To identify the best evidence in the management of indicator, short and long term of prophylactic platelet transfusion in patient with myelodysplastic syndrome (MDS). We searched the latest evidence-based guidelines in PubMed,reviewed and appraised these guidelines. Clinical decision was made based on the guidelines and the actual patient with MDS. Perfect treatment effect was obtained through evidence-based clinical decision.
目的 探讨骨髓增生异常综合征（MDS）患者的临床特点。 方法 选取我院2008年3月－2012年10月确诊为MDS的231例患者临床资料进行回顾性分析。患者年龄21～87岁，中位年龄59岁。 结果 231例患者中，难治性血细胞减少伴多系发育异常（RCMD）最多见，占45.0%（104/231）；以贫血乏力症状就诊多见占66.7%（154/231）；血常规中以全血细胞均减少多见占61%（141例/231例）；网织红细胞以正常或增高为主占61%（141/231）；低荧光值增高多见62%（144/231）。乳酸脱氢酶和铁蛋白在各诊断亚型及各国际预后积分系统（IPSS）评分间存在差异，其中乳酸脱氢酶在难治性贫血伴原始细胞增多2型（RAEB-2）中高于综合组：难治性贫血（RA）、 难治性贫血伴环状铁粒幼细胞（RAS）、5q?综合征及RCMD相比较差异有统计学意义（P＜0.05），高危组乳酸脱氢酶高于中危1组及中危2组，其差异有统计学意义（P＜0.05），高危组铁蛋白高于中危1组其差异有统计学意义（P＜0.05），其余差异无统计学意义（P＞0.05）。染色体异常率为39%，其中20例为复杂染色体核型，IPSS评分中危1最多见为52.4%（55/105）。 结论 MDS临床表现多样，缺乏特异性，需综合骨髓涂片、活检、细胞遗传学的结果提高诊断率。
目的:探讨骨髓细胞形态学变化特征在鉴别诊断骨髓增生异常综合征(MDS-RA)及巨幼红细胞性贫血(MA)中的意义。方法:骨髓片瑞氏染色,记数骨髓中有核细胞200个,并观察其形态。结果:(1)MDS的骨髓象除巨幼样变外,还有形态的异常。以淋巴样小巨核细胞最具有诊断意义。(2)巨幼红细胞性贫血三系血细胞的巨变程度比MDS-RA明显.结论:MDS-RA与MA细胞形态学既具有相似性,又具有各自不同特征。
ObjectiveTo systematically review the effectiveness and safety of demethylation agents in patients with myelodysplastic syndrome. MethodsRandomized controlled trials (RCTs) about demethylation agents in treating myelodysplastic syndrome was electronically searched in PubMed, EMbase, The Cochrane Library (Issue 3, 2013), Web of Science, CNKI, VIP, WanFang Data and CBM from inception to March 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Meta-analysis was performed using RevMan 5.1 software. ResultsA total of 4 studies involving 816 patients were finally included. The results of meta-analysis showed that:for patients with myelodysplastic syndrome at middle/advanced stage, compared with the best supportive treatment plan, demethylation agents improved complete remission (CR) (OR=19.14, 95%CI 5.33 to 68.7, P < 0.000 01), partial remission (PR) (OR=20.63, 95%CI 5.76 to 73.93, P < 0.000 01), hematological improvement (HI) (OR=3.58, 95%CI 2.40 to 5.34, P < 0.000 01), and the incidences of Grade Ⅲ or Ⅳ neutropenia (OR=3.82, 95%CI 2.67 to 5.47, P < 0.000 01), Grade Ⅲ or Ⅳ thrombocytopenia (OR=3.98, 95%CI 2.55 to 6.23, P < 0.000 01), and mortalities (OR=0.52, 95%CI 0.35 to 0.77, P < 0.000 01), all with significant differences; and part of patients suffered from Grade Ⅲ or Ⅳ thrombocytopenia and tolerable adverse reaction caused by non-hematologic change. ConclusionCurrent evidence suggests that demethylation agents in treating myelodysplastic syndrome have apparently curative effects. Besides, it could prolong the time of turning into acute myelocytic leukemia, reduce mortalities, and improve patients' quality of life.
Objective To explore the prognostic value of red cell volume distribution width (RDW) for hematological malignancies. Methods PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were searched for related literatures on myelodysplastic syndrome, leukemia and other hematological malignancies and pretreatment RDW from the establishment of databases to April 5, 2022. The main statistical indicators were Hazard ratio (HR) and its 95% confidence interval (CI). Stata 12.0 SE software was used for analysis, and Q test was used to evaluate literature heterogeneity. Subgroup pooled analysis was used to evaluate the prognostic value of RDW. Results A total of 7 articles were included, with a total of 804 patients. A fixed-effect model was selected for meta-analysis, and the results showed that patients with elevated pretreatment RDW had worse overall survival [HR=2.91, 95%CI (2.01, 4.22), I2=0%, P=0.714]. The results of subgroup analysis for different types of diseases showed that in myelodysplastic syndrome group [HR=2.61, 95%CI (1.28, 5.31), I2=22.0%, P=0.258)], chronic myeloid leukemia group [HR= 3.24, 95%CI (1.91, 5.51), I2=0%, P=0.546], and adult T-cell leukemia/lymphoma group [HR=2.64, 95%CI (1.22, 5.70)], the overall survival rate of patients with elevated pretreatment RDW were worse. Sensitivity analysis showed that the study was stable and there was no heterogeneity in the overall study result.Conclusion Elevated pretreatment RDW is associated with overall survival and can be used as an indicator for evaluating the prognosis of hematological malignancies, but large sample studies are still needed to determine the best predictive cutoff for various diseases.
Objective To explore the mode and role of differential expression of circular RNAs (circRNAs) in myelodysplastic syndrome (MDS). Methods We preprocessed and analyzed the circRNA expression profile datasets GSE163386, GSE94591, and GSE81173 in the GEO (Gene Expression Omnibus) database. By using the circBank database and the ENCORI, miRDB, and miRWalk databases to predict microRNAs (miRNAs) that interacted with differentially expressed circRNAs and messenger RNAs (mRNAs), the circRNA-miRNA-mRNA axis was constructed. We retrieved miRNAs related to MDS in PubMed and further obtained competing endogenous RNA (ceRNA) networks related to MDS by taking intersections. Results Through analysis, 128 differentially expressed circRNAs were identified, 48 highly expressed, and 80 low expressed. Among differentially expressed circRNAs with multiple differences>10, 3 were upregulated and 11 were downregulated. Through analysis, 101 differentially expressed mRNA were identified, with 9 upregulated and 92 downregulated. Intersecting with the MDS related miRNAs retrieved by PubMed, we further obtained the MDS related ceRNA network, namely circRNA (has_circ_0061137)-miRNA (has-miR-16-5p)-mRNA (RUBCNL, TBC1D9, SLC16A6) and circRNA (has_circ_0061137)-miRNA (has-miR-125b-5p)-mRNA (CCR5, SLC16A6, IRF4), all of which were downregulated. Conclusion The ceRNA networks revealed in this study may help elucidate the circRNA mechanism in MDS.