Objectives: To analyze the value of the WT1 mRNA expression level in the diagnosis and prognostic evaluation of myelodysplastic syndrome (MDS) . Methods: A total of 403 patients with MDS, suspected MDS, and acute myeloid leukemia secondary to MDS (AML-MDS) from eight clinical trial centers in China were included in this multicenter, prospective study. Nucleic acid was extracted from the peripheral blood (PB) and bone marrow (BM) samples and WT1 mRNA expression was measured using the WT1 mRNA assay kit. Results: A good correlation (r=0.778) was observed between the expression levels of WT1 mRNA in PB and BM. The expression levels of WT1 mRNA in both PB and BM increased with increasing FAB (French-American-British) or WHO (2008) (world health organization) classification scores, and increasing IPSS-R or WPSS-R prognostic scores. A statistically significant difference was observed in the expression levels of WT1 mRNA in PB and BM between MDS and AML-MDS patients (PB: 3.11±0.98 vs 4.57±0.53, P<0.05; BM: 3.73±0.93 vs 4.92±0.81, P<0.05). A statistically significant difference also existed in the expression levels of WT1 mRNA in PB and BM between the IPSS-R relatively low-risk group (extremely low-risk + low-risk) and the relatively high-risk group (medium risk + high risk + extremely high risk) MDS patients (PB: 2.60±0.76 vs 3.48±0.91, P<0.05; BM: 3.50±0.82 vs 3.89±0.97, P<0.05). Statistically significant differences were observed in the WT1 mRNA expression levels between the IPSS-R low-risk group (extremely low-risk + low-risk + moderate risk) and the high-risk group (high-risk + extremely high-risk) MDS patients in PB and BM (PB: 2.82±0.89 vs 3.61±0.85, P<0.05; BM: 3.61±0.84 vs 3.92±1.05, P<0.05). Statistically significant differences were also observed in the expression levels of WT1 mRNA in PB and BM of MDS patients between the WPSS-R relatively low-risk group (extremely low-risk + low-risk + moderate risk) and the relatively high-risk group (high-risk + extremely high-risk) (PB: 2.56±0.79 vs 3.61±0.82, P<0.05; BM: 3.45±0.83 vs 3.93±1.00, P<0.05) . Conclusion: A good correlation was observed between the expression levels of WT1 mRNA in PB and BM specimens of MDS patients, and the expression level of WT1 mRNA is related to the disease risk of MDS.
目的： 分析WT1 mRNA表达量对骨髓增生异常综合征（MDS）诊断及预后评估的价值。 方法： 此项多中心、前瞻性研究纳入国内8个临床试验中心403例MDS、疑似MDS和继发于MDS的急性髓系白血病（AML-MDS）患者，同时取外周血（PB）和骨髓（BM）样本，提取核酸，用WT1 mRNA测定试剂盒测定WT1 mRNA表达量。 结果： PB和BM中WT1 mRNA表达量有很好的相关性（r＝0.778）。PB和BM中的WT1 mRNA表达量均随FAB或WHO（2008）分型的严重程度及IPSS-R或WPSS-R预后评分的增高而升高。MDS与AML-MDS患者PB和BM中WT1 mRNA的表达量差异有统计学意义（PB：3.11±0.98对4.57±0.53，P<0.05；BM：3.73±0.93对4.92±0.81，P<0.05）。IPSS-R相对低危组（极低危+低危）与相对高危组（中危+高危+极高危）MDS患者PB和BM中WT1 mRNA表达量的差异均有统计学意义（PB：2.60±0.76对3.48±0.91，P<0.05；BM：3.50±0.82对3.89±0.97，P<0.05）。IPSS-R相对低危组（极低危+低危+中危）与相对高危组（高危+极高危）MDS患者PB和BM中WT1 mRNA表达量的差异均有统计学意义（PB：2.82±0.89对3.61±0.85，P<0.05；BM：3.61±0.84对3.92±1.05，P<0.05）。WPSS-R相对低危组（极低危+低危+中危）和相对高危组（高危+极高危）MDS患者PB和BM中WT1 mRNA表达量的差异均有统计学意义（PB：2.56±0.79对3.61±0.82，P<0.05；BM：3.45±0.83对3.93±1.00，P<0.05）。 结论： MDS患者PB与BM标本中WT1 mRNA的表达量有较好的相关性，且WT1 mRNA表达水平与MDS的疾病危险程度相关。.
Keywords: Bone marrow; Myelodysplastic syndromes; Peripheral blood; Prognosis; RNA, messenger.