VCS技术在白血病诊断中的价值  

Evaluation of VCS technology in diagnosis for leukemia

作　　者：徐双[1] 刘健[1] 赵磊[1] 贾玫[1] 刘宁[1] 

机构地区：[1]北京大学人民医院检验科,北京100044

出　　处：《中国实验诊断学》2013年第4期676-680,共5页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨Beckman Coulter LH750血细胞分析仪VCS技术在白血病诊断及分型中的应用。方法选取健康体检者112例,经骨髓穿刺符合血液病诊断标准的白血病患者163例,经LH750血细胞分析仪检测外周血获得VCS参数。通过受试者工作特征(ROC)曲线分析挑选出白血病和慢性粒细胞白血病(CML)敏感度和特异度都较高的VCS参数及相应的cutoff值。并对急性髓系白血病(AML)各亚型组间VCS参数的差异进行比较分析。结果对于区分正常人群与白血病人群,除去MLV、MLS、MEC、MES-SD在两组之间差异无统计学意义外,余VCS参数在两组之间差异均有统计学意义。利用ROC曲线可筛选出用于初步区分是否患病的三个参数:当MNC-SD cutoff值选取7.23时,其敏感度为87.7%,特异度为92.3%;当MNV-SD cutoff值选取23.35时,其敏感度为83.4%,特异度为87.6%;当MLC-SD cutoff值选取11.54时,其敏感度为88.9%,特异度为97.7%。对于区分CML与AML,WBC、MLV-SD、MMV-SD、MEV、MEV-SD、MNS、MMS、MES在两组间差异有统计学意义。利用ROC曲线比较后可得WBC、MNS、MEV三个参数曲线下面积、敏感度及特异度均较高:当WBC cutoff值选取34.5时,其敏感度为67.9%,特异度为63.9%;当MNS cutoff值选取120.8时,其敏感度为60.4%,特异度为61.1%;当MEV cutoff值选取164.5时,其敏感度为71.7%,特异度为70.3%,对于这三个参数,将其联合诊断,即三个参数中任意两个或两个以上参数大于cutoff值时,区分CML与AML的敏感度为84.9%(45/53),特异度为80.8%(63/78)。AML各亚型间,MNV、MNC-SD、MLC、MMS、MMC-SD存在统计学差异(F值分别为5.24、7.43、4.04、5.48、3.80,P<0.05)。结论 VCS技术方便、快捷,对白血病是较好的筛选试验,并且可对分型做出初步的判断。Objective To evaluate clinical application of VCS technology in diagnosis for leukemia and its subtypes by Beckman Coulter LH750 automated hematology analyzer. Methods Peripheral blood samples from 112 healthy sub- jects and 163 Leukemia patients were collected, then all the samples were analyzed by Coulter LH750 automated hema- tology analyzer to get the white blood cell VCS parameters . The cutoff values with high sensitivity and specificity were chosen by receiver operating characteristic （ROC） curves in leukemia and chronic myelogenous leukemia（CML）. The VCS parameters of different acute myelogenous leukemia （AML） subtypes were compared. Results To discriminate the healthy subjects and the leukemia, the VCS parameters except MLV. MLS, MEC, MES-SD showed a statistical sig- nificance,and MNC-SD,MNV-SD,MLC-SD are the best indicators in distinguishing healthy subjects and Leukemia pa- tients. When the cutoff value of MNC-SD get 7.23 ,a sensitivity of 88.7%and specificity of 92.3~were achieved;When the cutoff value of MNV-SD get23.35,a sensitivity of 83.4 % and specificity of 87.6 ~ were achieved;When the cutoff value of MLC-SD get 11.54,a sensitivity of 88.9%and specificity of 97.7 ~/00 were achieved. To distinguishing AML and CML, the parameters of WBC, MLV-SD MMV-SD, MEV, MEV-SD, MNS, MMS, MES had a statistical significance . By ROC curves,three parameters with high sensitivity and specificity were chosen：When the cutoff value of WBC get 34.5, a sensitivity of 67.9 ~ and specificity of 63.9 ~//0 were achieved;When the cutoff value of MNS get120. 8, a sensitiv- ity of 60.4%and specificity of 61.1%were achieved;When the cutoff value of MEV get 164.5,a sensitivity of 71.7% and specificity of 70.3%were achieved. And combined WBC,MNS,MEV,any two of the three or all the three parame- ters over the cutoff value, a sensitivity of 84.9 % （45/53） and specificity 0{80.8 % （63/78）were achieved. The differences of MNV,MNC-SD,MLC,MMS, MMC-SD for different AML subtypes were statistically significan, （F

关 键 词：白血病 VCS技术 诊断 分型 

分 类 号：R733.7[医药卫生—肿瘤]