细胞形态联合血液学在骨髓增生异常综合征与巨幼细胞性贫血鉴别中的效果

Effect of Cell Morphology Combined with Hematology in Differentiating Myelodysplastic Syndrome from Megaloblastic Anemia

目的探讨细胞形态联合血液学在骨髓增生异常综合征与巨幼细胞性贫血鉴别中的效果。方法回顾性分析2020年3月-2021年12月收治的骨髓增生异常综合征和巨幼细胞性贫血患者共61例,其中A组(骨髓增生异常综合征)28例,B组(巨幼细胞性贫血)33例。比较两组外周血涂片、骨髓细胞学检查、血液学指标情况,绘制ROC曲线分析不同检测对疾病的诊断效果。结果A组原粒细胞人数占比高于B组,巨红细胞人数占比低于B组(P<0.05)。两组间比较,B组巨核细胞减少程度、细胞外铁阳性率、红系和粒系减少程度高于A组,小巨核细胞、细胞内铁、类巨幼改变、成熟红细胞形态异常、核浆发育不平衡、原粒细胞大于5%低于A组(P<0.05)。根据ROC曲线可知,细胞形态学联合血液学指标对骨髓增生异常综合征、巨幼细胞性贫血敏感度、特异度分别为95.90%、87.50%,AUC=0.941(95%CI:0.881~0.994),高于细胞形态学、血液学指标单独检测(P<0.05)。结论骨髓增生异常综合征和巨幼细胞性贫血采用血液学指标检查结合细胞形态学检查,能提高临床诊断效能。

Objective To investigate the effect of cell morphology combined with hematology in the differentiation of myelodysplastic syndrome and megaloblastic anemia.Methods A total of 61 patients with myelodysplastic syndrome and megaloblastic anemia admitted from March 2020 to December 2021 were retrospectively analyzed,including group A(myelodysplastic syndrome,n=28)and group B(megaloblastic anemia,n=33).Peripheral blood smear,bone marrow cytology and hematology indexes of the two groups were compared,and ROC curve was drawn to analyze the diagnostic effect of different tests on diseases.Results The proportion of granulocyte in group A was higher than that in group B,and the proportion of macroerythrocyte was lower than that in group B(P<0.05).Compared between the two groups,the reduction degree of megakaryocyte,positive rate of extracellular iron,erythroid and granuloid in group B was higher than that in group A,and the change of small megakaryocyte,intracellular iron,megaloblastic,abnormal morphology of mature red blood cells,imbalance of karyoplasmic development,and granulocyte greater than 5%were lower than those in group A(P<0.05).According to the ROC curve,the sensitivity and specificity of the combination of cell morphology and hematology indexes for myelodysplastic syndrome and megaloblastic anemia were 95.90%and 87.50%,respectively,with AUC=0.941(95%CI:0.881-0.994),which was higher than that of cell morphology and hematology indexes alone(P<0.05).Conclusion The clinical diagnosis of myelodysplastic syndrome and megaloblastic anemia can be improved by hematologic index and cell morphology examination.