【摘要】 目的评价CD₅₅、CD₅₉在阵发性睡眠性血红蛋白尿（PNH）诊断中的价值。方法选取2002年1月—2015年I月复旦大学附属华山医院门诊及住院部所有行外周血淋巴细胞、中性粒细胞、红细胞表面CD₅₅、CD₅₉检测的血細胞減少患者264例,检测外周血淋巴細胞、中性粒細胞、红细胞表面CD₅₅、CD₅₉阴性表达比例,分别采用LCD₅₅^-、LCD₅₉^-、NCD₅₅^-、NCD₅₉^-、ECD₅₅^-、ECD₅₉^-表示。绘制受试者工作特征曲线（ROC曲线）,计算ROC曲线下面积（AUC）,采用Logistic回归联合ROC曲线进行多指标联合的诊断试验评价。结果PNH组30例,非PNH组234例。非PNH组外周血LCD₅₅^-、LCD₅₉^-、NCD₅₅^-、NCD₅₉^-、ECD₅₅^-、ECD₅₉^-均低于PNH组（尸<0.05）。外周血LCD₅₅^-、LCD₅₉^-、NCD₅₅^-、NCD₅₉^-、ECD₅₅^-、ECD₅₉^-断PNH的AUC分别为0.824、0.793、0.949、0.950、0.967、0.949,最佳临界值分别为3.8%、5.5%、12.7%、12.0%、7.4%、6.4%。外周血LCD₅₅^-、LCD₅₉^-、NCD₅₅^-、NCD₅₉^-、ECD₅₅^-、ECD₅₉^-联合诊断的Logistic回归方程为P=1/[1+e^-(-5.116-0.225×LCD₅₅^-+0.031×LCD₅₉⁺0.119×NCD₅₅^--0.01×CD₅₉^-+0.13×ECD₅₅^-+0.195×ECD₅₉^-)]。平行试验显示,粒红联合平行试验AUC最大,为0.954(95%CI（0.911,0.997）];序列试验显示,粒红联合序列试验AUC最大,为0.928(95%Cl（0.856,1.000）],三系联合序列试验AUC最小为0.750(95%CI（0.633,0.867）]。结论诊断PNH时,CD₅₅、CD₅₉的诊断临界点并不是传统定义>10%。中性粒細胞、红细胞表面CD₅₅、CD₅₉表达对PNH的诊断价值明显优于淋巴細胞表面CD₅₅、CD₅₉表达。多指标联合诊断并不能提高灵敏度、特异度及AUC,说明CD₅₅、CD₅₉的表达可能存在共线性。更多还原

【Abstract】 Objective To evaluate the value of CD₅₅ and CD₅₉ in the diagnosis of paroxysmal nocturnal hemoglobinuria（PNH）.Methods 264 cases of cytopenia patients who were detected CD₅₅ and CD₅₉ in lymphocytes,neutrophil,erythrocytes surface in outpatient and inpatient of Huashan Hospital Affiliated to Fudan University from January 2002 to January 2015 were collected,detected the ratio of CD₅₅ and CD₅₉ negative expression in lymphocytes,neutrophil,erythrocytes surface,respectively indicated with LCD₅₅^-,LCD₅₉^-,NCD₅₅^-,NCD₅₉^-,ECD₅₅^-,ECD₅₉^-,.Drawed ROC curve,and calculated AUG.Many indicators combined diagnostic test evaluation uses Logistic regression combined with ROC curve.Results PNH group 30 cases,non PNH group 234 cases.The LCDCD₅₅^-,LCD₅₉^-,NCDCD₅₅^-,NCD₅₉^-,ECDCD₅₅^-,ECD₅₉^-,in non PNH group were lower than those in PNH group（P<0.05）.AUC of LCDCD₅₅^-,LCD₅₉^-,NCDCD₅₅^-,NCD₅₉^-,ECDCD₅₅^-,ECD₅₉^-,in the diagnosis of PNH were 0.824,0.793,0.949,0.950,0.967,0.949,and the optimal critical value were 3.8%,5.5%,12.7%,12.0%,7.4%,6.4%。Logistic regression equation of LCD₅₅^-,LCD₅₉^-,NCD₅₅^-,NCD₅₉^-,ECD₅₅^-,ECD₅₉^-combine diagnosis of PNH was P-1/(1+e-(-5.116-0.225×LCD₅₅^-+0.031×LCD₅₉^;+0.119×NCD₅₅^--0.01×NCD₅₉^-+0.13×ECD₅₅^-,+0.195×ECD₅₉^-).Parallel,test showed that AUC of neutrophil iojont J.Parallel test showed that AUC oi neutrophil joint erythrocytes parallel test was the largest,0.954(95%CI（0.911,0.997）].Sequence test showed that AUC of neutrophil joint erythrocytes sequence test was the largest,0.928(95%CI（0.856,1.000）],AUC of lymphocytes,neutrophil joint erythrocytes sequence test was the minimum,0.750(95%CI（0.633,0.867）].Conclusion Diagnosis of PNH,the critical value of CD₅₅,CD₅₉ are not the traditional definition>10%.The value of CD₅₅ and CD₅₉ in neutrophil,erythrocytes surface in the diagnosis of PNH are obviously better than in lymphocyte surface.The multi-index joint diagnosis does not improve the sensitivity,specific and AUC,the expression of CD₅₅ and CD₅₉ possible collinearity.更多还原