| 摘要: |
| ［摘要］ 目的 探讨网织红细胞血红蛋白含量（Ret-He）结合铁代谢参数诊断成人缺铁性贫血（IDA）的临床价值。方法 选取该院血液科2018-11～2019-10收治的165例患者，检测各自红细胞参数［血红蛋白（Hb）、红细胞平均体积（MCV）、红细胞平均血红蛋白含量（MCH）］、网织红细胞参数（Ret-He）、铁代谢参数［血清铁（SI）、血清铁蛋白（SF）］及炎症标志物［C反应蛋白（CRP）］。根据Hb水平和骨髓铁染色结果将受试者分为缺铁性贫血组(IDA组)53例、非缺铁性贫血组(NIDA组)34例、缺铁非贫血组35例和对照组43例，比较各组间上述指标的差异，并考虑炎症的影响。绘制各血液分析指标单独诊断IDA和Ret-He+SI+SF结合诊断IDA的受试者工作特征（ROC）曲线，计算各自的灵敏度和特异度。结果 IDA组各参数水平明显低于NIDA组、缺铁非贫血组和对照组，差异均有统计学意义（P<0.05）；NIDA组SI、SF水平明显高于缺铁非贫血组和对照组，差异均有统计学意义（P<0.05）；缺铁非贫血组Ret-He、Hb、MCV、MCH、SI、SF水平明显低于对照组，差异均有统计学意义（P<0.05）。炎症组与无炎症组患者血液SI、SF水平差异有统计学意义（P<0.05），Ret-He、Hb、MCV、MCH水平差异无统计学意义（P>0.05）。ROC曲线分析结果表明，Ret-He诊断IDA的cut-off值为28.8 pg，灵敏度为91.1%，特异度为90.9%，曲线下面积（AUC）为0.947（95%CI：0.875～0.984）。Ret-He+SI+SF结合诊断IDA的灵敏度为92.7%，特异度为93.5%，AUC为0.959（95%CI：0.900～0.988）。结论 Ret-He结合SI、SF诊断IDA具有较高的临床价值，其综合诊断效能优于Ret-He、Hb、MCV、MCH、SI、SF等指标的单独诊断。 |
| 关键词: 网织红细胞血红蛋白含量 缺铁性贫血 成人 |
| DOI：10.3969/j.issn.1674-3806.2020.07.15 |
| 分类号:R 446.11+3 |
| 基金项目: |
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| Clinical value of reticulocyte hemoglobin content combined with iron metabolism parameters in diagnosis of iron deficiency anemia in adults |
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ZHOU Liang, GUO Jian-hui, ZHANG Xiao-peng
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Department of Clinical laboratory, Haimen People′s Hospital, Jiangsu 226100, China
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| Abstract: |
| ［Abstract］ Objective To investigate the clinical value of reticulocyte hemoglobin content(Ret-He) combined with iron metabolism parameters in diagnosis of iron deficiency anemia(IDA) in adults. Methods One hundred and sixty-five patients were selected from the Department of Hematology of Haimen People′s Hospital during November 2018 and October 2019. The red blood cell parameters［hemoglobin(Hb), mean corpuscular volume(MCV), mean corpuscular hemoglobin content(MCH)］, reticulocyte parameters(Ret-He), iron metabolism parameters［serum iron(SI), serum ferritin(SF)］ and inflammatory markers［C-reactive protein(CRP)］ were detected in the patients. The research subjects were divided into four groups according to different hemoglobin levels and bone marrow iron staining results: iron deficiency anemia(IDA) group(n=53), non-iron deficiency anemia(NIDA) group(n=34), iron-deficiency non-anemia group(n=35) and control group(n=43). The differences of the above-mentioned indexes were compared among the four groups and the effect of inflammation was also considered. The receiver operating characteristic(ROC) curves of IDA and Ret-He+SI+SF were drawn to diagnose IDA by the individual indicator and the joint indicator respectively. The sensitivities and the specificities of each indicator and Ret-He+SI+SF were calculated. Results The levels of the parameters in the IDA group were significantly lower than those in the NIDA group, the iron-deficiency non-anemia group and the control group(P<0.05). The levels of SI and SF in the NIDA group were significantly higher than those in the iron-deficiency non-anemia group and the control group(P<0.05). The levels of Ret-He, Hb, MCV, MCH, SI and SF in the iron-deficiency non-anemia group were significantly lower than those in the control group(P<0.05). There were significant differences in the levels of SI and SF in the patients′ blood between the inflammatory group and the non-inflammatory group(P<0.05), while there were no significant differences in the levels of Ret-He, Hb, MCV and MCH between the two groups(P>0.05). The results of ROC curve analysis showed that the cut-off value of Ret-He for diagnosing IDA was 28.8 pg, with the sensitivity being 91.1%, the specificity being 90.9%, and the area under the curve(AUC) being 0.947(95%CI: 0.875～0.984). The sensitivity and the specificity of Ret-He+SI+SF in diagnosing IDA were 92.7% and 93.5% respectively, and the AUC was 0.959(95%CI: 0.900～0.988). Conclusion Ret-He combined with SI and SF has a higher clinical value in diagnosis of IDA, and its comprehensive diagnosis efficiency is better than the diagnosis efficiency of Ret-He, Hb, MCV, MCH, SI and SF alone for diagnosis of IDA. |
| Key words: Reticulocyte hemoglobin content(Ret-He) Iron deficiency anemia(IDA) Adults |
