四种检验方法不同组合对急性髓系白血病和骨髓增生异常综合征的诊断价值研究

Diagnostic value of different combinations of four test methods for AML and MDS

目的:探讨外周血涂片、骨髓涂片、流式细胞术、染色体核型显带技术不同组合对急性髓系白血病(AML)和骨髓增生异常综合征(MDS)的诊断价值。方法:收集50例AML和50例MDS初诊患者,比较组合一(外周血涂片+骨髓涂片)、组合二(外周血涂片+骨髓涂片+流式细胞术)、组合三(外周血涂片+骨髓涂片+染色体核型显带技术)、组合四(外周血涂片+骨髓涂片+流式细胞术+染色体核型显带技术)的诊断检出率。结果:在50例AML患者中,组合一、二、三、四的诊断检出率分别为64%、90%、68%、92%。50例MDS患者中,组合一、二、三、四的诊断检出率分别为60%、84%、62%、86%。组合二、四诊断检出率高于组合一(均P<0.05)。组合三诊断检出率与组合一相比无统计学差异,组合二诊断检出率与组合四相比亦无统计学差异(均P>0.05)。结论:染色体异常可以为诊断提供相关遗传学证据,对化疗方案选择与预后评价提供参考,因此组合四对这两种疾病治疗方案的优化及预后评估更具有指导作用。而组合二可以大幅度提高AML与MDS的早期诊断水平,且检测费用相对不高,可以在基层医院推广。

Objective:To investigate the diagnostic value of different combinations of four test methods:peripheral blood smear,bone marrow smear,flow cytometry,and chromosome karyotype banding for acute myeloid leukemia(AML)and myelodysplastic syndrome(MDS).Methods:100 cases of newly diagnosed AML and MDS patients were collected.The diagnostic detection rate of first combination(peripheral blood smear+bone marrow smear),second combination(peripheral blood smear+bone marrow smear+flow cytometry),third combination(peripheral blood smear+bone marrow smear+chromosome karyotype banding technique),fourth combination(peripheral blood smear+bone marrow smear+flow cytometry+karyotype banding technique)were compared.Results:Among the 50 AML patients,the diagnostic detection rates of first combination,second combination,third combination and fourth combination were 64%,90%,68%and 92%,respectively.Among the 50 MDS patients,the diagnostic detection rates of first combination,second combination,third combination and fourth combination were 60%,84%,62%and 86%,respectively.The diagnosis detection rate of second combination and fourth combination was higher than that of first combination(all P<0.05).There was no statistical difference in the diagnosis detection rate between third combination and first combination,and the diagnosis detection rate of second combination was not different from fourth combination(all P>0.05).Conclusion:Chromosomal abnormalities can provide relevant genetic evidence for diagnosis,and provide references for the selection of chemotherapy regimens and prognostic evaluation.Therefore,the fourth combination has a guiding role in the optimization of treatment options and prognostic evaluation of these two diseases.The second combination can greatly improve the early diagnosis of AML and MDS,and the detection cost is relatively low,and it can be promoted in primary hospitals.