Clinical value of erythrocyte parameters in multiple myeloma screening
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摘要: 目的 通过比较多发性骨髓瘤(MM)患者与健康体检人群红细胞参数的差异，探讨红细胞参数在MM患者筛查中的临床价值。方法 回顾性分析广州市番禺区中心医院2012年1月至2022年1月，初诊为MM患者109例(病例组)以及同期健康体检者110例(对照组)的红细胞参数。比较2组间血红蛋白(Hb)、平均红细胞体积(MCV)、红细胞体积分布宽度(RDW)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)的均值及阳性率的差异。进一步从病例组中筛选出贫血患者89例(MM贫血组)及对照组中筛选出非贫血者109例(对照非贫血组)，比较2组间红细胞相关参数的均值及阳性率差异，精准分析MM贫血患者的特点；并对差异有统计学意义的项目进一步进行受试者工作特征(ROC)曲线分析，探讨红细胞相关参数在MM中的诊断价值。结果 病例组和对照组比较，均值水平MCV、MCH差异无统计学意义(P>0.01)，Hb、MCHC、RDW差异有统计学意义(P < 0.01)；阳性率红细胞参数差异有统计学意义(P < 0.01)，尤以Hb(81.7%)、RDW(75.2%)阳性率较高。MM贫血组和对照非贫血组比较，均值水平MCV、MCH差异无统计学意义(P>0.01)，Hb、MCHC、RDW差异有统计学意义(P < 0.01)；阳性率红细胞参数差异有统计学意义(P < 0.01)，RDW阳性率高达84.3%。将Hb、RDW单独与联合分别进行ROC曲线分析，提示两者对MM均有较好的诊断价值，两者联合对MM的诊断价值更大。结论 红细胞参数在MM筛查中有重要的临床意义，深入掌握MM红细胞参数特点，对降低MM误漏诊率有重要的临床价值。Abstract: Objective To explore the clinical value of erythrocyte parameters by comparing the multiple myeloma(MM) patients and healthy people.Methods Erythrocyte parameters of 109 newly diagnosed MM patients(case group) and 110 healthy subjects(control group) in Guangzhou Panyu Central Hospital from January 2012 to January 2022 were retrospectively analyzed. The mean and positive rate of hemoglobin(Hb), mean corpuscular volume(MCV), RBC distribution width(RDW), mean corpuscular hemoglobin(MCH) and mean corpuscular hemoglobin concentration(MCHC) between the two groups were compared. Further, the mean value and positive rate of erythrocyte related parameters between the MM anemia group and control non-anemia group were compared to accurately analyze the anemia characteristics of MM anemia patients. Moreover, subjects' operating characteristic curve was further analyzed for the items with significant differences to explore the diagnostic value of erythrocyte related parameters in MM.Results Compared with the control group, there was no significant difference in MCV and MCH at the mean level(P>0.01), but significant difference in Hb, MCHC and RDW(P < 0.01). There was statistical difference in positive rate between the two groups(P < 0.01), and the positive rate of Hb(81.7%) and RDW(75.2%) was higher. Compared with the MM anemia group and control non-anemia group, there were no significant differences in MCV and MCH at the mean level(P>0.01), while significant differences in MCHC and RDW(P < 0.01).There was statistical difference in positive rate between the two groups(P < 0.01), the positive rate of RDW was up to 84.3% in the MM anemia group. The operating characteristic curves of Hb and RDW were analyzed separately and in combination, indicating that both Hb and RDW had good diagnostic value for MM, and the combination of Hb and RDW had the greatest diagnostic value for MM.Conclusion Erythrocyte parameters may be of great value in the diagnosis of MM. To in-depth analysis the characteristic of erythrocyte parameters in MM patients would be of great clinical value in significantly reducing the misdiagnosis rate of MM.
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Key words:
- multiple myeloma /
- erythrocyte parameters /
- anemia /
- diagnostic value
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表 1 病例组和对照组性别及年龄比较
项目 病例组(n=109) 对照组(n=110) 性别/例(%) 男 46(42.2) 46(41.8) 女 63(57.8) 64(58.2) 年龄/岁 66.48±11.34 65.58±11.16 
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表 2 病例组和对照组Hb、MCV、MCH、MCHC、RDW均值比较
X±S 项目 病例组(n=109) 对照组(n=110) t P Hb/(g·L-1) 77.39±27.26 142.09±13.31 22.293 < 0.001 MCV/fl 92.43±9.36 91.75±5.18 -0.660 0.510 MCH/pg 29.96±3.52 30.63±1.86 1.756 0.081 MCHC/(g·L-1) 323.92±17.45 333.88±7.53 5.478 < 0.001 RDW/% 54.03±11.66 41.97±2.50 -10.563 < 0.001
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表 3 病例组和对照组Hb、MCV、MCH、MCHC、RDW阳性率比较
例(%) 项目 病例组(n=109) 对照组(n=110) χ2 P Hb/(g·L-1) 89(81.7) 1(0.9) 147.446 < 0.001 MCV/fl 32(29.4) 5(4.5) 24.006 < 0.001 MCH/pg 25(22.9) 6(5.5) 13.769 < 0.001 MCHC/(g·L-1) 34(31.2) 0 - < 0.001 RDW/% 82(75.2) 14(12.7) 86.871 < 0.001
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表 4 MM贫血组和对照非贫血组MCV、MCH、MCHC、RDW均值比较
X±S 项目 MM贫血组(n=89) 对照非贫血组(n=109) t P MCV/fl 92.33±10.20 91.71±5.18 -0.523 0.602 MCH/pg 29.61±3.76 30.63±1.87 2.328 0.022 MCHC(g·L-1) 320.28±16.12 333.96±7.52 7.381 < 0.001 RDW/% 56.15±11.76 41.90±2.41 -11.236 < 0.001
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表 5 MM贫血组和对照非贫血组MCV、MCH、MCHC、RDW阳性率比较
例(%) 项目 MM贫血组(n=89) 对照非贫血组(n=109) χ2 P MCV/fl 31(34.8) 5(4.6) 30.127 < 0.001 MCH/pg 25(28.1) 6(5.5) 18.926 < 0.001 MCHC(g·L-1) 32(36.0) 0 - < 0.001 RDW/% 75(84.3) 13(11.9) 103.848 < 0.001
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表 6 Hb、RDW的ROC曲线分析
检验项目 曲线下面积 标准误 P 最佳临界值 灵敏度/% 特异度/% 95%CI 下限 上限 Hb 0.963 0.013 < 0.001 120.50 89.90 96.40 0.937 0.990 RDW 0.882 0.025 < 0.001 45.05 77.10 90.90 0.833 0.931 Hb+RDW(预测概率) 0.967 0.013 < 0.001 0.47 90.80 98.20 0.943 0.992
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