摘要
目的:建立深圳地区4～13岁健康儿童低血红蛋白密度(low hemoglobin density,LHD%)参考区间,并探讨其在儿童缺铁性贫血诊疗中的应用价值。方法:选择2017年6月-2018年1月来深圳龙岗区第二人民医院体检的健康儿童560例作为健康儿童组,并选择同期缺铁性贫血(iron-deficiency anemia,IDA)患儿91例作为IDA组。采用Sysmex XN-9000全自动血细胞分析仪检测血常规,根据红细胞平均血红蛋白浓度(mean corpuscular hemoglobin concentration,MCHC)计算LHD%,并对结果进行统计分析。结果:健康儿童LHD%为(2.53±0.89)%,95%参考区间为(0.79%,4.27%),其中男性和女性分别为(2.85±0.93)%和(2.14±0.80)%,95%参考区间分别为(1.03%,4.67%)和(0.57%,3.71%),男性高于女性,差异有统计学意义(t=3.176,P<0.05)。健康男性儿童中以7～10岁的LHD%最低,为(2.63±0.84)%,低于其他年龄段,但差异无统计学意义(t=0.616、0.861,P>0.05),女性儿童以11～13岁的LHD%最低,为(2.03±0.70)%,明显低于其他年龄段,但差异无统计学意义(t=0.592、0.773,P>0.05),且7～10岁的男女LHD%含量比较,差异无统计学意义(t=0.382,P>0.05)。IDA患儿治疗前LHD%为(31.62±11.08)%,明显高于健康儿童,差异有统计学意义(t=13.816,P<0.01),其中男患儿为(32.19±11.54)%,女患儿为(30.87±11.06)%,差异无统计学意义(t=0.854,P>0.05)。治疗后,IDA患儿LHD%为(9.61±5.24)%,明显低于治疗前,差异有统计学意义(t=7.912,P<0.05)。当LHD%cut-off值取4.30%时,曲线下面积(AUC)为0.923,敏感性为92.21%,特异性为98.6%;当MCHC cut-off值取322 g/L时,LHD%对IDA患者诊断的敏感性高达84.05%,明显高于MCHC的62.38%,两者比较差异有统计学意义(x~2=3.215,P<0.05)。结论:建立了深圳4～13岁健康儿童LHD%参考区间,LHD%对IDA患儿的诊疗具有一定的应用价值,且优于MCHC诊断指标。
Objective:To establish the reference interval for the low hemoglobin density(LHD%)of healthy children aged 4-13 years in Shenzhen,and to explore its application value in the diagnosis and treatment of children with iron deficiency anemia.Method:From June 2017 to January 2018,560 healthy children who came to the Second People's Hospital of Longgang District in Shenzhen City were selected as the healthy children group,and selected the same iron deficiency anemia(IDA)in children with 91 cases as IDA group.Blood routine was detected by Sysmex XN-9000 automatic hematocyte analyzer,LHD% was calculated according to the mean hemoglobin concentration(MCHC)of red blood cells,and the results were statistically analyzed.Result:The LHD% of healthy children was(2.53±0.89)%,and the 95% reference interval was(0.79%,4.27%),among them,males and females(2.85±0.93)% and(2.14±0.80)% respectively,the 95% reference intervals were(1.03%,4.67%)and(0.57%,3.71%),respectively,males were higher than females,the difference was statistically significant(t=3.176,P<0.05).Among healthy male children,LHD% between 7 and 10 years old was the lowest(2.63±0.84)%,lower than other age groups,but the difference was not statistically significant(t=0.616,0.861,P>0.05),LHD% of female children aged 11-13 years was the lowest(2.03±0.70)%,significantly lower than that of other age groups,but the difference was not statistically significant(t=0.592,0.773,P>0.05),there was no statistically significant difference in LHD% content between men and women aged 7 to 10 years(t=0.382,P>0.05).LHD% of IDA children before treatment was(31.62±11.08)%,significantly higher than that of healthy children,with statistically significant difference(t=13.816,P<0.01).Among them,male children(32.19±11.54)% and female children(30.87±11.06)%,the difference was not statistically significant(t=0.854,P>0.05).After treatment,LHD% of IDA children was(9.61±5.24)%,significantly lower than that before treatment,the difference was statistically significant(t=7.912,P<0.05).When the LHD% cut-off value was 4.30%,the area under the curve(AUC)was 0.923,the sensitivity was 92.21%,and the specificity was 98.6%,when the cut-off value of MCHC was 322 g/L,the sensitivity of LHD% to IDA patients was as high as 84.05%,significantly higher than that of MCHC(62.38%),the difference was statistically significant( x~2=3.215,P<0.05).Conclusion:The reference interval of LHD% for healthy children aged 4-13 years in Shenzhen was established,LHD% is of certain application value in the diagnosis and treatment of IDA children,and is superior to the diagnostic index of MCHC.
引文
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