流式细胞术外周血细胞检测对急性白血病微小残留病变的诊断价值

Diagnostic value of peripheral blood cell detection by flow cytometry for minimal residual lesions in acute leukemia

目的探讨流式细胞术(FCM)外周血细胞检测对急性白血病(AL)微小残留病变(MRD)的诊断价值。方法选择2020年5月至2022年5月柘城县人民医院收治的AL患者160例,采用相同的治疗方案,治疗结束后72 h内进行FCM外周血细胞检测。以骨髓细胞形态学检查作为金标准,分析FCM外周血细胞检测对AL MRD的诊断价值,并计算FCM外周血细胞检测结果与金标准的一致性。随访1年,比较MRD阳性、阴性患者复发情况。结果160例AL患者经骨髓细胞形态学检查发现105例MRD阳性,55例阴性。FCM外周血细胞检测诊断AL MRD的敏感度[95.2%(100/105)]、特异度[94.6%(52/55)]、准确度[95.0%(152/160)]、阳性预测值[97.1%(100/103)]、阴性预测值[91.2%(52/57)]。FCM外周血细胞检测结果与骨髓细胞形态学检查结果一致性极好(Kappa=0.890)。MRD阳性患者复发率为72.4%(76/105)高于阴性患者的30.9%(17/55),差异有统计学意义(P<0.05)。结论AL MRD诊断中应用FCM外周血细胞检测准确度、敏感度较高,对复发有一定预测价值,值得临床广泛应用。

Objective To explore the diagnostic value of flow cytometry(FCM)peripheral blood cell assay for minimal residual lesions(MRD)in acute leukemia(AL).Methods A total of 160 AL patients admitted to Zhecheng County People′s Hospital from May 2020 to May 2022 were selected.The same treatment regimen was used,and FCM peripheral blood cell testing was performed within 72 hours after treatment.The diagnostic value of FCM peripheral blood cell detection for AL MRD was analyzed using bone marrow cytomorphometry as the gold standard was calculated.In addition,a one-year follow-up was conducted to compare the recurrence of MRD positive and negative patients.Results A total of 160 patients with AL were found to be positive for MRD in 105 cases and negative in 55 cases by bone marrow cell morphology examination.The sensitivity[95.2%(100/105)],specificity[94.6%(52/55)],accuracy[95.0%(152/160)],positive predictive value[97.09%(100/103)],and negative predictive value[91.2%(52/57)]of FCM peripheral blood cell detection in the diagnosis of AL MRD.The results of consistency between FCM peripheral blood cell detection and bone marrow cell morphology examination is excellent(Kappa=0.890).The recurrent rate of MRD positive patients was 72.4%(76/105),which was higher than that of negative patients(30.9%(17/55),with a statistically significant difference(P<0.05).Conclusion The application of FCM in peripheral blood cell detection in the diagnosis of AL MRD has high accuracy and sensitivity,and has certain predictive value for recurrence,which is worthy of widespread clinical application.