LDH、HBDH、LDH同工酶和胆红素在MA和MDS鉴别中的作用研究

The research of the effect of serous LDH,HBDH,LDH isozyme and bilirubin on the differential diagnosis between MA and MDS

目的探讨血清乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH)、乳酸脱氢酶同工酶(LDH-i)和胆红素在巨幼细胞贫血(MA)和骨髓增生异常综合征(MDS)鉴别诊断中的作用。方法采用Hitachi-7170/7600型全自动生化分析仪、随机配套试剂、标准程序进行检测,空腹测定MA及MDS患者血清LDH、HBDH、LDH-i及胆红素;应用SPSS13.0统计软件进行统计学处理。结果 32例MA患者8,3.1%表现不同程度黄疸,以间接胆红素(IBIL)增高为主7,9.5%伴LDH、HBDH和LDH-i增高,多数增高达3～10倍;MDS患者血清LDH、HBDH、LDH-i及胆红素基本处于正常范围,且显著低于MA患者(P<0.01)。MA患者组LDH和HBDH均与总胆红素(TBIL)及IBIL呈显著正相关(P﹤0.05)。LDH-i与TBIL(r=0.59,P=0.096)和IBIL(r=0.60,P=0.091)无相关性,但LDH、HBDH和LDH-i的水平两两相关(P﹤0.01)。结论 MA患者血清LDH、HBDH、LDH-i和胆红素均明显高于MDS患者,MA患者LDH、HBDH、LDH-i与胆红素的增高与骨髓内原位溶血、红细胞破坏增加有关,因此,LDH、HBDH、LDH-i与胆红素的测定对于MA、MDS两者鉴别诊断具有指导意义。

Objective： To investigate the effect of serous lactate dehydrogenase（LDH）,hydroxybutyrate dehydrogenase（HBDH）,lactate dehydrogenase isozyme（LDH-i） and bilirubin on the differential diagnosis between megaloblastic anemia（MA） and myelodysplastic syndrome（MDS）.Methods： The Hitachi 7170/7600 automatic biochemistry analyzer and the standard agent and procedure were used in the detecting serous LDH,HBDH,LDH-i and bilirubin after abrosia.SPSS13.0 PC package were used in statistical treatment.Results： In 32 cases with MA,83.1% of patients displayed different degree jaundice and most of them had high indirect bilirubin（IBIL）,and 79.5% of cases had high LDH,HBDH and LDH-i with a 3-10 times increase.The serous LDH had significantly positive correlation with total bilirubin（TBIL） and IBIL（P﹤0.05） respectively,and so did the level of HBDH.The level of LDH-i had no correlation with TBIL（r =0.59,P=0.096） and IBIL（r=0.60,P=0.091） respectively.Furthermore,the positive correlation was significant between every two items of the serous LDH,HBDH and LDH-i（P﹤0.01）.The levels of LDH,HBDH,LDH-i and bilirubin in MA were all higher than those in MDS（P﹤0.01）.Conclusion： In MA,the increase of serous LDH,HBDH,LDH-i and bilirubin is possibly due to myeloid haemolysis in situ and the increase of hematoclasis.All of LDH,HBDH,LDH-i and bilirubin in MA are higher than those in MDS（P﹤0.01）,which have significance in the differential diagnosis between the two diseases.