各红细胞参数在缺铁性贫血鉴别中的应用
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摘要
目的检验文献中红细胞参数对缺铁性贫血(IDA)的鉴别符合性,建立新的红细胞参数界值,以健康人群检验其符合性。方法以多个红细胞参数对217例IDA患者、非IDA贫血62例以及健康人群262例(年龄段为40～55岁)进行回顾性分析,分析其红细胞参数的区间范围和统计学差异。以文献中的诊断界值检验三个人群组,讨论其符合性。以缺铁性贫血和非缺铁性贫血患者绘制新的ROC曲线,以新的Cut-off值检验三组人群的符合性。结果健康人群组与IDA患者间的RDW指数(RDWI)差异无统计学意义(t=1.96,P=0.07),其他组间的红细胞参数差异有统计学意义(P <0.05)。文献中对三个人群组的鉴别符合性较低,新的Cut-off值鉴别的符合性较好,平均红细胞体积(MCV)、Shine和Lal指数(SLI)、Ehsani指数、平均红细胞血红蛋白含量(MCH)的ROC曲线下面积分别为0.947、0.963、0.982、0.982、0.981。结论文献中的诊断界值在临床中应用有一定的局限性,应根据实际情况重新建立ROC曲线,分析Cut-off值。
Objective To establish a new threshold value of erythrocyte parameters for identifying iron deficiency anemia by examining the coincidence of erythrocyte parameters in literatures,and to test the coincidence of erythrocyte parameters in healthy people. Methods 217 IDA patients,62 non-IDA anemia patients and 262 healthy people(age range 40 ～ 55)were retrospectively analyzed with multiple erythrocyte parameters. The interval range and statistical difference of erythrocyte parameters were analyzed. The diagnostic thresholds in the literature were used to test three population groups and to discuss their conformity. New ROC curves were drawn for patients with iron deficiency anemia and noniron deficiency anemia,and new Cut-off values were used to test the coincidence of the three groups. Results There was no significant difference in RDWI between healthy group and IDA patients(t = 1.96,P = 0.07),but there was significant difference in erythrocyte parameters between other groups(P < 0.05). In the literature,the coincidence of three groups was low,and the coincidence of new Cut-off values was good. The area under the ROC curves of MCV,SLI,Ehsani index and average erythrocyte volume(MCH)is the largest,which is 0.947,0.963,0.982,0.982 and 0.981. Conclusion The diagnostic boundary value in the literaturehas some limitation in clinical application. The ROC curve should be reconstructed and the Cut-off value should be analyzed according to the actual situation.
Objective To establish a new threshold value of erythrocyte parameters for identifying iron deficiency anemia by examining the coincidence of erythrocyte parameters in literatures,and to test the coincidence of erythrocyte parameters in healthy people. Methods 217 IDA patients,62 non-IDA anemia patients and 262 healthy people(age range 40 ～ 55)were retrospectively analyzed with multiple erythrocyte parameters. The interval range and statistical difference of erythrocyte parameters were analyzed. The diagnostic thresholds in the literature were used to test three population groups and to discuss their conformity. New ROC curves were drawn for patients with iron deficiency anemia and noniron deficiency anemia,and new Cut-off values were used to test the coincidence of the three groups. Results There was no significant difference in RDWI between healthy group and IDA patients(t = 1.96,P = 0.07),but there was significant difference in erythrocyte parameters between other groups(P < 0.05). In the literature,the coincidence of three groups was low,and the coincidence of new Cut-off values was good. The area under the ROC curves of MCV,SLI,Ehsani index and average erythrocyte volume(MCH)is the largest,which is 0.947,0.963,0.982,0.982 and 0.981. Conclusion The diagnostic boundary value in the literaturehas some limitation in clinical application. The ROC curve should be reconstructed and the Cut-off value should be analyzed according to the actual situation.
引文
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[10]URRECHAGA E.Red blood cell microcytosis and hypochromia in the differential diagnosis of iron deficiency andβ-thalassaemia trait[J].Int J of Lab Hematol,2010,31(5):528-534.
[11]洪萍,于亚梅,周霖,等.红细胞分布宽度在儿童先天性心脏病相关肺高压病情评估中的应用[J].实用医学杂志,2018,34(17):2884-2887.
[12]郑丹,张胜,崔可,等.平均血小板体积联合红细胞分布宽度对重症急性胰腺炎预后的价值[J].实用医学杂志,2018,34(08):1294-1296,1300.
[13]生媛,胡伟,王贤,等.113例缺铁性贫血患者红细胞参数检测结果分析[J].国际检验医学杂志,2012,33(22):2764-2765.
[14]URRECHAGA E,BORQUE L,ESCANERO J F.The role of automated measurement of red cell subpopulations on the sysmex XE5000 analyzer in the differential diagnosis of microcytic anemia[J].Int J Lab Hematol,2011,33(1):30-36.
[2]URRECHAGA E,BORQUE L,ESCANERO J F.Erythrocyte and reticulocyte indices on the LH 750 as potential markers of functional iron deficiency[J].Anemia,2010(4):625-919.
[3]王小钦.缺铁性贫血的诊断[J].诊断学理论与实践,2014,6(6):566-569.
[4]HOFFMANN J J M L,URRECHAGA E,AGUIRRE U.Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia:A meta-analysis[J].Clin Chem Lab Med,2015,53(12):1883-1894.
[5]田民杰,李艳.DXH800红细胞新参数在缺铁性贫血中的应用[J].临床输血与检验,2018(1):76-78.
[6]URRECHAGA E,UNCETA M,BORQUE L,et al.Low hemoglobin density potential marker of iron availability[J].Int J Lab Hematol,2011,34(1):47-51.
[7]DOPSAJ V,MARTINOVIC J,DOPSAJ M.Early detection of iron deficiency in elite athletes:could microcytic anemia factor(Maf)be useful[J].Int J Lab Hematol,2014,36(1):37-44.
[8]SIRDAH M,TARAZI I,NAJJAR E A,et al.Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the beta-thalassaemia minor from iron deficiency in Palestinian population[J].Int J Lab Hematol,2010,30(4):324-330.
[9]EHSANI M A,SHAHGHOLI E,RAHIMINEJAD M S,et al.Anew index for discrimination between iron deficiency anemia and beta-thalassemia minor:results in 284 patients[J].Pakistan J of Bio Sci,2009,12(5):473.
[10]URRECHAGA E.Red blood cell microcytosis and hypochromia in the differential diagnosis of iron deficiency andβ-thalassaemia trait[J].Int J of Lab Hematol,2010,31(5):528-534.
[11]洪萍,于亚梅,周霖,等.红细胞分布宽度在儿童先天性心脏病相关肺高压病情评估中的应用[J].实用医学杂志,2018,34(17):2884-2887.
[12]郑丹,张胜,崔可,等.平均血小板体积联合红细胞分布宽度对重症急性胰腺炎预后的价值[J].实用医学杂志,2018,34(08):1294-1296,1300.
[13]生媛,胡伟,王贤,等.113例缺铁性贫血患者红细胞参数检测结果分析[J].国际检验医学杂志,2012,33(22):2764-2765.
[14]URRECHAGA E,BORQUE L,ESCANERO J F.The role of automated measurement of red cell subpopulations on the sysmex XE5000 analyzer in the differential diagnosis of microcytic anemia[J].Int J Lab Hematol,2011,33(1):30-36.