Abstract
目的研究骨髓增生异常综合征(MDS)患者铁代谢参数和临床特征。方法对2015年6月至2016年3月间初诊未经祛铁治疗的94例MDS患者的铁代谢参数和临床特征进行回顾性调查。结果94例初治MDS患者中,71例(75.53%)贫血,56例(59.57%)存在输血依赖,52例(55.32%)存在铁过载。IPSS低危/中危-1较中危-2/高危铁过载多见(P<0.01)。铁过载组和非铁过载组比较,血清铁(SI)升高[36.5(8.5~64.7)µmol/L对25.2(3.7~45.3)µmol/L,P<0.01],转铁蛋白饱和度(TSAT)降低[43.5%(12.2%~77.2%)对53.4%(14.8%~97.5%),P<0.01],不稳定细胞铁(LCI)及细胞内活性氧簇(ROS)差异无统计学意义。靶器官(心、肝、胰岛等)功能临床资料比较中,铁过载组ALT及B型钠尿肽前体分别为25(3~158)U/L及190(6~4 281)ng/L,均明显高于非铁过载组的16(5~80)U/L及84(12~2 275)ng/L(P=0.03及P=0.05)。难治性贫血伴环状铁粒幼红细胞(RARS)患者与非RARS患者铁代谢参数差异均无统计学意义(P>0.05),输血依赖程度和输血量显著影响SI、TSAT及SF(P值均<0.01),但LCI及ROS组间差异无统计学意义。无输血依赖、非铁过载的38例患者中,骨髓红系病态造血、幼红细胞比例增高组LCI水平显著增高。结论初治MDS患者贫血及输血依赖现象较为常见,输血频率和输血量显著影响铁代谢参数。而无输血依赖的非铁过载患者骨髓红系病态造血、幼红细胞比例增高影响LCI水平,LCI可以作为衡量铁过载和铁分布重要的早期指标。
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