脑脊液MRD联合乳酸脱氢酶检测在中枢神经系统白血病诊断中的应用价值

摘要

目的 探讨急性白血病脑脊液微小残留白血病细胞(MRD)联合乳酸脱氢酶(LDH)检测在中枢神经系统白血病(CNSL)早期诊断中的应用价值,为临床诊断和病情发展及治疗效果评价提供实验室诊断依据.方法 选择该院住院患者无血液病及中枢神经系统器质性病变、脑脊液常规和生化检验各项指标均为正常者30例作为对照组,骨髓穿剌FAB形态学和流式细胞免疫分型确诊的急性白血病(AL)96例作为疾病组.用流式细胞术法检测对照组和疾病组脑脊液中的MRD,用速率法检测对照组和疾病组脑脊液中LDH的活性,并对检测结果进行比较分析.结果 96例急性白血病患者中,30例伴中枢神经系统白血病脑脊液MRD检测阳性者13例,阳性率为43.33%.66例无CNSL组未检出MRD.96例急性白血病患者中30例伴中枢神经系统白血病(CNSL)组脑脊液LDH水平为(30.54±10.29)U/L,显著高于无 CNSL组(16.16±7.12)U/L,两者比较差异具有统计学意义(P<0.05).结论 急性白血病脑脊液中MRD、 LDH 检测可作为早期诊断CNSL的实验室诊断指标,MRD联合 LDH 检测可提高CNSL阳性诊断率.%Objective To study the apllication value of cerebraspinal fluid minimal residual leukemia cells(MRLCs) combined with lactate dehydrogenase(LDH) detection in early diagnosis of central nervous system leukemia(CNSL) to provide a laboratory basis for clinical diagnosis and evaluation of disease progression and therapeutic effect.Methods Thirty inpatiernts without blood disease and central nervous system(CNS) organic diseases,and normal CSF routine and detected biochemical indexes were selected as the control group and 96 cases of acute leukemia (AL) diagnosed by bone marrow puncture FAB morphology and flow cytometry typing served as the disease group.Flow cytometry was used to detect the MRLCs in CSF,the activity of LDH in CSF was detected by the rate method,and the detection results were performed the comparative analysis.Results Among 96 cases of AL,30 patients with CNSL had 13 cases of positive MRLCs in CSF,the positive rate was 43.33%,among 66 cases of non-MRLCs,MRLCs was not detected detected.Among 96 cases of AL,CSF LDH level in 30 cases of CNSL was (30.54±10.29)U/L,which was significantly higher (16.16±7.12)U/L in the patients without CNSL,the difference between the two groups was statistically significant (P<0.05).Conclusion The detection of MRLCs and LDH in CSF of AL can be used as a laboratory diagnostic index for early diagnosis of CNSL,and MRLCs combined with LDH detection can improve the positive diagnosis rate of CNSL.