摘要
目的通过计算机网格计点法定量分析骨髓增生异常综合征(MDS)患者网硬蛋白纤维化强度(RFD),初步探讨其与患者预后相关性。方法观察2017年2月至2019年12月就诊于上海市同仁医院血液科的32例初发MDS患者骨髓切片,经Gomori染色后光学显微镜成像系统摄片,依据网型测微器原理建立计算机网格记点软件,对患者骨髓切片RFD进行定量分析,比较其与人工半定量法统计骨髓纤维化程度异同,Cox回归方法进一步研究RFD值与MDS预后的相关性。结果32例患者中男17例,女15例,中位年龄69岁(32~91岁)。计算机计点法定量分析RFD与人工半定量法分析骨髓纤维化程度呈正相关(r=0.497,P=0.004)。初发MDS伴原始细胞增多(MDS-EB)组患者骨髓RFD较非MDS-EB组患者明显增高(9.55%±0.75%比1.71%±0.23%,P<0.001);Cox回归模型分析表明RFD值相比人工半定量分析骨髓纤维化程度更具有预后评估价值,初发骨髓RFD值为MDS患者预后不良因素(RR=1.337,95%CI:1.085~1.648,P=0.006)。初发RFD>5.54%患者的总生存(OS)明显短于RFD≤5.54%的患者(P=0.001)。初发RFD>9.81%MDS-EB患者的OS明显短于RFD≤9.81%患者(P=0.003)。结论骨髓纤维组织异常增生是MDS患者预后不良的潜在高危因素。
Objective To quantitatively analyze the reticulin fiber intensity density(RFD)in patients with myelodysplastic syndrome(MDS)by using the computer-aided grid point method,and preliminarily explore its correlation with the prognosis of MDS patients.Methods Bone marrow(BM)slices from 32 primary MDS patients treated in Tongren Hospital Shanghai Jiao Tong University School of Medicine from February 2017 to December 2019 were observed.Images were taken by the optical microscope imaging system after the Gomori staining.The computer grid marking software was developed according to the principle of the mesh micrometer to assess RFD,meanwhile,the artificial semi-quantitative were used to assess the fibrosis of bone marrow.The co-relation between the above two methods was evaluated,and the relationship between RFD and prognosis of MDS patients were further investigated with Cox regression analysis.Results Of the patients,there were 17 males and 15 females with a median age of 69 years(32-91 years).The RFD quantitatively analyzed by the computer-based method was positively correlated with the myelofibrosis grade by the artificial semi-quantitative analysis(r=0.497,P=0.004).The RFD in patients diagnosed with MDS complicated with excess blasts(MDS-EB)was significantly higher than that in the non-MDS-EB group((9.55%±0.75%)vs(1.71%±0.23%),P<0.001).Cox regression model analysis showed that the RFD of MDS patients had better prognostic value when compared with the artificial semi-quantitative analysis,which was also a poor prognostic factor(RR=1.337,95%CI:1.085-1.648,P=0.006).The overall survival(OS)of patients with RFD>5.54%was significantly shorter than that with RFD≤5.54%(P=0.001).The OS of MDS-EB patients with RFD>9.81%was significantly shorter than that in patients with RFD≤9.81%(P=0.003).Conclusion Abnormal proliferative fibrosis of bone marrow is a potential high-risk factor for poor prognosis of MDS patients.
作者
翟元梅
蒋雪玮
张庭华
常莉
赵莉敏
杨莉
翁巍
刘立根
Zhai Yuanmei;Jiang Xuewei;Zhang Tinghua;Chang Li;Zhao Limin;Yang Li;Weng Wei;Liu Ligen(Department of Hematology,Tongren Hospital Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第31期2460-2464,共5页
National Medical Journal of China
基金
上海交通大学“医工交叉基金”(YG2017QN61)。
作者简介
通信作者:刘立根,Email:liuligen@shsmu.edu.cn。
