[红系细胞过碘酸-希夫染色在骨髓增生异常综合征中的意义研究]
[Study on the implications of erythroblasts periodic acid-Schiff stain in myelodysplastic syndromes].
作者信息
Liu Liu, Cui Wen, Zhang Hong-li, Xu Ze-feng, Zhang Feng-kui, Zheng Yi-zhou, Zhang Yue, Qin Tie-jun, Xiao Zhi-jian
机构信息
Institute of Hematology and Blood Diseases Hospital, The State Key Laboratory of Experimental Hematology, Tianjin 300020, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2011 Apr;32(4):259-64.
OBJECTIVE
To investigate the implications of erythroblasts periodic acid-Schiff (PAS) stain for myelodysplastic syndromes (MDS) dyserythropoiesis, diagnosis and differential diagnosis.
METHODS
PAS stain of bone marrow (BM) erythroblasts in 406 MDS patients, 207 non-severe aplastic anemia (NSAA), 144 immune thrombocytopenic purpura (ITP), 67 megaloblastic anemia (MegA), 76 iron deficiency anemia (IDA), 50 paroxysmal nocturnal hemoglobinuria (PNH), and 50 acute erythroid leukemia (AEL) as well as some related laboratory parameters in MDS patients were analyzed retrospectively.
RESULTS
PAS-positive detection rate was significantly higher in MDS (53.0%) than in NSAA (14.5%), ITP (27.1%) and PNH (16.0%), but was significantly lower in MDS than in AEL (84.0%) (all P = 0.000). There was no significant difference in PAS-positive detection between MDS and MegA (46.3%), or MDS and IDA (40.8%) (P = 0.310, 0.052, respectively). Erythroblasts PAS-positive rate (Median, M = 1%) and PAS-positive scores (M' = 2) was significantly lower in MDS than in AEL (M = 8%; M' = 17), and significantly higher than in NSAA (M = 0%; M' = 0), ITP (M = 0%; M' = 0), PNH (M = 0%; M' = 0), MegA (M = 0%; M' = 0), and IDA (M = 0%; M' = 0) (all P < 0.05). The cut-off value of PAS-positive rate and score for distinguishing MDS from the other groups except AEL were 0.5% and 0.5, with a sensitivity and specificity of 60.8% and 74.4%, respectively. For MDS patients, the percentage of BM erythroid cells was significantly higher in PAS-positive group than in PAS-negative group (P < 0.05), and so were megakaryocyte count, lymphocyte-like micromegakaryocytes count and percentage of micromegakaryocyte (P = 0.002, 0.000, 0.000, respectively). HGB, MCV, MCH and MCHC were significantly lower in PAS-positive group (all P < 0.05), and so was the neutrophil alkaling phosphatase (NALP) (P = 0.000). PAS-positive detection rate, positive rate and score were higher in MDS patients with abnormal karyotype than with normal karyotype, and were also higher in IPSS high/intermediate-risk 2 group than in low/intermidiate-risk 1 group.
CONCLUSION
The positive reaction of erythroblasts PAS stain is an indicator of dyserythropoiesis. It is helpful to the diagnosis of MDS patients.
目的
探讨幼红细胞过碘酸 - 希夫（PAS）染色对骨髓增生异常综合征（MDS）红系造血异常、诊断及鉴别诊断的意义。
方法
回顾性分析406例MDS患者、207例非重型再生障碍性贫血（NSAA）、144例免疫性血小板减少性紫癜（ITP）、67例巨幼细胞贫血（MegA）、76例缺铁性贫血（IDA）、50例阵发性睡眠性血红蛋白尿（PNH）和50例急性红系白血病（AEL）患者的骨髓幼红细胞PAS染色情况以及MDS患者的一些相关实验室参数。
结果
MDS患者的PAS阳性检出率（53.0%）显著高于NSAA（14.5%）、ITP（27.1%）和PNH（16.0%），但显著低于AEL（84.0%）（均P = 0.000）。MDS与MegA（46.3%）或MDS与IDA（40.8%）之间的PAS阳性检出率无显著差异（分别为P = 0.310、0.052）。MDS患者幼红细胞PAS阳性率（中位数，M = 1%）和PAS阳性积分（M' = 2）显著低于AEL（M = 8%；M' = 17），且显著高于NSAA（M = 0%；M' = 0）、ITP（M = 0%；M' = 0） 、PNH（M = 0%；M' = 0）、MegA（M = 0%；M' = 0）和IDA（M = 0%；M' = 0）（均P < 0.05）。区分MDS与除AEL外其他组的PAS阳性率和积分的截断值分别为0.5%和0.5，灵敏度和特异度分别为60.8%和74.4%。对于MDS患者，PAS阳性组的骨髓红系细胞百分比显著高于PAS阴性组（P < 0.05），巨核细胞计数、淋巴细胞样微巨核细胞计数及微巨核细胞百分比也显著高于PAS阴性组（分别为P = 0.002、0.000、0.000）。PAS阳性组的血红蛋白（HGB）、平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）和平均红细胞血红蛋白浓度（MCHC）显著降低（均P < 0.05），中性粒细胞碱性磷酸酶（NALP）也显著降低（P = 0.000）。核型异常的MDS患者的PAS阳性检出率、阳性率和积分高于核型正常者，国际预后评分系统（IPSS）高危/中危2组高于低/中危1组。
结论
幼红细胞PAS染色阳性反应是红系造血异常的指标，有助于MDS患者的诊断。
Zotero 插件