血清叶酸、维生素B12及铁蛋白在四种血液病演变中的意义

The clinical value of serum folk acid, vitamin Bl2 and ferritin in the evolution of several blood diseases

目的 探讨造血原料在再生障碍性贫血（AA）、阵发性睡眠性血红蛋白尿（PNH）、骨髓增生异常综合征（MDS）、急性白血病（AL）之间克隆演变的规律.方法 采用放射免疫法检测AA、PNH、MDS、AL患者治疗前后叶酸及维生素B12酶联法检测血清铁蛋白,比较每组患者治疗前后造血原料的差别,以健康志愿者为健康对照组,并比较各组患者与健康对照组之间的差别.结果 各组患者治疗前造血原料检测结果及与健康对照组比较：PNH组叶酸低于对照组（P〈0.05）;MDS患者维生素B12、血清铁蛋白显著高于健康对照组（P均〈0.05）;AL患者叶酸显著低于健康对照组（P〈0.05）,维生素B12、铁蛋白显著高于健康对照组（P均〈0.01）.与AA组治疗前比较：MDS患者维生素B12及铁蛋白均显著增高（P均〈0.01）;AL患者叶酸显著降低（P〈0.05）,维生素B12及铁蛋白均显著增高（P均〈0.05）.与MDS患者治疗前比较：AL患者叶酸显著降低（P〈0.05）,维生素B12、铁蛋白显著增高（P均〈0.05）.组内治疗前后比较：从患者治疗后铁蛋白增高（P〈0.05）;PNH患者治疗后较治疗前叶酸增高（P〈0.05）,维生紊B12及铁蛋白较治疗前差异无统计学意义（P均〉0.05）;MDS患者治疗后较治疗前叶酸差异无统计学意义（P〉0.05）,维生素B12及铁蛋白均显著降低（P均〈0.05）;AL患者治疗后较治疗前叶酸显著增高（P〈0.05）,维生素B12及铁蛋白均显著降低（P均〈0.05）.结论 血清叶酸、维生素B12及铁蛋白在AA、PNH、MDS、AL之间差异有统计学意义,对提示4种疾病之间的克隆演变、预后及治疗转归方面有一定意义.

Objective To explore the regularity of hematopoietic materials during the clonal evolution of aplastic anemia（AA）, paroxysmal nocturnal hemoglobinuria （PNH） , myelodysplastic syndrome （MDS） and acute leukemia（AL）. Methods Patients diagnosed as AA, PNH, MDS and AL were recruited as cases and health volunteers were recruited as controls. Serum folic acid, vitamin B12 and ferritin levels were measured by radioimmunoassay and competitive enzyme immunoassay,before and after-treatment. Results Before treatment,the level of serum folic acid in PNH group were significantly lower than that in the control group（P〈0. 05）. Vitamin B12 and ferritin levels of MDS patients were higher than the control group （P 〈 0. 05）; Serum Folic acid level in AL patients was significantly lower than the control group （P 〈 0. 05）. In contrast, vitamin B12 and ferritin levels were higher than the control group（P 〈0. 05）. Compared to pre-treatments AA patients, vitamin B12 and ferritin levels of MDS patients were significantly higher（P 〈0. 01） ;Serum folic acid level in AL patients was significantly lower（P 〈 0.05）. However,vitamin B12 and ferritin levels were higher. Compared to pre-treatments MDS patients, serum folic acid level in AL patients was significantly lower（P 〈 0. 05） , whereas vitamin B12 and ferritin levels were higher（P 〈 0. 05）. The comparison of hematopoietic materials between pre-and post-treatments among the groups showed that there was no significant difference for AA patients between pre- and post-treatments in the levels of serum folic acid and vitamin Bl2 （P 〉 0. 05）, whereas ferritin was significantly higher after treatment caused by transfusion in AA patients（P〈0. 05） ;ln PNH patients,serum folic acid was significantly higher after treatment（P〈0. 05） ,and there was no significant difference in the levels of vitamin B12 and ferritin between pre-and post-treatments （P 〉0. 05）. In MDS patients, there was no significant difference in the level of ferum folic acid between pre-and post-treatments （P 〉 0. 05） , whereas vitamin B12 and ferritin levels were significantly lower after treatment （P 〈 0. 05）; In AL patients,serum folic acid was significantly higher after treatment（P 〈0. 05） .whereas the levels of vitamin B12 and ferritin were significantly lower after treatment （P 〈0. 05）. Conclusions There are significant difference in serum folic acid,vitamin B12 and ferritin among the patitents of AA,PNH,MDS and AL and would be helpful in discovering the interrelationship among the four diseases pertinent to the clonal evolution,prognosis,treatment and prognosis.