【摘要】 目的探讨骨髓增生异常综合征（MDS）患儿血清乳酸脱氢酶（LDH）、β2微球蛋白（β2-MG）、铁蛋白（SF）、维生素B₁₂表达的变化及临床应用价值。方法选取2019年2月至2020年6月川北医学院附属医院收治的72例MDS患儿为研究组,另选取同期体检的健康儿童30例为对照组。检测两组的血清LDH、β2-MG、SF、维生素B₁₂水平,并绘制受试者工作特征（ROC）曲线,评估其对MDS的诊断价值。将研究组患儿按照国际预后积分系统（IPSS）分为低危组（15例）、中危Ⅰ组（22例）、中危Ⅱ组（20例）、高危组（15例）,比较分析不同亚组患儿的血清LDH、β2-MG、SF、维生素B₁₂水平。结果研究组的血清LDH、β2-MG、SF水平均明显高于对照组,差异均有统计学意义（t值分别为5.832、5.462、7.923,P<0.05）;研究组与对照组的维生素B₁₂水平比较差异无统计学意义（t=0.863,P>0.05）。血清LDH、β2-MG、SF和维生素B₁₂联合检测的曲线下面积（AUC）最高为0.946,诊断效果最好。低危组、中危Ⅰ组、中危Ⅱ组的血清LDH、β2-MG、SF水平均明显低于高危组（F值分别为17.080、10.032、5.613,P<0.05）,低危组、中危Ⅰ组均明显低于中危Ⅱ组,低危组明显低于中危Ⅰ组（t=2.065～8.037,P<0.05）;低危组、中危Ⅰ组、中危Ⅱ组和高危组的血清维生素B₁₂水平比较差异无统计学意义（F=0.229,P>0.05）。结论 MDS患儿血清LDH、β2-MG、SF水平均明显升高,且病情较为严重的患儿明显高于病情较轻的患儿,LDH、β2-MG、SF和维生素B₁₂在MDS的诊断中具有重要临床意义,联合诊断效能更高。更多还原

【Abstract】 Objective To investigate the changes and clinical application values of serum lactate dehydrogenase（LDH）,β2-microglobulin（β2-MG）,serum ferritin（SF） and vitamin B₁₂ in children with myelodysplastic syndrome（MDS）.Methods A total of 72 children with MDS who were admitted to the Affiliated Hospital of North Sichuan Medical College from February 2019 to June 2020 were selected as the research group, and 30 healthy children who came to the hospital for physical examination were selected as the control group.The serum LDH,β2-MG,SF and vitamin B₁₂ levels of the two groups were detect, and the receiver operating characteristic（ROC） curve was drawn to evaluate their diagnostic value on MDS.According to the International Prognostic Scoring System（IPSS）,children in the research group were divided into the low-risk group（15 cases）,moderate-risk group Ⅰ（22 cases）,moderate-risk group Ⅱ（20 cases） and high-risk group（15 cases）.The serum LDH,β2-MG,SF and vitamin B₁₂ levels of children in different subgroups were compared and analyzed.Results The levels of serum LDH,β2-MG and SF in the research group were significantly higher than those in the control group, and the differences were statistically significant（t=5.832,5.462 and 7.923,respectively, P<0.05）.There was no significant difference in the levels of vitamin B₁₂ between the research group and the control group（t=0.863,P>0.05）.The combined detection of serum LDH,β2-MG,SF and vitamin B₁₂ was of the highest area under the receiver operating characteristic curve（AUC） of 0.946 and the best diagnostic effect.The levels of serum LDH,β2-MG and SF in the low-risk group, moderate-risk group Ⅰ and moderate-risk group Ⅱwere obviously lower than those in the high-risk group（F=17.080,10.032 and 5.613,respectively, P<0.05）,the low-risk group and moderate-risk group Ⅰ were lower than the moderate-risk group Ⅱ and the low-risk group were lower than moderate-risk group Ⅰ（t=2.065-8.037,respectively, P<0.05）.There was no significant difference in the level of vitamin B₁₂ among the low-risk group, moderate-risk group Ⅰ,moderate-risk group Ⅱ and high-risk group（F=0.229,P>0.05）.Conclusion The levels of serum LDH,β2-MG and SF in children with MDS are significantly increased, and those of children with more severe illness are significantly higher than children with mild illness.LDH,β2-MG,SF and vitamin B₁₂ are of important clinical significancein the diagnosis of MDS,and the combined diagnosis efficiency is higher.更多还原