【摘要】 目的探讨血清铁蛋白（SF）、维生素B₁₂(Vit B₁₂)和叶酸（FA）对骨髓增生异常综合征（MDS）3种亚型[难治性贫血（RA）型、难治性贫血伴有原始细胞增多（RAEB）-Ⅰ型、RAEB-Ⅱ型]的辅助诊断价值及在预后评价中的意义。方法检测55例MDS患者（RA型13例、RAEB-Ⅰ型18例、RAEB-Ⅱ型24例）和50名体检健康者（正常对照组）SF、FA及Vit B₁₂水平。根据MDS国际预后积分系统（IPSS）将55例MDS患者分为相对低危组（25例）和相对高危组（30例）。采用受试者工作特征（ROC）曲线评价3项指标在MDS危险程度评估中的价值。采用Kaplan-Meier生存曲线评价3项指标对MDS患者预后评估的价值。结果MDS组3种亚型SF、Vit B₁₂和FA水平均明显高于正常对照组（P<0.01）,其中RAEB-Ⅱ型患者3项指标升高最为显著。相对高危组SF、Vit B₁₂和FA水平明显高于相对低危组（P<0.01）。ROC曲线分析显示,SF、Vit B₁₂和FA单项检测区分MDS相对高危和相对低危的曲线下面积（AUC）分别为0.749、0.791和0.811,最佳临界值分别为425.77 ng/m L、940.77 pg/m L和18.28 ng/m L,3项指标联合检测的AUC为0.907。当以FA+Vit B₁₂+SF(同时满足SF>425.77 ng/m L、Vit B₁₂>940.77 pg/m L和FA>18.28 ng/m L)进行预后分组时,预后良好组中位生存时间明显高于预后不良组（P<0.01）。结论 SF、Vit B₁₂和FA对MDS的3种亚型均有一定的辅助诊断价值,3项指标联合检测对MDS的预后评估有较好的价值。更多还原

【Abstract】 Objective To investigate the roles of serum ferritin（SF）,vitamin B₁₂(Vit B₁₂)and folic acid（FA）in the auxiliary diagnosis and prognosis evaluation of 3 subtypes of myelodysplastic syndrome（MDS）[refractory anemia（RA）,refractory anemia with excess blasts（RAEB）-Ⅰ and RAEB-Ⅱ]. Methods A total of 55 MDS patients（13 cases of RA,18 cases of RAEB-Ⅰ and 24 cases of RAEB-Ⅱ） and 50 healthy subjects（healthy control group） were enrolled,and the levels of SF, Vit B₁₂ and FA were determined. The 55 MDS patients were classified into relatively low risk group（25 cases）and relatively high risk group（30 cases）according to the International Prognostic Scoring System（IPSS）. Receiver operating characteristic（ROC）curve was used to evaluate the roles of SF,Vit B₁₂ and FA in assessing the risk of MDS. The roles of SF,Vit B₁₂ and FA for prognosis was evaluated by Kaplan-Meier survival curve. Results The levels of SF,Vit B₁₂ and FA in the 3 subtypes of MDS group were higher than those in healthy control group（P<0.01）,especially for RAEB-Ⅱ patients. The levels of SF,Vit B₁₂ and FA in relatively high risk group were higher than those in relatively low risk group（P<0.01）. ROC curve analysis showed that the areas under curve（AUC） of single determinations of SF,Vit B₁₂ and FA for distinguishing MDS patients with low risk from high risk were 0.749,0.791 and 0.811,respectively. The optimal cut-off values of SF,Vit B₁₂ and FA were 425.77 ng/m L,940.77 pg/m L and 18.28 ng/m L,respectively. The AUC of the combined determination was 0.907. The median survival time of good prognosis group was longer than that of poor prognosis group（P<0.01）,when FA+Vit B₁₂+SF(SF>425.77 ng/m L,Vit B₁₂>940.77 pg/m L and FA>18.28 ng/m L) was used to predict prognosis. Conclusions The single determinations of SF,Vit B₁₂ and FA have auxiliary diagnostic value for the 3 subtypes of MDS. The combined determination of SF,Vit B₁₂ and FA plays a role in the prognosis evaluation of MDS.更多还原