摘要:
目的:探讨老年骨髓增生异常综合征临床特点、治疗效果及影响预后的因素.方法:回顾性分析1998年1月 –2015年12月我科收治的24例老年骨髓增生异常综合征患者,总结其流行病学特征、外周血象变化、WHO分型、IPSS评分等资料.按治疗方法分为4组,比较治疗前后血红蛋白水平、血小板计数及中性粒细胞计数,评价其治疗1个月、2个月及3个月后的疗效.总结难治性贫血患者的生存期,进行生存分析及COX模型建立,比较其治疗方法的优劣及影响患者预后的因素.结果:24例患者平均年龄为81岁,均为男性,常见心脑血管并发症,也可并发其他肿瘤.病例中难治性贫血(RA)患者的比例最高,达到79.2%,低危患者占大多数,比例达到87.5%.传统治疗方法、单用造血生长因子、氨磷汀联合造血生长因子、化疗的3个月有效率分别为60%、60%、93%、60%.氨磷汀联合造血生长因子可有效提高患者10年生存率,治疗3个月后的血红蛋白水平影响患者生存率.结论:老年骨髓增生异常综合征多发生于男性,以难治性贫血最多见,低危为主.氨磷汀联合造血生长因子治疗方案可有效改善患者长期预后.%Objective: To investigate the clinical characteristics, therapeutic effects and factors affecting prognosis in elderly myelodysplastic syndromes (MDS) patients. Methods: A total of 24 elderly MDS patients who were admitted into our department from January 1998 to December 2015 were retrospectively analyzed. Epidemiological features, changes in blood indexes, World Health Organization (WHO) cancer classification and the International Prognostic Scoring System (IPSS) were summarized. Patients were divided into 4 groups according to their treatment. Hemoglobin levels, platelet counts and neutrophil counts were measured and compared before and after treatment. The survival of patients with refractory anemia was assessed using Cox model and the efficacy of different treatment protocols and the factors affecting prognosis were compared. Results: The results showed that average age of patients was 81 years, and all were male. Cardiovascular and cerebrovascular co-morbidities were commonly observed, while there were some other concurrent cancers. Among the cases, refractory anemia (RA) accounted for 79.2% and low-risk patients accounted for 87.5%. The 3-month efficacies of the traditional treatment protocol, administration of hematopoietic growth factor alone, administration of hematopoietic growth factor and amifostine and chemotherapy were 60%, 60%, 93% and 60%, respectively. Combined treatment of amifostine and hematopoietic growth factor effectively enhanced patients' 10-year survival rate. Hemoglobin levels after 3 months of treatment affected patients' survival rate. Conclusion: It is concluded that MDS occur more often in male elderly patients, in which refractory anemia is most commonly found. Low-risk patients represented the majority. Combined treatment using amifostine and hematopoietic growth factor effectively improve the long-term prognosis of MDS patients.