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1、·428·中国实验血液学杂志JournalofExperimentalHematology2002;10(5):428-432原位检测细胞凋亡率及增殖率对骨髓增生异常综合征的诊断意义1龚 明,陈书长,陈 杰(中国医学科学院、中国协和医科大学、北京协和医院,北京100730;1北京中日友好医院,北京100029)摘要 观察原位检测骨髓细胞凋亡率及增殖细胞核抗原(PCNA)表达率在MDS临床鉴别、疗效观察及向白血病转化中的诊断作用。采用原位末端转移酶介导标记(TUNEL)法和免疫组化ABC法对60例MDS,30例AML,21例CAA,16例溶血性贫血,15例巨幼细胞性贫血以及
2、30例正常对照进行检测,统计凋亡细胞阳性率及PCNA表达率。结果发现,骨髓有核细胞凋亡率及PCNA表达率在各类疾病的表达有显著差异,低增生MDS可与其他疾病相鉴别,MDS转化的白血病与原发白血病的骨髓有核细胞凋亡率及PCNA表达率无差异,临床治疗对MDS组,CAA组,AML组骨髓有核细胞凋亡率及PCNA表达率有显著影响。结论:原位检测骨髓有核细胞凋亡率及PCNA阳性表达率可作为MDS临床诊断、鉴别诊断的有效方法,临床治疗对凋亡率及PCNA表达率有明显影响,可作为疗效判断指标之一。关键词 原位检测;细胞凋亡;增殖细胞核抗原;骨髓增生异常综合征中图分类号 R73317;R7
3、3313SignificanceofInSituIdentificationofApoptosisandProliferationRatesinDiagnosisofMyelodysplasticSyndromes1GONGMing,CHENShu2Chang,CHENJie(DepartmentofHematology,PekingUnionMedicalCollegeHospital,ChineseAcademyofMedicalSciencesandPekingUnion1MedicalCollege,Beijing100730,China;BeijingChina2
4、JapanFriendshipHospital,Beijing100029,China)AbstractInordertoinvestigatethesignificanceofapoptosisandproliferationratesindifferentialdiagnosis,evaluatingcurativeeffectandleukemiatransformationinmyelodysplasticsyndromes,apoptosisindex(AI)andproliferatingindex(PI)wereassyedinmarrowsmearsfrom
5、60casesofMDS,30AML,21chronicaplasticanemia(CAA),16hemolyticanemia,15megaloblasticanemiaand30normalcontrols.TheapoptoticcellswereassayedwithTUNELtechniqueandproliferatingcellnuclearantigen(PCNA)byimmunohistochemicalmethodinsitu.TheresultsshowedthataverageAIinmarrowsmearsfrom39caseswithMDSpr
6、iortherapywas(11.2±8.8)%andPIwas(17.3±8.7)%,significantdifferenceswereobservedinMDSgroupandnormalcontrolgroup,aswellasinAML,CAA,megaloblasticanemiaandhemolyticanemiagroups.HypoplasticMDScandistinguishedfromCAAbyAIandPI.ClinicaltherapyinducedsignificantalterationofAIandPIinMDS,AMLandCAA.Aft
7、ertherapyofMDS,theAIdroppedfrom(11.2±8.8)%to(6.6±0.7)%.ItwasconcludedthatexaminationofAIandPIofmarrowcellsinsitumayprovidevaluableprognosticinformation,alsocancontributetoevaluatetherapeuticeffectiveness.Keywordinsituidentification;apoptosis;proliferatingcelln