中文摘要：

目的 探讨合并疾病对骨髓增生异常综合征（MDS）患者预后的影响.方法 回顾性分析676例连续入组有详细合并疾病评估的MDS患者临床资料并进行统计学分析.结果 676例患者中395例（58.4％）伴有合并疾病（合并疾病组）,281例（41.6％）不伴合并疾病（无合并疾病组）.两组患者≥60岁比例（32.4％对18.5％）、骨髓原始细胞比例中位数[0.035（0～0.190）对0.025（0～0.190）]、染色体核型异常比例（37.5％对35.9％）、分型诊断构成比和修正版国际预后积分系统（IPSS-R）分组比较,差异均有统计学意义（P值均＜ 0.05）.多因素COX分析证实合并疾病为影响患者总生存（OS）的独立预后因素（HR=3.051,95％CI2.018～4.612,P＜0.001）.按MDS特异性合并疾病指数（MDS-CI）评分模型对伴有合并疾病的MDS患者进行危险度分组,低、中、高危患者中位OS时间分别为32（1～153）、19（2～85）、13（1～37）个月,而不伴有合并疾病的患者中位OS时间为96（1～166）个月,差异有统计学意义（P＜0.001）.IPSS-R低危、中危及高危组患者根据MDS-CI模型进行再分组,各组患者OS时间比较差异均有统计学意义（P值均＜0.01）.结论 合并疾病是MDS患者独立于IPSS-R之外的预后影响因素.

英文摘要：

Objective To discuss the impact of comorbidities on the outcomes of patients with MDS.Methods The clinical characteristics of 676 MDS patients with detailed comorbidities evaluations was analyzed retrospectively.Results There were 395/676 cases （58.4%） with comorbidities （group 1）,281/676 cases （41.6%） without （group 2）.Significant differences were seen in the distribution of age （≥ 60 y）,bone marrow blasts,abnormal karyotype,WHO 2008 subtypes and IPSS-R risk cohorts （P〈0.05） between the two groups.While gender,HGB concentrations,WBC levels,platelet levels and serum ferritin were not significantly different （P〉0.05）.Independent prognostic significance of comorbidities was seen in both uni-variate and multi-variate analyses （P〈0.001）.According to MDS-specific comorbidity index （MDS-CI）,the median survival were 32 （1-153） months,19 （2-85） months and 13 （1-37） months in the low-risk,intermediate-risk and high-risk cohorts respectively,while 96 （1-166） months in cohorts without any comorbidities,of which significant differences were seen （P〈0.001）.The MDS-CI allowed further stratification in the IPSS-R low-risk,intermediate-risk and high-risk cohorts （P〈0.001）.Conclusion Comorbidities provides prognostic stratification independently of IPSS-R for MDS patients.