用于预测免疫功能正常的不明原因发热患者血液系统疾病的“骨髓评分”
A "bone marrow score" for predicting hematological disease in immunocompetent patients with fevers of unknown origin.
作者信息
Wang Hao-Yuan, Yang Ching-Fen, Chiou Tzeon-Jye, Yang Sheng-Hsiang, Gau Jyh-Pyng, Yu Yuan-Bin, Liu Chun-Yu, Liu Jin-Hwang, Chen Po-Min, Hsu Hui-Chi, Fung Chang-Phone, Tzeng Cheng-Hwai, Hsiao Liang-Tsai
机构信息
From the Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (H-YW, J-PG, Y-BY, C-YL, J-HL, P-MC, H-CH, C-HT, L-TH); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (H-YW, C-FY, T-JC, S-HY, J-PG, Y-BY, C-YL, J-HL, P-MC, H-CH, C-PF, C-HT, L-TH); Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C-FY); Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (T-JC); Division of Oncology and Hematology, Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan (S-HY); Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (H-CH); and Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C-PF).
出版信息
Medicine (Baltimore). 2014 Dec;93(27):e243. doi: 10.1097/MD.0000000000000243.
Delayed diagnosis of hematological malignancies in immunocompetent patients with fever of unknown origin (FUO) remains an exhausting challenge for non-hematologist physicians. This retrospective cohort study aimed to establish a scoring system, "bone marrow (BM) score", to identify FUO patients who require early bone marrow biopsy (BMB) to diagnose hematological disease. Two cohorts, comprising 85 (training) and 20 (validation) eligible immunocompetent patients, with FUOs diagnosed between January 1, 2006 and July 31, 2013, underwent BMBs and were enrolled in the study. Demographic, laboratory, imaging, diagnostic, and outcome data were collected and retrospectively analyzed. Factors associated with hematological etiologies diagnosed using BMBs in the training cohort were identified and scored according to the relative hazards. These were further validated using the validation cohort. For the training cohort, 29 of 85 (34.1%) patients had hematological etiologies diagnosed using BMB. Seven factors significantly predicted the diagnostic yield of hematological diseases in the BM and were scored, with the 6 points for leucoerythroblastic changes in peripheral blood smears, 5.5 for elevated ferritin level (>1000 ng/mL), 4 for splenomegaly, 2 for thrombocytopenia, 1.5 for each of elevated lactate dehydrogenase levels and anemia, and 1 for neutropenia. When the cut-off value of the scoring system was set to 6, its sensitivity and specificity to diagnose hematological diseases in the BM of immunocompetent FUO patients were 93% and 58%, respectively. For the validation cohort, 7 of 20 (35%) patients had hematological disease, and all had BM scores higher than the cut-off, with the sensitivity and specificity at 100% and 77%, respectively. As immunocompetent FUO patients with hematological disease have poor prognoses, the "BM score" is valuable for non-hematologist physicians to identify immunocompetent FUO patients requiring early BMB.
对于免疫功能正常但病因不明发热（FUO）的患者，血液系统恶性肿瘤的延迟诊断对非血液科医生而言仍然是一项艰巨的挑战。这项回顾性队列研究旨在建立一种评分系统——“骨髓（BM）评分”，以识别那些需要早期进行骨髓活检（BMB）来诊断血液系统疾病的FUO患者。两个队列，分别由85名（训练队列）和20名（验证队列）符合条件的免疫功能正常的患者组成，这些患者在2006年1月1日至2013年7月31日期间被诊断为FUO，均接受了BMB并纳入研究。收集了人口统计学、实验室检查、影像学、诊断及预后数据，并进行回顾性分析。确定训练队列中与通过BMB诊断的血液系统病因相关的因素，并根据相对风险进行评分。这些因素在验证队列中进一步得到验证。对于训练队列，85名患者中有29名（34.1%）通过BMB诊断出有血液系统病因。七个因素可显著预测骨髓中血液系统疾病的诊断率并进行了评分，外周血涂片出现幼粒幼红细胞改变得6分，铁蛋白水平升高（>1000 ng/mL）得5.5分，脾肿大得4分，血小板减少得2分，乳酸脱氢酶水平升高和贫血各得1.5分，中性粒细胞减少得1分。当评分系统的临界值设定为6时，其对免疫功能正常的FUO患者骨髓中血液系统疾病诊断的敏感性和特异性分别为93%和58%。对于验证队列，20名患者中有7名（35%）患有血液系统疾病，且所有患者的BM评分均高于临界值，敏感性和特异性分别为100%和77%。由于患有血液系统疾病的免疫功能正常的FUO患者预后较差，“BM评分”对于非血液科医生识别需要早期进行BMB的免疫功能正常的FUO患者很有价值。
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