乳酸脱氢酶在细胞形态相似的伯基特淋巴瘤和急性淋巴细胞白血病鉴别诊断中的意义  

Significance of lactate dehydrogenase in differential diagnosis of Burkitt lymphoma and acute lymphoblastic leukemia presenting similar bone marrow cell morphology

作　　者：张崇唯[1] 王云燕 曾德琴 金咏梅[1] 陈姣[1] 粟军[1] 郑沁[1] ZHANG Chong-wei;WANG Yun-yan;ZENG De-qin;JIN Yong-mei;CHEN Jiao;SU Jun;ZHENG Qin(Department of Laboratory Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院实验医学科

出　　处：《现代预防医学》2019年第23期4408-4412,共5页Modern Preventive Medicine

基　　金：四川省科技厅重点研发项目(编号:2019YFS0313,2017FZ0061)

摘　　要：目的评价血清乳酸脱氢酶(lactate dehydrogenase,LDH)在骨髓细胞形态相似难以区分的伯基特淋巴瘤(burkitt lymphoma, BL)和急性淋巴细胞白血病(acute lymphoblastic leukaemia, ALL)鉴别诊断中的价值,并确定其相应的临床诊断阈值。方法回顾2007年1月1日-2019年3月31日在四川大学华西医院骨髓细胞形态学初诊为伯基特淋巴瘤的患者66例,采用流式细胞免疫分析技术(FCM)进行确诊。进一步分析初诊时患者血清LDH水平,并借助受试者工作特征曲线(receiver operating characteristic curve, ROC)确定诊断阈值。结果形态学初诊为BL的66例患者中,经FCM确诊,有35例BL,31例B-ALL。确诊为BL的患者血清LDH水平显著高于B-ALL(P<0.001)。ROC曲线下面积为0.871。当诊断界值为1100.5 IU/L时,诊断特异性为77.4%,灵敏度为88.6%。结论 LDH可作为骨髓细胞形态相似难以区分的伯基特淋巴瘤与急性淋巴细胞白血病鉴别诊断的重要辅助指标,伯基特淋巴瘤的最佳临床诊断阈值为LDH≥1 100.5 IU/L。Objective To evaluate the value of serum lactate dehydrogenase(LDH) in the differential diagnosis of Burkitt lymphoma(BL) and acute lymphoblastic leukaemia(ALL) with similar bone marrow cell morphology, and to determine the clinical diagnostic threshold. Methods From 1 January 2007 to 31 March 2019, 66 patients who were initially diagnosed as BL by bone marrow cells morphological examination in West China Hospital of Sichuan University were reviewed. Flow cell immunotyping(FCM) was used for making a definite diagnosis. Serum LDH levels of patients at the period of initial diagnosis were further analyzed, and receiver operating characteristic curve(ROC) was drawn. Results Among the 66 patients who were initially diagnosed as BL by bone marrow cells morphological examination, only 35 cases were identified as BL and the other 31 cases were identified as B-ALL after FCM analysis. Serum LDH level of BL patients was significantly higher than that of B-ALL patients(P<0.001). The area under the ROC curve was 0.871, and the test accuracy was relatively high. When Youden′s index(YI) was 1100.5 IU/L, the diagnostic specificity was 77.4% and the sensitivity was 88.6%. Conclusion Serum LDH level can be used as an important assistant indicator for the differential diagnosis between BL and ALL with similar cell morphology, which is difficult to distinguish by bone marrow cells morphological examination. The optimal clinical diagnostic threshold is more than 1100.5 IU/L.

关 键 词：乳酸脱氢酶 骨髓细胞形态 伯基特淋巴瘤 急性淋巴细胞白血病 鉴别诊断 

分 类 号：R181.32[医药卫生—流行病学]