[1]洪俊,饶永彩.应用ROC曲线确定流式细胞术髓过氧化酶检测结果在急性白血病分类中的最佳临界值[J].现代检验医学杂志,2015,30(05):76-80.[doi:10.3969/j.issn.1671-7414.2015.05.023]
　HONG Jun,RAO Yong-cai.Detecting Optimal Cut-off Value of Flow Cytometry Myeloperoxidase(fMPO) by Receiver Operator Characteristic Curve in the Classification of Acute Leukemia[J].Journal of Modern Laboratory Medicine,2015,30(05):76-80.[doi:10.3969/j.issn.1671-7414.2015.05.023]
点击复制

应用ROC曲线确定流式细胞术髓过氧化酶检测结果在急性白血病分类中的最佳临界值()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第30卷
期数:
2015年05期
页码:
76-80
栏目:
论著
出版日期:
2015-12-10

文章信息/Info

Title:
Detecting Optimal Cut-off Value of Flow Cytometry Myeloperoxidase(fMPO) by Receiver Operator Characteristic Curve in the Classification of Acute Leukemia
作者:
洪俊1; 饶永彩2
1.武汉大学人民医院检验科，武汉430060；2.武汉生物制品所，武汉430060
Author(s):
HONG Jun1; RAO Yong-cai2
1.Department of Clinical Laboratory，Renmin Hospital of Wuhan University，Wuhan 430060，China； 2.Wuhan Institute of Biological Products，Wuhan 430060，China
关键词:
髓过氧化酶; 受试者工作曲线; 急性白血病; 临界值
分类号:
R557；R446.113
DOI:
10.3969/j.issn.1671-7414.2015.05.023
文献标志码:
A
摘要:
目的用受试者工作曲线(ROC曲线)法，评价流式细胞术髓过氧化酶检测(fMPO)在急性白血病分类中的预测和诊断价值，并确定其在急性白血病分类中的最佳临界值(Cut-off)。方法收集武汉大学人民医院2010年1月~2012年6月血液科门诊及住院急性白血病(ALS)患者198例，其中急性髓性白血病(AML)119例，急性淋巴细胞白血病(ALL)54例和急性未分类白血病25例。采用流式细胞术(FCM)和酶细胞化学技术对MPO进行测定，以细胞化学法MPO(CMPO)≥3％和/或≥两种泛髓细胞标准物表达作为鉴别诊断急性髓细胞白血病的金标准。并用SSPS软件绘制ROC曲线确定最佳临界值，并将其与fMPO临界值为3%和10%时的诊断效能指标(敏感度、特异度、误诊率、漏诊率、阳性预告值、阴性预告值)进行初步对比。结果AML组和急性未分类白血病组fMPO水平显著高于ALL组(U=40，41；P均<0．05)。ROC曲线显示曲线下面积(AUC)为0.967，标准误0.04，95%置信区间为0．85～1.0，依据Youden指数最大原则，确定fMPO最佳临界值为5.5%，此时灵敏度为98 .7％，特异度为92 .1%，其特异度明显高于fMPO为3%时的22.2％和10%时的70％(χ2＝11.23，8.11；P均<0．05)，而灵敏度3%时的98.6％和10%时的96.5％差异无统计学意义(χ2＝0．72，0.61；P均>0．05)。结论fMPO临界值5.5%作为急性白血病分类的诊断界值比较合适，可以提高临床的诊断。
Abstract:
ObjectiveTo evaluate the value of flow cytometry myeloperoxidase (fMPO) in the classification of acute leukemia and determine the optimal cut-off value of fMPO for the classification of acute leukemia by receiver operator characteristic(ROC) curve．MethodsBy retrospective analysis，with acute leukemia (ALS) 198 cases，119 cases of acute myeloid leukemia (AML) (AML group)，54 cases of acute lymphoblastic leukemia (ALL group) and 25 cases of acute leukemia unclassified,by flow cytometry (FCM) and enzyme cytochemical techniques,MPO was determined by cell chemistry MPO (CMPO) ≥3% and/or≥two pan-myeloid expression gold standard as a differential diagnosis of acute myeloid leukemia standards．And draw the ROC curve to determine the optimal threshold value，and with 3% and 10% of fMPO cut-off value in the differential diagnosis of AML，such as a preliminary comparison of the effectiveness of using SSPS software．ReasultsFMPO AML group was significantly higher than ALL group，acute leukemia Unclassified group and control group．ROC curve showed the area under the curve (AUC) was 0.967，standard error of 0.04，95% confidence interval 0.85 to 1.0，based on the principle of maximum Youden index to determine the optimal cut-off value of 5.5% fMPO，when sensitivity was 98.7%，the specificity was 92.1%，significantly higher than 98.6% and 22.2％ of fMPO 3% and 96.5％ and 70％ of fMPO 10%．ConclusionfMPO cut-off value of 5.5% as a diagnostic cutoff value moreappropriate classification of acute leukemia，can improve clinical diagnosis．

参考文献/References:

［1］van den Ancker W，Terwijn M，Westers TM，et al．Acute leukemias of ambiguous lineage：diagnostic consequences of the WHO 2008 classification［J］．Leukemia，2010，24(7)：1392-1396．
[2]Swerdlow SH，Campo E，Harris NL，et al．WHO classification of tumours of haematopoietic and lymphoid tissues［M］．4th Ed．Lyon：IARC Press，2008．
[3]Bennett JM，Catovsky D，Daniel MT，et al．Proposals for the classification of the acute leukaemias．French-American-British (FAB) co-operative group［J］．Br J Haematol，1976，33(4)：451-458．
[4]Bene MC，Castoldi G，Knapp W，et al．Proposals for the immunological classification of acute leukemias．European Group for the Immunological Characterization of Leukemias (EGIL)［J］．Leukemia，1995，9(10)：1783-1786．
[5]Bain BJ，Barnett D，Linch D，et al．Revised guideline on immunophenotyping in acute leukemias and chronic lymphoproliferative disorders［J］．Clin Lab Haematol，2002，24(1)：1-13．
[6]van den Ancker W，Westers TM，de Leeuw DC，et al．A threshold of 10% for myeloperoxidase by flow cytometry is valid to classify acute leukemia of ambiguous and myeloid origin［J］．Cytometry Part B Clin Cytom，2013，84(2)：114-118．
[7]Belurkar S，Mantravadi H，Manohar C，et al．Correlation of morphologic and cytochemical diagnosis with flow cytometric analysis in acute leukemia［J］．J Cancer Res Ther，2013，9(1)：71-79．
[8]Guy J，Antony-Debré I，Benayoun E，et al．Flow cytometry thresholds of myeloperoxidase detection to discriminate between acute lymphoblastic or myeloblastic leukaemia［J］．Br J Haematol，2013，161(4)：551-555．
[9]Peffault de Latour R，Legrand O，Moreau D，et al．Comparison of flow cytometry and enzyme cytochemistry for the detection of myeloperoxidase in acute myeloid leukaemia：interests of a new positivity threshold［J］．Br J Haematol，2003，122(2)：211-216．

备注/Memo

备注/Memo:
作者简介：洪俊(1973-)，男，博士，副主任技师，主要从事临床免疫及血液学方面的研究。
更新日期/Last Update: 1900-01-01