血清SF、LDH及骨髓细胞形态学表现在骨髓增生异常综合征和巨幼细胞性贫血鉴别诊断中的临床意义

Clinical Significance of Serum SF and LDH and Morphological Features of Bone Marrow Cells in the Differential Diagnosis of Myelodysplastic Syndrome and Megaloblastic Anemia

目的探究血清铁蛋白(SF)、乳酸脱氢酶(LDH)及骨髓细胞形态学表现在骨髓增生异常综合征(MDS)和巨幼细胞性贫血(MA)鉴别诊断中的临床意义。方法选择本院2013年1月至2016年12月收治的MDS患者40例(MDS组)与MA患者40例(MA组),比较两组临床症状、外周血涂片检查及骨髓细胞形态学结果 ;分别通过电化学发光免疫分析法、速率法检测血清SF、LDH水平,且以同期健康体检40例正常人员(对照组)血清SF、LDH水平为对照。结果 MA组出血症状发生率15.00%,显著低于MDS组的47.50%(P <0.05),贫血、感染方面两组比较差异均无统计学意义(P>0. 05);MA组外周血涂片可见细胞总数、单核细胞正常形态、单核细胞异常形态比例均显著大于MDS组,多分叶核中性粒细胞比例显著小于MDS组(P<0.05);MA组粒系、红系、巨核系病态造血与MDS组比较存在显著差异(P<0.05);MA组原始细胞、核型异常所占比例均显著小于MDS组(P <0.05);MA组、MDS组血清SF、LDH水平均显著高于对照组(P <0.05),MA组血清SF水平显著低于MDS组、LDH水平显著高于MDS组(P <0. 05)。结论 MA患者相比MDS患者血清SF显著降低,而LDH水平显著升高,两者骨髓细胞形态学有相似之处,也有不同征象,血清SF、LDH水平及骨髓细胞形态学对MA、MDS鉴别诊断有一定的意义。

Objective To explore the clinical significance of serum ferritin(SF),lactate dehydrogenase(LDH)and morphological features of bone marrow cells in the differential diagnosis of myelodysplastic syndrome(MDS)and megaloblastic anemia(MA). Methods 40 patients with MDS(MDS group) and 40 patients with MA( MA group) treated in the hospital from January 2013 to December 2016 were enrolled in this study. The clinical symptoms, results of peripheral blood smear examination and bone marrow cell morphology were compared between these two groups. The serum levels of SF and LDH were detected by electrochemiluminescence immunoassay and rate method. 40 normal persons were selected as control group,and their serum SF and LDH levels were taken as controls. Results The incidence rate of bleeding symptoms in MA group was significantly lower than that in MDS group(15. 00% vs 47. 50%)(P < 0. 05),but there was no significant difference in anemia or infection between these two groups(P > 0. 05). The peripheral blood smears showed that the total visible cell count, proportions of normal and abnormal morphology of monocytes were significantly larger or higher, while the proportion of multiple segmented neutrophil was lower in MA group than MDS group( P < 0.05). There were significant differences between MA group than MDS group in granulocyte, erythroid and megakaryocyte dyshaematopoiesis(P <0. 05). The proportions of initial cells and karyotype abnormalities in MA group were significantly lower than those in MDS group(P <0.05). Serum SF and LDH levels in MA group than MDS group were significantly higher than those in the control group(P <0.05). The serum SF level was significantly lower,while the LDH level was significantly higher in MA group than MDS group(P <0.05). Conclusion The serum SF level is significantly lower,while the LDH level is significantly higher in patients with MA than that in patients with MDS. There are similarities and differences in bone marrow cell morphology. Serum SF and LDH levels and bone marrow cell morphology are of significance for the differential diagnosis of MA and MDS.