| ObjectiveIn this study,by collecting the clinical data of patients with myelodysplastic syndrome(MDS)including gender,age,diagnostic classification,prognostic risk,blood transfusion volume,iron metabolism index,and blood stasis syndrome score to discuss the clinical characteristics of MDS iron overloading,and analyzed the relationship between MDS iron overload and blood stasis.It can guide the clinical physicians to pay attention to the MDS iron overload and provide traditional Chinese medicine(TCM)syndrome differentiation reference basis.And it will better guide the clinical diagnosis and treatment of MDS patients with iron overload in Chinese medicine.MethodsA total of 66 patients with MDS from December 2019 to December 2021 were included according to the criteria.We need to collect the clinical data of patients with MDS including gender,age,diagnostic classification,prognostic risk,blood transfusion volume,iron metabolism index,and blood stasis syndrome score to discuss the clinical characteristics of MDS iron overloading and analyze the relationship between MDS iron overload and blood stasis.Results1.Comparison of clinical characteristics between iron overload and non-iron overload patients with MDS① Comparison of gender between MDS iron overload and non-iron overload groups.Among 36 MDS iron overload patients,27 were males(75.0%)and 9 were females(25.0%).There were 30 patients with non-iron overload,including 16 males(53.3%)and 14 females(46.7%).Finally,there was no significant difference in gender between MDS patients with iron overload and non-iron overload by statistical analysis.(P>0.05).②Comparison of age between MDS iron overload and non-iron overload groups.The average age of MDS iron overload patients was(62.9±15.4)years old,and that of MDS non-iron overload patients was(61.3 ± 15.4)years old.Statistically,there was no significant difference between the average age of the MDS iron overload group and the MDS non-iron overload group(P>0.05).③ Comparison of the subtypes of MDS patients with iron overload and non-iron overload.There were 36 MDS iron overload patients,among which 7(19.4%)were diagnosed as MDS-EB1 subtype,6(16.7%)were diagnosed as MDS-EB2 subtype,and 13(36.1%)were diagnosed as MDS-MLD subtype.There were 5 patients(13.9%)diagnosed as MDS-RS subtype,0 patients(13.9%)diagnosed as MDS-SLD subtype,and 5 patients(13.9%)diagnosed as MDS-U subtype.There were 30 non-iron overload patients with MDS,including 4 patients diagnosed as MDS-EB1 subtype(13.3%),6 patients diagnosed as MDS-EB2 subtype(20.0%),and 8 patients diagnosed as MDS-MLD(26.7%),and 1 patient diagnosed as MDS-RS subtype(3.3%).8 patients were diagnosed as MDS-SLD subtype,accounting for 26.7%,and 3 patients were diagnosed as MDS-U,accounting for 10.0%.Statistical analysis showed that there was a significant difference in the MDS-SLD subtype between iron overload MDS and non-iron overload MDS groups(P<0.05).④Comparison of prognostic stratification between iron overload and non-iron overload MDS patients.The revised IPSS-R prognostic risk was divided,the patients with very low and low-risk MDS were divided into the lower risk group,and the patients with medium risk,high,and very high-risk MDS were divided into the higher risk group.Among MDS iron overload patients,there were 17 cases(47.2%)in the lower-risk group and 19 cases(52.8%)in the higher-risk group.In MDS patients with non-iron overload,22 cases(73.3%)were classified into the lower risk group,and 8 cases(26.7%)were classified into the higher risk group.According to statistical analysis,there was a significant difference in prognosis stratification between the iron overload MDS group and the non-iron overload MDS group(P<0.05),and the proportion of iron overload MDS patients in the higher risk group was significantly higher than that in the low-risk group(P<0.05).⑤ Comparison of blood transfusion volume between MDS iron overload and non-iron overload groups.In MDS iron overload group,there were 14 patients with blood transfusion volume<10U(38.9%),and 20 patients with blood transfusion volume>10U(74.1%).In MDS non-iron overload group,there were 29 patients with blood transfusion volume<10U(96.7%),and 1 patient with blood transfusion volume>10U(3.3%).Statistically,there was a significant difference in blood transfusion volume between the MDS iron overload group and MDS non-iron overload group(P<0.05).The proportion of blood transfusion volume<10U in patients with MDS iron overload(14/36,38.9%)was significantly lower than that in patients with non-iron overload(29/30,96.7%)(P<0.05),and the proportion of blood transfusion volume>10U in patients with MDS iron overload(22/36,61.1%)was significantly higher than that in patients with non-iron overload(1/30,3.3%)(P<0.05).⑥ Comparison of iron metabolism between MDS iron overload and non-iron overload groups.The serum ferritin of the MDS iron overload group was 2070.13±512.67,and that of the MDS non-iron overload group was 353.32±273.73.Statistical analysis showed that there was a significant difference in serum ferritin between MDS patients with iron overload and non-iron overload(P<0.05),and the level of serum ferritin in MDS patients with iron overload group was significantly higher than that in MDS patients with iron overload group(P<0.05).Among 66 MDS patients,10 patients were deficient in iron metabolism indexes such as transferrin,iron,and total iron-binding ability.Other iron metabolism indexes of 56 MDS patients in the iron overload group and non-iron overload group were analyzed.In the MDS iron overload group,transferrin was 1.97±0.60,serum iron was 31.45 ± 14.07,unsaturated iron was 10.31±11.14,transferrin saturation was 74.41±25.98,and total iron-binding force was 41.72±10.67.In MDS non-iron overload group,the measured values of transferrin were 2.46±0.70,serum iron 25.20±9.80,unsaturated iron 25.97±17.71,transferrin saturation 54.34±27.02 and total iron-binding force 50.30±12.72.Statistical analysis showed that except for serum iron,there was no significant difference between the MDS iron overload group and non-iron overload group(P>0.05),and there were significant differences in transferrin,transferrin saturation,unsaturated iron,and total iron-binding force between MDS iron overload group and non-iron overload group(P<0.05).2.Distribution of blood stasis syndrome in patients with MDS iron overloadAccording to analyze the quantitative standard of blood stasis syndrome,blood stasis quantization standard list(more than 4 points diagnosis of blood stasis)including tongue,complexion,skin,pain,bleeding,consciousness,mental consciousness the symptom such as signs,according to the degree of illness weight properly set(0),mild(1),moderate(2),severe(3 points).According to the total score of blood stasis syndrome from high to low sorting,face total integral 34,abnormal pulse condition total score 32,abnormal tongue like total 29,30,skin abnormalities total integral consciousness paresthesia total score 17 13,bleeding,pain,total integral total score 10,limb paresthesia total score 7,remove the lump,accumulated total score 3,abnormal mental consciousness total score 2.It can be seen that the most common symptoms of iron overload and blood stasis of MDS are abnormal complexion,pulse,tongue,and skin,followed by consciousness paresthesia,pain,and bleeding.Finally,symptoms of paresthesia,lump accumulation,and mental abnormality are rare.3.Comparison of clinical characteristics between blood stasis syndrome and non-blood stasis syndrome in iron overload MDS patients① Comparison of gender between MDS iron overload blood stasis syndrome and non-blood stasis syndrome.There were 27 MDS patients with iron overload blood stasis syndrome,including 19 males(70.4%)and 8 females(29.6%).There were 9 MDS patients with iron overload and non-blood stasis syndrome,including 8 males(88.9%)and 1 female(11.1%).Statistical analysis showed that there was no significant difference in gender between MDS iron overload blood stasis syndrome and non-blood stasis syndrome(P>0.05).②Comparison of age between MDS iron overload blood stasis syndrome and non-blood stasis syndrome groups.The average age of patients with MDS iron overload blood stasis syndrome and non-blood stasis syndrome was(65.59±13.77)years old,and(55.00 ± 17.98)years old in the non-blood stasis syndrome group.Statistically,there was no significant difference in the average age of the MDS iron overload blood stasis syndrome group and the non-blood stasis syndrome group(P>0.05).③Comparison of the subtypes between MDS iron overload blood stasis syndrome and non-blood stasis syndrome groups.There were 27 MDS patients with iron overload blood stasis syndrome including 6 MDS-EB1 patients(22.2%),6 MDS-EB2 patients(22.2%),and 8 MDS-MLD patients(29.6%).MDS--RS in 4 cases(14.8%)and MDS-U in 3 cases(11.1%);There were 9 patients without blood stasis syndrome,including 1 MDS-EB1(11.1%),0 MDS-EB2(0),5 MDS-MLD(55.6%),1 MDS-RS(11.1%),0 MDS-SLD(0),and 2 MDS-U(22.2%).According to statistical analysis,there was no significant difference in subtype diagnosis between MDS iron overload blood stasis syndrome and non-blood stasis syndrome(P>0.05).④Comparison of prognostic stratification between MDS iron overload blood stasis syndrome and non-blood stasis syndrome groups.The revised IPSS-R prognostic risk was divided,the patients with very low and low-risk MDS were divided into the lower risk group,and the patients with medium risk,high,and very high-risk MDS were divided into the higher risk group.Among MDS patients with iron overload blood stasis syndrome,there were 10 cases(37.0%)in the lower risk group and 17 cases(63.0%).7 cases(77.8%)of patients with non-blood stasis syndrome were classified into the low-risk group,and 2 cases(22.2%)were classified into the high-risk group.According to statistical analysis,there was no significant difference in prognostic risk stratification between MDS iron overload blood stasis syndrome and non-blood stasis syndrome(P>0.05).⑤Comparison of blood transfusion volume between MDS iron overload blood stasis syndrome and non-blood stasis syndrome.In MDS patients with iron overload blood stasis syndrome,7 patients with blood transfusion volume<10U accounted for 25.9%,and 20 patients with blood transfusion volume>10U accounted for 74.1%.In the non-blood stasis group,there were 7 patients with blood transfusion volume<10U(77.8%),and 2 patients with blood transfusion volume>10U(22.2%).According to statistical analysis,there was a significant difference in blood transfusion volume between the two groups,and the proportion of blood stasis syndrome increased with the increase in blood transfusion volume(P<0.05).⑥Comparison of blood stasis score between MDS iron overload blood stasis syndrome and non-blood stasis syndrome groups.The score of blood stasis syndrome of MDS with iron overload was(5.74±1.79)and that of non-blood stasis syndrome was(2.22 ± 1.09).Statistical analysis showed that there was a significant difference in the score of blood stasis syndrome in MDS patients with iron overload and non-blood stasis syndrome,and the score of iron overload and blood stasis syndrome was significantly higher than that of non-blood stasis syndrome(P<0.05).3.Correlation analysis of clinical characteristics and blood stasis syndrome of MDS patients with iron overload.Spearman correlation analysis was conducted on iron metabolism indexes,blood transfusion volume,and blood stasis syndrome score of 36 MDS patients with iron overload after the normality test.Serum ferritin was significantly positively correlated with blood stasis syndrome score(r=0.542,P<0.05).There was a significant negative correlation between transferrin and blood stasis syndrome score(R=-0.350,P<0.05).There was no correlation between iron clearance,transferrin saturation,total iron-binding ability,and blood stasis syndrome score(P>0.05).There was a significant positive correlation between blood transfusion volume and blood stasis score(R=0.739,P<0.05).Conclusions① The proportion of patients with iron overload in MDS compared with non-iron overload patients was significantly different in MDS-SLD subtypes,prognostic stratification,transfusion volume,and iron metabolism-related indicators.Furthermore,the proportion of patients with high prognosis risk,high transfusion volume,high serum ferritin,and transferrin saturation,or low transferrin,unsaturated iron,and total iron-binding was significantly higher in the iron overload group than in the non-iron overload.In addition,the proportion of patients with MDS-SLD subtype,low transfusion volume was significantly lower in the iron overload group than in the non-iron overload.② MDS iron overload patients who met the criteria for blood stasis evidence were 75.0%.In MDS iron overload blood stasis,the most common symptoms were abnormal pulse,abnormal tongue,abnormal facial color,and abnormal skin.③ The score of MDS iron overload blood stasis syndrome was significantly positively correlated with serum ferritin and blood transfusion volume,and negatively correlated with transferrin. |
