自动血细胞分析参数对骨髓增生异常综合征和再生障碍性贫血的鉴别诊断价值

Performance of Automatic Blood Cell Analysis Parameters for Differential Diagnosis of Myelodysplastic Syndromes and Aplastic Anemia

目的探讨自动血细胞分析参数对骨髓增生异常综合征(MDS)和再生障碍性贫血(AA)的鉴别诊断价值。方法收集北京大学深圳医院2002年12月～2011年2月确诊为MDS或AA患者的病案资料,对符合纳入标准的病例诊断当次检查的自动血细胞分析参数资料进行统计学分析,找出差异有统计学意义的血细胞分析参数,并以ROC曲线评价这些指标对MDS和AA的鉴别诊断价值。结果 33例MDS和36例AA患者被纳入研究。根据可供评估的资料,MDS患者组与AA患者组比较,平均红细胞血红蛋白浓度(MCHC)(328.58±17.24 g/L vs 342.47±18.75 g/L,n=33/36)显著减低(P=0.002 1),而单核细胞百分比(MONO%)(11.48±9.99 vs 6.94±2.50,n=32/34)、血小板分布宽度(PDW%)(13.51±4.24 vs 10.62±3.68,n=20/22)和血小板比容(PCT%)(0.11±0.10 vs 0.04±0.07,n=11/15)显著增高(P值分别为0.0202,0.0231和0.0356),其余指标两者比较差异无统计学意义。在最适cut-off值条件下,以上四个指标鉴别诊断MDS和AA的ROC曲线下面积分别为0.706(95%可信区间:0.584～0.809),0.666(0.540～0.778),0.668(0.506～0.805)和0.745(0.538～0.894);MONO%和MCHC对鉴别诊断MDS和AA有较高的特异度和阳性预测值,分别为97.06%,88.89%和93.3%,80.0%。结论 MONO%和MCHC可作为鉴别诊断MDS和AA的简单易行指标。

Objective To evaluate the performance of automated blood ceil analysis parameters for differential diagnosis of myelodysplastic syndromes （MDS） and aplastic anemia （AA）. Methods Data of automatic blood cell analysis parameters at diagnosis of confirmed patients with MDS and AA from December 2002 to February 2011 in Peking University Shenzhen Hospital were retrospectively reviewed. Results 33 cases of MDS and 36 cases of AA were recruited in this study. Based on the evaluable data, mean corpuscular hemoglobin concentration （MCHC） （328.58 - 17.24 g/L vs 342.47 ± 18.75 g/L, n 33/36） was significantly lower （P=0. 002 1） ,while monocyte percentage （MONO%）（11. 48±9.99 vs 6.94±2.50,n=32/ 34） ,platelet distribution width （PDW%）（13.51±4.24 vs 10.62±3.68,n=20/22） and platelet hematocrit （PCT%）（0. 11 ±0. 10 vs 0. 04±0. 07,n=11/15） were markedly higer （all P〈0.05） in patients with MDS than that of AA. No significantly differences for other blood cell analysis parameters were seen between patients with MDS and AA. Under the condition of best cut off value,areas under the ROC curve of MCHC,MONO% ,PDW and PCT were 0. 706 （95% confidence in- terval：0. 584±0. 809）,0. 666 （0. 540±0. 778）,0. 668 （0. 506±0. 805） and 0. 745 （0. 538±0. 894） respectively. MONO% and MCHC had high specificities （97. 06% and 88.89% ） and positive predictive values （93.3% and 80.0% ） for differential diagnosis of MDS from AA. Conclusion MONO% and MCHC may be used as simple indicators for differential diagnosis of MDS and AA.