难治性贫血与巨幼细胞性贫血患者实验室特征比较的Meta分析  

Laboratory characteristics comparison between patients with refractory anemia and megaloblastic anemia:a Meta-analysis

作　　者：陈荣 沈建箴[1] Chen Rong;Shen Jianzhen(Department of Hematology,Fujian Institute of Hematology,Fujian Provincial Key Laboratory on Hematology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建省血液病研究所,福建省血液病学重点实验室,福建医科大学附属协和医院血液内科,福州350001

出　　处：《白血病．淋巴瘤》2020年第10期610-618,共9页Journal of Leukemia & Lymphoma

基　　金：福建省科技高校产学合作项目(2018Y4004);福建省医学创新项目(2017-CX-16);福建省血液医学中心项目(2011702#)。

摘　　要：目的探讨难治性贫血(RA)和巨幼细胞性贫血(MA)患者外周血象及骨髓细胞形态学的差异。方法通过计算机检索中国期刊全文数据库(CNKI)、万方数据库、维普数据库,并对纳入的文献进行扩大检索。对符合纳入标准的研究进行资料提取、质量评价后,采用Stata 14.0软件进行Meta分析。结果纳入41篇文献,共计3192例患者。在临床特征方面,RA患者淋巴结肿大发生率高于MA患者(OR=0.43,95%CI=0.22~0.84,P=0.014)。在外周血检查中MA患者全血细胞减少、幼红及幼粒细胞同时减少以及MCV>100 fl发生率高于RA患者,两组差异均有统计学意义(OR=2.56,95%CI 2.04~3.21,P<0.01;OR=1.93,95%CI 1.47~2.53,P<0.01;OR=4.29,95%CI 2.20~8.37,P<0.01),但RA白细胞和血红蛋白同时减少发生率高于MA患者,且有核细胞PAS阳性率更高,两组差异均有统计学意义(OR=0.55,95%CI 0.37~0.82,P=0.003;OR=0.00,95%CI 0.00~0.01,P<0.01)。在骨髓形态学检查中RA患者红系病变、红系巨幼变、粒系病变和淋巴样小巨核发生率均高于MA患者,两组差异均有统计学意义(OR=0.03,95%CI 0.03~0.04,P<0.01;OR=3.55,95%CI 2.29~5.51,P<0.01;OR=0.06,95%CI 0.05~0.08,P<0.01;OR=0.01,95%CI 0.00~0.01,P<0.01)。结论RA患者外周有核细胞PAS阳性率更高,骨髓红系病变、粒系病变和淋巴样小巨核更严重,而MA患者外周血全血细胞减少、MCV>100 fl以及幼红细胞及幼粒细胞同时减少更严重。To investigate the cell morphology difference of peripheral blood and bone marrow between patients with refractory anemia (RA) and megaloblastic anemia (MA).Methods Studies were retrieved from China Notional Knowledge infrastructure (CNKI), WanFang and VIP database, and then the references listed in all studies were further searched. The data of included studies were extracted and the quality was evaluated, and then meta-analysis was made by using Stata14.0 software.Results A total of 41 literatures and 3 192 patients were included. In terms of clinical features, the incidence of lymphadenopathy in RA patients was higher than that in MA patients (OR = 0.43, 95% CI 0.22-0.84, P = 0.014). In the peripheral blood test, the incidence of pancytopenia, the simultaneously decreased number of young granulocytes and red granulocytes and MCV > 100 fl in MA patients was higher than that in RA patients;the differences were statistically significant (OR = 2.56, 95% CI 2.04-3.21, P < 0.01;OR = 1.93, 95% CI 1.47-2.53, P < 0.01;OR = 4.29, 95% CI 2.20-8.37, P < 0.01), but the incidence of simultaneously severer decreased number of white blood cells and hemoglobin in RA patients was higher than that in MA patients, and the positive rate ofPAS in nuclear cells was higher, and the difference was statistically significant (OR = 0.55, 95% CI 0.37-0.82, P = 0.003;OR = 0.00, 95% CI 0.00-0.01, P < 0.01). In the bone marrow morphology examination, the incidence of erythroid lesions, megaloblastic, granulocyte lesions and lymphoid small megakaryocytes in RA patients was higher than that in MA patients;the differences were statistically significant (OR = 0.03, 95% CI 0.03-0.04, P < 0.01;OR = 3.55, 95% CI 2.29-5.51, P < 0.01;OR = 0.06, 95% CI 0.05-0.08, P < 0.01;OR = 0.01, 95% CI 0.00-0.01, P < 0.01).Conclusions RA patients have a higher positive rate of peripheral nucleated PAS and severer bone marrow erythroid lesions, granulocytic lesions, and lymphoid megakaryocytes, whereas MA have severer peripheral blood pancytopenia, MCV>100 fl and s

关 键 词：难治性贫血 巨幼细胞性贫血 实验室特征 META分析 

分 类 号：R556[医药卫生—血液循环系统疾病]