摘要
目的 评价流式细胞术（FCM）在骨髓增生异常综合征（MDS）亚型难治性血细胞减少伴多系发育异常（RCMD）和再生障碍性贫血（AA）的鉴别诊断中的价值.方法 回顾性盲法分析168例RCMD和77例AA患者的骨髓流式数据,比较流式分析结果与诊断金标准进行诊断试验评价.结果 单个免疫表型的异常用于鉴别诊断RCMD和AA,特异度较高（75.3%～100.0%）,但灵敏度较低（5.4%～50.0%）.用提高灵敏度的平行试验重新进行评价,CD＋34细胞≥1%、髓系原幼细胞≥3%、粒细胞CD117异常表达这3项指标联合髓系原幼细胞CD13表达缺失或粒细胞CD33表达增强,诊断的灵敏度有了较大提高（〉62%）,而特异度没有明显降低（〉92%）.根据上述评价得出的不同诊断价值,对8个原幼细胞和髓系异常抗原表达指标给以不同评分,以积分值≥1.5分判断为RCMD,〈1.5分判断为AA,灵敏度和特异度均较高,在RCMD与AA组,分别为64.9%和93.5%.结论 单个免疫表型指标鉴别诊断RCMD和AA,特异度高,但灵敏度较低.CD＋34细胞≥1%、髓系原幼细胞≥3%和粒细胞CD117异常表达这3项指标与其他几项组合可获得较好的灵敏度和特异度.积分法可以更精确地鉴别RCMD和AA.
Objective To evaluate the value of flow cytometry （ FCM） for the differential diagnosis between myelodysplasia （MDS） subtype refractory cytopenia with multiple dysplasia （RCMD） and aplastic anemia （AA）. Methods The flow cytometric data of bone marrow samples from 168 cases of RCMD and 77 cases of AA were analyzed retrospectively in blind, and its results were compared with gold standard to evaluate its diagnosis values. Results The specificity of abnormal of single immunophenotype in the surface of granulocytes and myeloblasts was high （range 75.3% -100% ） , but the sensitivity was very low （range 5.4%-50% ）. In parallel tests, the sensitivity and specificity of the combination of CD＋34 cells≥1% , myeloblasts ≥3% , abnormal expression of CD117 in granulocytes and loss of CD13 in myeloblasts or increased intensity of CD33 in granulocytes were higher than other combinations. The sensitivity and specificity of above combination were more than 62% and 92% , respectively. In the scoring method,different score was given to 8 markers according to different diagnostic value, which were CD＋34 cells ≥1 % ,myeloblasts≥3% , abnormal expression of CD117 in granulocytes, loss of CD13 in myeloblasts, increased intensity of CD33 in granulocytes, loss of CD13 in granulocytes, loss of CD10 in granulocytes, and decreased SSC in granulocytes. The sensitivity and specificity were both high if we defined that the total score ≥1.5 was RCMD and the score 〈 1. 5 was AA. Conclusions The value of abnormal of single immunophenotype for differential diagnosis between RCMD and AA is low. Parallel tests can increase the diagnostic sensitivity obviously and not decrease the specificity. CD＋34 cells≥1% , myeloblasts≥3% and abnormal expression of CO117 in granulocytes were the most important markers. The scoring method is precise to distinguish RCMD from AA.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2010年第6期508-511,共4页
Chinese Journal of Internal Medicine
