网织红细胞血红蛋白联合血清乳酸脱氢酶检测在巨幼细胞性贫血鉴别诊断中的应用

Application of reticulocyte hemoglobin content and lactate dehydrogenase examination for the diagnosis of megaloblastic anemia

目的：探讨网织红细胞血红蛋白（ Ret?He）和乳酸脱氢酶（ LDH）联合检测对巨幼细胞性贫血（ MA）和难治性贫血（ MDS?RA）鉴别诊断的临床价值。方法选取50例MA患者、50例MDS?RA患者和50名同期健康体检志愿者，分别检测其Ret?He和血清LDH含量。分析各组间的上述指标的检测结果；采用ROC曲线分析评价Ret?He、LDH单独检测及联合检测对于MA的诊断价值。结果3组间Ret?He值比较差异有统计学意义（ F＝13．483，P＜0．001），MA组与MDS?RA组、健康对照组相比差异均有统计学意义（P均＜0．05）。3组间LDH值比较差异有统计学意义（F＝1676．445，P＜0．001），且MA组与MDS?RA组及健康对照组，MDS?RA组与健康对照组相比差异均有统计学意义（ P均＜0．05）。 Ret?He、LDH单独检测和联合检测在其诊断MA的临界值处的灵敏度分别为65．8％、61．0％、89．2％，特异度分别为79．5％、68．9％、80．3％，ROC曲线下面积分别为0．720、0．642、0．875。结论 Ret?He和LDH联合检测对于鉴别MA和MDS?RA有一定的临床指导意义。

Objective To investigate the clinical significance and application of combined determina?tion of reticulocyte hemoglobin ( Ret?He ) and lactate dehydrogenase ( LDH ) on differential diagnosis between megaloblastic anemia(MA) and myelodysplastic syndrome(MDS). Methods Fifty case patients with MA,50 cases patients with MDS?RA and 50 healthy people were selected as study objects. All of them were tested of Ret?He and LDH. Variance analysis and LSD method were used to compare the test results of the above indicators be?tween each group. The diagnostic value of Ret?He,LDH alone detection and joint detection for MA by ROC curve analysis. Results Variance analysis showed that the index of Ret?He of three groups was different( F=13. 483, P<0. 001),and that of MA group was significantly higher than MDS?RA group and controlled group(P<0. 05) . For LDH detection, variance analysis showed that there were significant differences among three groups ( F=1 676. 445,P<0. 001) ,and there were significant differences between MA group compared with MDS?RA group and control group,MDS?RA group compared with control group( P<0. 05) . Furthermore,the sensitivities of the detection of Ret?He,LDH and combined determination were 65. 8%,61. 0%,89. 2% respectively,the specifici?ties were 79. 5%,68. 9%,80. 3% respectively,and the AUC were 0. 720,0. 642,0. 875 respectively. Conclusion Combined determination of Ret?He and LDH can provide better diagnostic efficiency in distinguishing MA from MDS?RA.