[应用常规实验室参数诊断骨髓增生异常综合征患者的初步研究]

[Preliminary study of diagnosis of patients with myelodysplastic syndromes by routine laboratory parameters].

作者信息

Li Lin, Nie Ling, Yu Ming-Hua, Zheng Yi-Zhou, Zhang Yue, Xu Ze-Feng, Hao Yu-Shu, Xiao Zhi-Jian

机构信息

State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2008 Sep;29(9):623-8.

PMID:19175993

Abstract

OBJECTIVE

To explore the value of routine laboratory parameters in diagnosis of myelodysplastic syndromes (MDS) and differential diagnosis of patients with hypoplastic MDS from chronic aplastic anemia (CAA) for providing reference standard for primary hospitals.

METHODS

The laboratory parameters at diagnosis of 152 MDS patients with less than 0.05 bone marrow blasts and 86 CAA patients were retrospectively analyzed.

RESULTS

There were significant differences between MDS and CAA in Hb, red cell distribution width-coefficient variation (RDW-CV), immature reticulocyte fraction (IRF), BPC, the ratio of G1 (the sum percentage of myeloblast and promyelocyte) to G2 (the sum percentage of neutrophilic myelocyte and metamyelocyte) (Ratio G), the ratio of El (the sum percentage of proerythroblast and early erythroblast) to E2 (the sum percentage of intermediate erythroblast and late erythroblast) (Ratio E), megakaryocyte count (Meg), erythroblast PAS, neutrophil alkaline phosphatase (N-ALP), and serous levels of indirect bilirubin (IBIL), lactose dehydrogenase (LDH), folic acid (FA), VitB12 and ferritin. Chromosome abnormalities were found in 74 MDS patients (48.7%) but in none of CAA patients (P < 0.001). Furthermore, for differentiating MDS with less than 0.05 blasts from CAA, the sensitivity and specificity of combination of Meg, PAS, and IBIL level was 89.1% and 92.7%, the Youden index (gamma) was 0.818. Moreover, in the seven hypoplastic MDS cases, BPC, myeloblast percentage, Ratio G, Meg, erythroblast PAS and FA were statistically different from those of CAA; the sensitivity and specificity of combination of PAS and BPC was 85.7% and 100%, the gamma was 0.857; the sensitivity and specificity combination of Ratio G, Meg PAS was 85.7% and 98.8% respectively, the gamma was 0.845.

CONCLUSION

The routine laboratory parameters, especially BPC, Meg, Ratio G, PAS, IBIL may be helpful for the diagnosis of MDS and differential diagnosis of hypoplastic MDS from CAA.

摘要

目的

探讨常规实验室指标在骨髓增生异常综合征（MDS）诊断及低增生性MDS与慢性再生障碍性贫血（CAA）鉴别诊断中的价值，为基层医院提供参考标准。

方法

回顾性分析152例骨髓原始细胞比例小于0.05的MDS患者及86例CAA患者的诊断时实验室指标。

结果

MDS与CAA患者在血红蛋白（Hb）、红细胞分布宽度变异系数（RDW-CV）、未成熟网织红细胞比例（IRF）、血小板计数（BPC）、G1（原始粒细胞与早幼粒细胞百分比之和）与G2（中性中幼粒细胞与晚幼粒细胞百分比之和）的比值（Ratio G）、E1（原红细胞与早幼红细胞百分比之和）与E2（中幼红细胞与晚幼红细胞百分比之和）的比值（Ratio E）、巨核细胞计数（Meg）、幼红细胞糖原染色（PAS）、中性粒细胞碱性磷酸酶（N-ALP）以及间接胆红素（IBIL）、乳酸脱氢酶（LDH）、叶酸（FA）、维生素B12和铁蛋白血清水平方面存在显著差异。74例MDS患者（48.7%）存在染色体异常，而CAA患者均无染色体异常（P<0.001）。此外，对于鉴别原始细胞比例小于0.05的MDS与CAA，Meg、PAS及IBIL水平联合检测的敏感度和特异度分别为89.1%和92.7%，约登指数（γ）为0.818。此外，在7例低增生性MDS病例中，BPC、原始粒细胞百分比、Ratio G、Meg、幼红细胞PAS及FA与CAA患者存在统计学差异；PAS与BPC联合检测的敏感度和特异度分别为85.7%和100%，γ为0.857；Ratio G、Meg、PAS联合检测的敏感度和特异度分别为85.7%和98.8%，γ为0.845。