Objective: To investigate the distribution of peripheral blood lymphocytes and natural killer (NK) cells, and its influence on the prognosis of patients with myelodysplastic syndromes (MDS).
Methods: The lymphocytes proportion, absolute lymphocyte counts (ALC), NK cell proportion and absolute NK cell counts (ANKC) as well as the related data of 95 MDS patients diagnosed between 2013 and 2017 analyzed retrospectively. The correlation of ALC and ANKC with prognosis was also analyzed.
Results: As compared with low ALC patients, MDS patients with ALC≥0.885×109/L had a higher overall response rate (66.7% vs 35.8%) (P＜0.01). The ALC of effective patients after treatment significatitly increased in compaison of ALC at diagnosis. Multivariate analysis indicated that patients with ALC≥0.885×109/L had long overall survival (OS) time in comparison with patients with low level (16.4 vs 12.4 months) (P＜0.05). The OS time of patients with ANKC≥0.110×109/L was shorter in comparison with patients with low level (10.9 vs 16.3 months) (P＜0.01). Otherwise, blast, cytogenetic risks and treatment response were also independent risk factors of MDS (P＜0.05). Revised International Prognostic Scoring System (IPSS-R) combined with ANKC could improve predictive accuracy of IPSS-R alone (AUC 0.718 vs 0.674) (P＜0.05).
Conclusion: Lymphocytes and NK cells are important for the prognosis evaluation of MDS patients.
题目: 初诊骨髓增生异常综合征患者自然杀伤细胞分布特点及与预后的相关性.
目的: 分析骨髓增生异常综合征（MDS）患者外周血淋巴细胞及自然杀伤（NK）细胞的分布及其对预后的影响.
方法: 回顾性分析2013年-2017年就诊的95例初诊MDS患者的淋巴细胞比例和绝对值（ALC），NK细胞比例和绝对值（ANKC）及相关临床资料，分析各指标与预后的关系，应用曲线下面积（AUC）评估预后模型的精确度.
结果: 与低ALC的MDS患者相比,初诊MDS患者中，ALC≥0.885×109/L的患者治疗后的总体反应（OR）率较高（66.7% vs 35.8%）（P＜0.01）；治疗有效的患者，ALC较初诊时显著增高（0.959±0.510）×109/L vs (1.448±1.009)×109/L（P＜0.05）。多因素生存分析显示，ALC≥0.885×109/L者总生存（OS）时间较长（16.4 vs 12.4个月，P＜0.05）；ANKC≥0.110×109/L者OS时间较短（10.9 vs 16.3个月，P＜0.01）。此外，原始细胞、染色体分型及疗效也是影响MDS患者预后的独立危险因素（P＜0.05）；修正的国际预后积分系统（IPSS-R）联合ANKC（IPSS-RN）能提高单一的IPSS-R对预后提示的精确度（AUC之比为0.718 vs 0.674，P＜0.05）.
结论: 淋巴细胞及NK细胞对MDS患者预后评估有较重要意义.