急性髓系白血病患者血清腺苷脱氨酶测定的意义

Determination of serum adenosine deaminase in patients with acute myeloid leukemia significance

目的探讨血清腺苷脱氨酶(ADA)在急性髓系白血病(AML)的变化规律及其意义。方法收集山东省立医院2012年1月至2013年12月75例治疗前急性髓系白血病患者(其中63例AML患者进行自身治疗前后比较)和86例健康对照者外周血血清。采用PNP-XTO-POD偶联连续监测法测定血清腺苷脱氨酶(ADA)水平,采用速率法测定谷草转氨酶(AST)、谷丙转氨酶(ALT)和谷氨酰转肽酶(GGT)水平。检测健康对照组与AML组血清ADA水平,比较AML治疗前后ADA水平变化,采用受试者工作特征曲线(ROC曲线)确定ADA最佳截点,并将AML治疗前患者分为低ADA组(ADA<13.50 U/L)和高ADA组(ADA≥13.50 U/L),分析两组间年龄、性别、AST、ALT和GGT差异。结果 AML组患者ADA水平[15.30(9.50,31.30)U/L]显著高于健康对照组[8.45(7.05,11.35)U/L],差异有统计学意义(P<0.001);AML组治疗后ADA水平[10.70(8.10,14.90)U/L]显著低于AML治疗前[14.70(9.60,26.70)U/L],差异有统计学意义(P<0.001);采用ROC曲线,将AML治疗前患者分为高ADA组(ADA≥13.50 U/L)和低ADA组(ADA<13.50 U/L),其中高ADA组中AST、ALT及GGT水平显著高于低ADA组(AST Z=-3.102,P=0.002;ALT Z=-2.046,P=0.041;GGT Z=-2.794,P=0.005)。结论 ADA检测可以作为AML患者的一项常规辅助检查,对AML的疾病诊断及评估病情的发展具有一定的价值。

Objective To explore the changes and its significance of serum adenosine deaminase（ADA） in patients with acute myeloid leukemia（AML）. Methods The peripheral blood sera of 75 patients with AML（of which 62 had comparison before and after the treatment） and 86 healthy controls（control group） were collected in the Shand ong Provincial Hospital from January 2012 to December 2013. Serum adenosine deaminase（ADA） was detected by using the PNP-XTO-POD coupling continuous monitoring method, and the alanine transaminase（ALT）, glutamic oxaloacetic transaminase（AST） and gamma glutamyl transpeptidase（GGT） were detected using performance rate method. The serum ADA levels were detected between the control group and AML group. The change of ADA levels were compared in AML group before and after treatment. The receiver-operating characteristic curve（ROC curve） was used to determine the best cutoff point of ADA. Then AML patients before treatment were divided into low ADA group（ADA13.50 U/L）and high ADA group（ADA13.50 U/L） according to the cutoff point. The differences in age, sex, AST, ALT and GGT were analyzed between the two groups. Results The ADA levels in the AML group [15.30（9.50, 31.30）（U/L）] were significantly higher than [8.45（7.05, 11.35） U/L] in the normal control group（Z=5.922, P0.001）. Furthermore, the ADA levels in the before treatment group [10.70（8.10, 14.90） U/L] were significantly lower than [14.70（9.60, 26.70） U/L]those after treatment group（Z=-3.590, P0.001）. Using ROC curve, the before treatment group patients were divided into high ADA group（ADA≥13.50 U/L） and low ADA group（ADA13.50 U/L）. The levels of AST, ALT and GGT in high ADA group were significantly higher than those in low ADA group（AST Z=-3.102, P=0.002; ALT Z=-2.046, P=0.041; GGT Z=-2.794, P=0.005）. Conclusion ADA detection can be used as a routine examination in patients with AML, which has a certain value to the development of disease diagnosis and severity evaluation of AML.