血清SF、LDH、维生素B_(12)水平及骨髓细胞形态学对骨髓增生异常综合征和巨幼细胞性贫血的鉴别诊断

Clinical significance of serum SF,LDH and vitamin B_(12) levels and bone marrow cell morphological features in the differential diagnosis of myelodysplastic syndrome and megaloblastic anemia

目的探讨血清铁蛋白(SF)、乳酸脱氢酶(LDH)、维生素B_(12)水平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。方法选取2018年7月~2020年7月我院收治的53例MDS(MDS组)和55例MA(MA组)患者为研究对象,同时选取同期于我院进行体检的40名健康者作为对照组。比较各组血清SF、LDH、维生素B_(12)水平,并分析骨髓细胞形态学。结果MDS组血清SF、维生素B_(12)水平高于MA组,LDH水平低于MA组(P<0.05);MDS组外周血涂片中检出原粒细胞检出率高于MA组,巨红细胞检出率低于MA组(P<0.05);MDS组骨髓细胞学形态中原始细胞≥5%、核浆发育不平衡、环状铁粒幼红细胞、小巨核细胞及单圆核巨核细胞检出率高于MA组,幼粒巨幼变细胞、巨幼变幼红细胞检出率低于MA组(P<0.05)。结论血清SF、LDH、维生素B_(12)水平及骨髓细胞形态学表现对MDS和MA的鉴别诊断具有一定的临床意义。

Objective This study was conducted to investigate the clinical significance of serum ferritin(SF),lactate dehydrogenase(LDH)and vitamin B_(12) levels and bone marrow cell morphological features in the differential diagnosis of myelodysplastic syndrome(MDS)and megaloblastic anemia(MA).Methods Between July 2018 and July 2020,53 patients with MDS(MDS group)and 55 patients with MA(MA group)were enrolled in this study.Meanwhile,40 healthy people receiving physical examination in our hospital during the same period were selected as the control group.Serum levels of SF,LDH and vitamin B_(12) were determined,and bone marrow cell morphology was analyzed.Results MDS group had higher serum SF and vitamin B_(12) levels but lower LDH levels than MA group(P<0.05).The detection rate of progranulocytes in peripheral blood smear in MDS group was higher than that in MA group,and the detection rate of megacytes in MDS group was lower than that in MA group(P<0.05).For bone marrow cell morphology,the detection rates of initial cells≥5%,karyoplasm imbalanced development,ringed sideroblasts,small megakaryocytes and mononuclear megakaryocytes were higher in MDS group than in MA group,while detection rates of megaloblastic myelocytes and megaloblastic erythroblasts were lower in MDS group than in MA group(P<0.05).Conclusion Serum SF,LDH,Vitamin B_(12) levels and bone marrow cell morphology were significant for the differential diagnosis of MDS and MA.