Value Of LDH、RDW、IBIL、MCV In Differential Diagnosis Of MA And MDS

Objective: To analyze megaloblastic anemia(MA)and myelodysplastic syndrome(MDS)patients with lactate dehydrogenase(LDH),total bilirubin(TBIL),indirect bilirubin(IBIL),mean corpuscular volume(MCV),red blood cell volume distribution width(RDW),red blood cell count(RBC),white blood cell count(WBC),platelet count(PLT),hemoglobin(HB),reticulocyte parameters,vitamin B12,folic acid,with or without increased liver and spleen,direct Coombs test,with or without fever and other data gaps,in order to guide more accurate,fast differential diagnosis of MA and MDS.Diagnosing the disease early,starting treatment early.Materials and Methods: The data of MA and MDS patients from January 1,2010 to December 31,2015 admitted to our hospital were retrospectively collected,whose date was relatively complete.we collected a total of 116 patients,of whom the number of MA patients was 36(male 20,female1 6),the average age was 68.11 years,the number of MDS patients was 80(male 53,female 27),mean age 60.24 years.The diagnosis of MA and MDS were in accordance with zhinan Zhang《third edition of blood disease and clinical standards》.To evaluate the difference of LDH,TBIL,IBIL,MCV,RDW,RBC,WBC,PLT,HB,reticulocyte count,reticulocyte ratio,the proportion of immature reticulocyte,vitamins B12,folic acid,with or without increased liver and spleen,direct Coombs test,with or without fever between MA and MDS patients.Using SPSS 17.0 software for drawing ROC curve to determine the optimal threshold of the test for the differential diagnosis of MA and MDS,and its sensitivity and specificity.Using rate represented Count data.Using mean ± standard deviations represented measurement data.Using the chi-square test for comparing rates between the two groups.Using the t test for comparing the mean between the two groups.P <0.05 indicated statistical significance,P <0.01 indicated significant statistical significance.Results: 1.The LDH values of MA group were significantly higher than MDS group(P=0.000).The area under the ROC curve was 0.92,P = 0.000.The cutoff value of LDH was 410 U / L,the sensitivity and specificity of LDH for differential of MA and MDS was 80.6% and 93.7%.In MA group,LDH was in negative correlation with HB,the correlation coefficient was-0.406,P <0.05.2.The RDW-SD values of MA group were significantly higher than MDS group(P=0.002).The area under the ROC curve was 0.669,P = 0.004.The cutoff value of RDW-SD was 80.15 f L,the sensitivity and specificity of RDW-SD for differential of MA and MDS was 42.9% and 85.9%.In MA group,RDW-SD was in negative correlation with HB,the correlation coefficient was-0.479,P <0.01.3.The RDW-CV values of MA group were higher than MDS group(P=0.013).4.The MCV values of MA group were higher than MDS group(P=0.000).The area under the ROC curve was 0.772,P=0.000.The cutoff value of MCV was 115.65 f L,the sensitivity and specificity of MCV for differential of MA and MDS was 58.3% and 90%.5.The TBIL values of MA group were significantly higher than MDS group(P=0.000).The area under the ROC curve was 0.817,P =0.000.The cutoff value of TBIL was 30.3 umol / L,the sensitivity and specificity of TBIL for differential of MA and MDS was 61.1% and 91.2%.In MA group,TBIL was in negative correlation with HB,the correlation coefficient was-0.471,P <0.01.6.The IBIL values of MA group were significantly higher than MDS group(P=0.000).The area under the ROC curve was 0.818,P =0.000.The cutoff value of IBIL was 20.3 umol / L,the sensitivity and specificity of IBIL for differential of MA and MDS was 52.8% and 93.7%.In MA group,third edition was in negative correlation with HB,the correlation coefficient was-0.253,P <0.01.7.The vitamin B12 values of MA group were significantly lower than MDS group(P=0.000).The folate values of MA group were significantly lower than MDS group(P=0.015).8.The rate of having increased liver and spleen in MA and MDS had no statistically significant difference(P=0.672).9.The rate of having fever in MA and MDS had no statistically significant difference(P=0.178).10.The positive rate of direct Coombs test in MA group and MDS group had no statistically significant difference(P=0.612).11.The WBC values in MA and MDS had no statistically significant difference(P = 0.37).In MA group,WBC was positive correlation with HB,the correlation coefficient was 0.392,P <0.05.12.The PLT values in MA and MDS had no statistically significant difference(P = 0.915).In MA group,PLT was positive correlation with HB,the correlation coefficient was 0.666,P <0.01.13.The reticulocyte count values in MA and MDS had no statistically significant difference(P = 0.055).14.The proportion of immature reticulocyte in MA and MDS had no statistically significant difference(P = 0.543).15.The reticulocyte ratio in MA and MDS had no statistically significant difference(P = 0.782)Conclusions: 1.The LDH values of MA were significantly higher than MDS.Greater possibility of higher LDH prompts MA.2.The TBIL,IBIL values of MA were significantly higher than MDS.Greater possibility of higher TBIL,IBIL prompts MA.3.The MCV values of MA were significantly higher than MDS.Greater possibility of MCV prompts MA.4.The RDW-SD,RDW-CV values of MA were significantly higher than MDS.Greater possibility of higher RDW-SD,RDW-CV prompts MA.