骨髓细胞形态学检查血清铁蛋白和乳酸脱氢酶在多发性骨髓瘤诊断中的价值

Value of bone marrow cell morphology,serum ferritin and lactate dehydrogenase in the diagnosis of multiple myeloma

目的探究骨髓细胞形态学检查与血清铁蛋白(SF)、乳酸脱氢酶(LDH)联合用于多发性骨髓瘤(MM)临床诊断中的价值。方法以126例确诊的MM患者(观察组)和21例同期因其他原因接受骨髓穿刺的受试者(对照组)为对象。测定分析2组骨髓浆细胞占比和血清SF、LDH水平。受试者工作特征曲线(ROC)分析各指标在不同分期MM诊断中的价值。结果对照组和观察组不同分期患者骨髓浆细胞占比,血清SF和LDH水平间差异均具有统计学意义(P<0.01),对照组<MMⅠ期<MMⅡ期<MMⅢ期(P<0.05)。曲线下面积曲线分析显示,骨髓细胞形态学检查和血清SF、LDH水平测定均对不同分期的MM具有一定诊断价值(AUC=0.582~0.767、0.663~0.849、0.779~0.856),而3项指标联合测定能有效提高不同分期MM的诊断灵敏度,且MM患者病情越重,诊断效能越明显(75.8%、82.1%和90.7%)。结论骨髓细胞形态学检查和血清SF、LDH水平联合测定对不同分期MM均具有良好诊断价值。

Objective To explore the value of bone marrow cell morphology examination combined with serum ferritin(SF)and lactate dehydrogenase(LDH)in the clinical diagnosis of multiple myeloma(MM).Methods One hundred and twenty-six confirmed MM patients(observation group)and 21 subjects who underwent bone marrow aspiration for other reasons during the same period(control group)were selected as subjects.The proportion of bone marrow cells,serum SF and LDH levels in the two groups were determined and analyzed.The receiver operating characteristic curve(ROC)was used to analyze the value of various indicators in the diagnosis of MM in different stages.Results The proportion of bone marrow cells,serum SF and LDH levels in the control group and the observation group in different stages were statistically significant(P<0.01),and those in the control group was lower than the observation group,and these factors in MM Ⅰ stage was lower than those in the Ⅱ and Ⅲ stages,MM Ⅱ stage was lower than Ⅲ stage(P<0.05).ROC curve analysis showed that the morphological examination of bone marrow cells,the determination of serum SF and LDH levels had a certain diagnostic value for different stages of MM(AUC=0.582~0.767,0.663~0.849,0.779~0.856),and the combined measurement of 3 indicators could effectively improve the diagnostic sensitivity of different stages of MM.The more severe the condition of MM patients,the more obvious the diagnostic efficiency(75.8%,82.1% and 90.7%).Conclusion The combined determination of morphological examination of bone marrow cells,serum SF and LDH levels have good diagnostic value for different stages of MM.