【摘要】 目的 探讨外周血CD34~+细胞检测在恶性血液病诊治中的应用价值。方法 回顾性收集2025年1月至9月蚌埠医科大学附属铜陵医院(铜陵市人民医院)血液内科收治的恶性血液病患者74例的临床资料，根据外周血白细胞计数绝对值分为低白细胞组(WBC<4.0×10~9/L,41例)和高白细胞组(WBC≥4.0×10~9/L,33例)，另外设健康对照组30例，采用流式免疫荧光法检测三组外周血中有核细胞数、CD34~+细胞绝对数(/μL)、CD34~+细胞百分比(%)，手工分类计数100个白细胞中原始及幼稚阶段的细胞(原幼细胞)百分比(%)；根据临床分型分为髓系组(n=26)、非髓系组(n=48)，与对照组比较分析各组间各指标的差异；将CD34~+细胞百分比(%)与原幼细胞(%)进行Spearman相关性分析；绘制受试者工作特征(ROC)曲线评估各指标的诊断价值。结果 有核细胞数：高白细胞组14.390(8.698,29.657)×10~9/L vs低白细胞组4.137(2.671,5.232)×10~9/L vs对照组5.025(4.474,6.067)×10~9/L；高白细胞组显著高于低蛋白组及对照组(P<0.001)，低白细胞组显著低于对照组(P<0.001)。CD34~+细胞绝对数：高白细胞组95.55(62.25,265.50)/μL vs低白细胞组88.50(56.25,122.25)/μL vs对照组4.88(2.94,7.27)/μL；高、低白细胞组均显著高于对照组(P<0.001)，且高白细胞组显著高于低白细胞组(P<0.001)。CD34~+细胞百分比：高白细胞组0.84(0.47,1.25)%vs低白细胞组2.12(1.27,3.32)%vs对照组0.10(0.08,0.12)%；高、低白细胞组均显著高于对照组(P<0.001)，但高白细胞组显著低于低白细胞组(P<0.001)。幼稚细胞百分比：高白细胞组1.00(1.00,9.75)%vs低白细胞组1.00(0.00,2.00)%vs对照组0.00(0.00,0.00)%；高、低白细胞组均显著高于对照组(P<0.001)，且高白细胞组显著高于低白细胞组(P<0.001)。按疾病分型，髓系组vs非髓系组vs对照组：有核细胞数分别为7.530(3.714,12.492)×10~9/L、7.068(4.913,12.697)×10~9/L、5.025(4.474,6.067)×10~9/L;CD34~+绝对数分别为100.50(70.75,236.00)/μL、94.00(51.00,155.50)/μL、4.88(2.94,7.27)/μL;CD34~+百分比分别为2.17(1.07,3.73)%、1.08(0.65,2.09)%、0.10(0.08,0.12)%；幼稚细胞百分比分别为2.00(1.00,9.00)%、1.00(0.00,2.00)%、0.00(0.00,0.00)%。髓系组和非髓系组的四项指标均显著高于对照组(P<0.001)；髓系组的CD34~+百分比和幼稚细胞百分比均显著高于非髓系组(P<0.05)。Spearman相关分析结果显示，CD34~+细胞百分比与幼稚细胞百分比呈正相关(r=0.459,P<0.001)。ROC曲线分析结果显示，以健康对照组为参照，有核细胞数、CD34~+细胞绝对数、CD34~+细胞百分比、幼稚细胞百分比诊断恶性血液病的曲线下面积(AUC)分别为0.587、0.996、0.982和0.844，临界值分别为7.818×10~9/L、16.0/μL、0.24%、1.0%，其中CD34~+细胞绝对数的AUC及约登指数最高。结论 外周血CD34~+细胞检测对恶性血液病的辅助性诊断和分型具有重要的应用价值，相较于传统外周血中原幼细胞百分比具备更高的敏感度和预测价值，有望替代其成为恶性血液病的常规监测指标。更多还原

【Abstract】 Objective To explore the application value of peripheral blood CD34~+cell detection in the diagnosis and treatment of malignant hematological diseases. Methods A total of 74 patients with malignant hematological diseases admitted to the Department of Hematology, Tongling Hospital Affiliated to Bengbu Medical University(Tongling People’s Hospital) from January 2025 to September were selected. According to the absolute value of peripheral blood white blood cells, the patients were divided into the low white blood cell group(WBC<4.0×10~9/L, n=41) and the high white blood cell group(WBC≥4.0×10~9/L, n=33). Thirty healthy subjects were set as the control group. Flow immunofluorescence was used to detect the nucleated cell count, absolute CD34~+cell count(/μL), and CD34~+cell percentage(%) in the peripheral blood of three group. Simultaneously, manual differential counting was used to determine the percentage(%) of blast and immature cells(blasts) per 100 white blood cells, and comparisons were made. Patients were further divided into a myeloid group(n=26) and a non-myeloid group(n=48) according to clinical type, and differences in various indicators among these groups and the control group were compared and analyzed. Spearman correlation analysis was performed between CD34~+cell(%) and blast cell(%). Receiver operating characteristic(ROC) curves for each indicator were plotted. Results Nucleated cell count(×10~9/L) was 14.390(8.698, 29.657) in high-WBC group,4.137(2.671, 5.232) in low-WBC group, and 5.025(4.474, 6.067) in the control group; the high-WBC group had a significantly higher count than the low-WBC and control groups(P<0.001), while the low-WBC group had a significantly lower count than the control group(P<0.001). Absolute CD34~+cell count(/μL) was 95.55(62.25, 265.50) in high-WBC group, 88.50(56.25, 122.25) in low-WBC group, and 4.88(2.94, 7.27) in the control group; both the high-and low-WBC groups had significantly higher counts than the control group(P<0.001), and the high-WBC group had a significantly higher count than the low-WBC group(P<0.001). Percentage of CD34~+cells(%) was 0.84(0.47, 1.25) in high-WBC group, 2.12(1.27, 3.32) in low-WBC group, and 0.10(0.08, 0.12) in the control group; both the high-and low-WBC groups had significantly higher percentages than the control group(P<0.001), but the high-WBC group had a significantly lower percentage than the low-WBC group(P<0.001). Percentage of blasts(%) was 1.00(1.00, 9.75) in high-WBC group, 1.00(0.00, 2.00) in low-WBC group, and 0.00(0.00, 0.00) in the control group; both the high-and low-WBC groups had significantly higher percentages than the control group(P<0.001), and the high-WBC group had a significantly higher percentage than the low-WBC group(P<0.001). By disease subtype(myeloid vs non-myeloid vs control), nucleated cell count(×10~9/L) was 7.530(3.714, 12.492) vs 7.068(4.913, 12.697) vs 5.025(4.474, 6.067); absolute CD34~+count(/μL) was 100.50(70.75, 236.00) vs 94.00(51.00, 155.50) vs 4.88(2.94, 7.27); percentage of CD34~+cells(%) was 2.17(1.07, 3.73) vs 1.08(0.65, 2.09) vs 0.10(0.08, 0.12); percentage of blasts(%) was 2.00(1.00, 9.00) vs 1.00(0.00, 2.00) vs 0.00(0.00, 0.00). All four indicators were significantly higher in both the myeloid and non-myeloid groups compared to the control group(P<0.001). The percentages of CD34~+cells and blasts were significantly higher in the myeloid group than in the non-myeloid group(P<0.05). Spearman correlation analysis showed a positive correlation between the percentage of CD34~+cells and the percentage of blasts(r=0.459, P<0.001). ROC curve analysis(using the healthy control group as reference) yielded area under the curve(AUC) values for diagnosing hematologic malignancies as follows: nucleated cell count, 0.587; absolute CD34~+cell count, 0.996; percentage of CD34~+cells, 0.982; percentage of blasts, 0.844. The corresponding cut-off values were 7.818×10~9/L, 16.0/μL, 0.24%, and 1.0%, respectively. The absolute CD34~+cell count demonstrated the highest AUC and Youden index. Conclusion The detection of peripheral blood CD34~+cells has significant application value in the auxiliary diagnosis and classification of malignant hematological diseases. Compared with the percentage of immature cells in the peripheral blood, it has higher sensitivity and predictive value, and is expected to replace it as a routine monitoring indicator for malignant hematological diseases.更多还原