血清VitB12、叶酸及LDH检测在骨髓增生异常综合征和巨幼红细胞性贫血鉴别诊断中的价值

The value of detection of serum VitB12,folic acid and LDH in differential diagnosis of myelodysplastic syndrome and megaloblastic anemia

目的探讨血清维生素B12(Vitamins B12,VitB12)、叶酸及乳酸脱氢酶(lactate dehydrogenase,LDH)检测在骨髓增生异常综合征(myelodysplastic syndrome,MDS)及巨幼红细胞性贫血(megaloblastic anemia,MA)鉴别诊断中的价值。方法回顾性分析MDS 41例与MA 66例的临床资料,另选择健康者50例为对照组,观察3组临床症状,比较3组血清VitB12、叶酸及LDH水平,采用ROC曲线判断其诊断效能。结果MA组感染、出血发生率均低于MDS组,贫血发生率高于MDS组(P<0.05)。MA组VitB12水平均低于MDS、对照组,LDH水平均显著高于MDS、对照组(P<0.05)。3组叶酸水平差异无统计学意义(P>0.05)。VitB12、叶酸、LDH诊断MDS的AUC依次为0.741、0.531、0.948,当VitB12水平高于139.355时,敏感度为100.0%,特异度为84.0%;当叶酸水平高于8.960时,敏感度为43.9%,特异度为94.0%;当LDH水平高于200.670时,敏感度为98.5%,特异度为100.0%;LDH诊断MDS的价值最高。VitB12、叶酸、LDH诊断MA的AUC依次为0.868、0.545、0.991,当VitB12水平高于139.355时,敏感度为100.0%,特异度为84.0%;当叶酸水平高于8.960时,敏感度为43.9%,特异度为94.0%;当LDH高于200.670时,敏感度为98.5%,特异度为100.0%;VitB12与LDH诊断MA的价值均高。结论血清VitB12、LDH检测对于MDS与MA鉴别诊断均有一定的效果,但LDH诊断效能较高,在今后临床值得借鉴,并根据患者实际情况合理运用。

Objective To explore the value of serum Vitamins B12(VitB12),folate and lactate dehydrogenase(LDH)detection in differential diagnosis of myelodysplastic syndrome(MDS)and megaloblastic anemia(MA).Methods The clinical data of 41 MDS and 66 MA patients were retrospectively analyzed.Another 50 healthy people were selected as the control group.The clinical symptoms of the three groups were observed and their serum VitB12,folic acid and LDH were compared.Its diagnostic efficiency was determined by the ROC curve.Results The infection rate and bleeding rate in the MA group were lower than those in the MDS group,but the rate of anemia was higher than that in the MDS group(P<0.05).The VitB12 levels in the MA group were higher than those in the MDS and control group,while the LDH value was significantly higher than that in the MDS group and the control group(P<0.05).No significant difference was found in folic acid among three groups(P>0.05).The area under the curve(AUC)of VitB12,folic acid,and LDH for diagnosis of MDS was 0.741,0.531,and 0.948,respectively.When VitB12 was higher than 139.355,the sensitivity was 100.0%and the specificity was 84.0%;When folic acid was higher than 8.960,the sensitivity was 43.9%and the specificity was 94.0%;when the LDH value was higher than 200.670,the sensitivity was 98.5%and the specificity was 100.0%.The LDH value was the most valuable in diagnosing MDS patients.The AUC of VitB12,folic acid,and LDH for the diagnosis of MA was 0.868,0.545,and 0.991,respectively.When VitB12 was higher than 139.355,the sensitivity was 100.0%and the specificity was 84.0%;when folic acid was higher than 8.960,the sensitivity was 43.9%and the specificity was 94.0%;when the LDH value was higher than 200.670,the sensitivity was 98.5%,and the specificity was 100.0%.Therefore,both VitB12 and LDH had a high diagnostic value for MA.Conclusion Serum VitB12 and LDH detection have a certain effect on the differential diagnosis of MDS and MA,but the diagnostic efficiency of LDH is relatively high.This is worthy of clinical application in the future and should be used reasonably according to the real situation of patients.