival with Log-Rank Check. Results:(1)212 cases of this group,73 patients≥60 years old,139 patients<60 years old, age range from 14 years old to 86 years old,the median age was 49 years old, and the incidence increased year by year. Older than 60 years between the two groups with less than 60 years old OS, P= 0.001, OS was significantly different between the two groups.(2) 212 cases of primary MDS patients peripheral blood cells three lines decreased have 105 patients, two-line reduction of 78 cases, single-line reduction of 29 cases; three groups of three lines to reduce the P OS= 0.000, the three groups was significantly different of OS.(3) 93 patients detectedβ2-MG,β2-MG were value of 2.29±1.18ug/L, whereβ2-MG≤2.0ug/L in 43 patients,β2-MG> 2.0ug/L in 50 cases, hemoglobin, white blood cells, platelets mean survival time ofβ2-MG≤2.0ug/L group were higher thanβ2-MG> 2.0ug/L group,β2-microglobulin in RA, RAS, RCMD, RAEB-Ⅰ, RAEB-Ⅱdifference between groups have not statistically significant.(4) 153 cases of primary MDS patients detection with LDH, the LDH mean was 271.80±84.32g/L, LDH in RA, RAS, RCMD, RAEB-Ⅰ, RAEB-Ⅱgradually increased, but comparison by LSD test, p> 0.05, between the sub-type of LDH was no significant difference.(5)Of all cases,144 cases did the SF test, SF mean was 633.95±225.12g/L, RA and RAEB-Ⅰcompared by the LSD test P<0.05, between the two groups has significant difference, RA and RAEB-Ⅱby the LSD between comparison test P<0.05, between the two groups has significant difference,In comparison between other groups p> 0.05 have no significant difference.(6)All patients did the bone marrow aspiration cytology, The reduction bone marrow cell proliferation be 14.6%, erythroid dysplasia changes mainly in the megaloblastic changes in red blood cells and multinucleated giant cells, granulocyte dysplasia mainly in the development is not nucleoplasm balance, false Pelger-Huet abnormalities, and changes in particle-based, megakaryocyte dysplasia mainly in appears small megakaryocyte.56 patients did bone marrow biopsy examination. Bone marrow hematopoietic tissue active, significantly active, extremely active in 47 cases (84%), extremely reduced, reducing the 9 patients (16%).28 patients (50%) have hematopoietic cell positioning disorder,39 patients (69.64%) have granulocyte immature premise cells abnormal localization (ALIP) phenomenon,42 patients (75%) have showed small megakaryocytes, pathological megakaryocytes. Bone marrow dysplasia with different coefficients of change in the WHO subtypes has no significant difference between groups (P> 0.05) and has no significant difference of OS (P= 0.062).(7) 122 cases of primary MDS found 33 cases of patients with clonal chromosomal abnormalities, abnormal detection rate of 27.05%, which commonly in +8,-7/7q-,-5/5q,-20/20q- chromosomal abnormalities. Assessment by IPSS score standards, low-risk group, intermediate risk group 1, intermediate risk group 2, high-risk group with higher risk in each group, the higher the incidence of chromosomal abnormalities. Prognosis according to IPSS karyotype groups, and poor prognosis the detection rate of chromosomal karyotypes in RA/RAS groups, RAEB-Ⅰgroup, RAEB-Ⅱgroup in turn increased significantly. Normal chromosomes, non-complex karyotype, complex karyotype differences between the three groups were significantly different overall survival。(8) 49 patients received follow-up data and chromosomal on the primary MDS patients with IPSS and WPSS, MDACC group, three prognostic scoring system showed that the time of diagnosis in patients able to make accurate judgments of their OS (P<0.0001), with the increase in risk groups The average and median OS OS decreased significantly. Three prognostic scoring systems have strong ties, but by comparison of the survival curve for the MDACC grading system to determine the best survival prognosis of primary MDS.Conclusion:(1) The disease of primary MDS gradually increasing in recent years and age≥60 years old poor prognosis.(2) Primary MDS patients with more tips, or three lines, two lines down, down coefficient the more the worse the prognosis; Bone marrow dysplasia can not determine the specific MDS subtypes and prognosis.(3) The hemoglobin, white blood cells, platelets mean survival time ofβ2-MG> 2.0ug/L group were lower than those of (β2-MG< 2.0ug/L, the level of the value have the relationship with progress of the disease and disease prognosis, it can be used in prognosis and disease monitoring of MDS patients.(4) Primary MDS patients with high LDH, LDH in the MDS subtypes have variability between the larger and overlap, according to LDH levels can not distinguish MDS subtypes.(5) SF in MDS patients is high, RAEB group was significantly higher than the RA group, SF has some clinical value to MDS patients on diagnosis, therapy and prognosis.(6) Chromosome to be detected as an important diagnostic indicator of karyotype analysis for the MDS and chromosome is very important in differential diagnosis, prognosis and monitoring of growth and decline of cloning.(7) IPSS and WPSS, MDACC have a better prognosis scoring system guide. MDACC is the best prognosis scoring system for forecast primary MDS. |
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