新型网织红细胞参数在贫血早期诊断中的价值
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摘要
目的探讨新型网织红细胞参数在贫血早期诊断中的应用及价值。方法应用Sysmex XE-5000血液分析仪对376例各类贫血患者和162例健康体检者网织红细胞参数进行检测并分析。结果缺铁性贫血组RET-He明显降低、巨幼红细胞性贫血组RET-He升高,与其他贫血组两两比较差异均有统计学意义(P<0.05);肾性贫血组IRF轻度升高,而再生障碍性贫血组IRF轻度降低,与其他贫血组两两比较差异均有统计学意义(P<0.05);溶血性贫血组RET、IRF、RPI均明显升高,与其他贫血组两两比较差异均有统计学意义(P<0.05)。当RET-He临界值分别为26.25 pg、36.45 pg时,诊断IDA、MA的灵敏度分别为84.8%、52.8%,特异度分别为96.8%、85.8%,ROC曲线下面积最大(0.940、0.757);当RPI临界值为2.15时,诊断HA的灵敏度为60.6%,特异度为92.3%,ROC曲线下面积最大(0.823)。结论新型网织红细胞参数(IRF、RET-He、RPI)可以更好地评价骨髓造血功能,为贫血早期诊断提供依据。
Objective To investigate the value of new reticulocyte parameters in early diagnosis of anemia. Methods 376 cases with anemia and 162 cases of healthy adults were selected, the reticulocyte parameters were measured by Sysmex XE-5000. Results RET-He decreased obviously in iron deficiency anemia group, RET-He increased in megaloblastic anemia group, and there was statistical significance on the difference between iron deficiency anemia and megaloblastic anemia groups and other anemia groups in RET-He(P<0.05); IRF increased slightly in anemia in chronic renal failure group and IRF decreased slightly in aplastic anemia group, these anemia groups were compared with other anemia groups respectively, and there was statistical significance on the difference in IRF(P<0.05); RET, IRF, RPI increased obviously in hemolytic anemia group, there was statistical significance on the difference between hemolytic anemia group and other anemia groups in RET, IRF, RPI(P<0.05). With the threshold limit value at 26.25 pg and 36.45 pg, the sensitivity, specificity of RET-He in the diagnosis of IDA and MA were 84.8%, 52.8% and 96.8%, 85.8%, and the area under ROC curve was 0.940, 0.757. With the threshold limit value at 2.15, the sensitivity, specificity of RPI in the diagnosis of HA were 60.6% and 92.3%, and the area under ROC curve was 0.823. Conclusion The new reticulocyte parameters(IRF, RET-He, RPI) can better evaluate the bone marrow hematopoietic function and provide the theoretical basis for early diagnosis of anemia.
Objective To investigate the value of new reticulocyte parameters in early diagnosis of anemia. Methods 376 cases with anemia and 162 cases of healthy adults were selected, the reticulocyte parameters were measured by Sysmex XE-5000. Results RET-He decreased obviously in iron deficiency anemia group, RET-He increased in megaloblastic anemia group, and there was statistical significance on the difference between iron deficiency anemia and megaloblastic anemia groups and other anemia groups in RET-He(P<0.05); IRF increased slightly in anemia in chronic renal failure group and IRF decreased slightly in aplastic anemia group, these anemia groups were compared with other anemia groups respectively, and there was statistical significance on the difference in IRF(P<0.05); RET, IRF, RPI increased obviously in hemolytic anemia group, there was statistical significance on the difference between hemolytic anemia group and other anemia groups in RET, IRF, RPI(P<0.05). With the threshold limit value at 26.25 pg and 36.45 pg, the sensitivity, specificity of RET-He in the diagnosis of IDA and MA were 84.8%, 52.8% and 96.8%, 85.8%, and the area under ROC curve was 0.940, 0.757. With the threshold limit value at 2.15, the sensitivity, specificity of RPI in the diagnosis of HA were 60.6% and 92.3%, and the area under ROC curve was 0.823. Conclusion The new reticulocyte parameters(IRF, RET-He, RPI) can better evaluate the bone marrow hematopoietic function and provide the theoretical basis for early diagnosis of anemia.
引文
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[2] 曾华,张智贤,倪李佳,等.网织红细胞血红蛋白含量在β-地中海贫血和缺铁性贫血病人中的变化研究[J].实验与检验医学,2013,31(3):205-207.
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[5] 钟玉钗,凌东波,尹惠芬,等.ADVIA2120网织红细胞参数在贫血中鉴别诊断的价值探讨[J].实验与检验医学,2015,33(6):758-760.
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[9] Lorenz L,Arand J,Buchner K,et al.Reticulocyte hemoglobin content as a marker of iron deficiency[J].Arch Dis Child Fetal Neonatal Ed,2015,100(3):198-202.
[10] 陈哲周,李美岩.网织红细胞血红蛋白含量诊断妊娠妇女铁缺乏的临床应用研究[J].中国全科医学杂志,2017,20(5):609-612.
[11] 王小钦,林果为.重新认识网织红细胞参数的临床价值[J].中华血液学杂志,2014,35(1):1-3.
[12] Karagulle M,Gunduz E,Sahin Mutlu F,et al.Clinical significance of reticulocyte hemoglobin content in the diagnosis of iron deficiency anemia[J].Turk J Haematol,2013,30(2):153-156.
[13] 胡宗海,杨欢欢,胡娟.肝硬化患者红细胞参数及网织红细胞生成指数分析[J].四川医学,2007,28(1):33-34.
[14] 杨学敏,尹亚兰,李光迪,等.Sysmex XE-5000血细胞分析仪各新参数在血液学检验中的应用[J].国际检验医学杂志,2011,32(17):1979-1981.
[15] 梁艳梅.血液网织红细胞的多参数分析在贫血患者临床鉴别诊断中的价值[J].中国实用医刊,2013,40(8):99-100.
[2] 曾华,张智贤,倪李佳,等.网织红细胞血红蛋白含量在β-地中海贫血和缺铁性贫血病人中的变化研究[J].实验与检验医学,2013,31(3):205-207.
[3] 黄华,陈林兴,尹俊,等.网织红细胞相关参数测定在贫血初筛诊断中的意义[J].汕头大学医学院学报,2008,21(3):151-153.
[4] Piva E,Brugnara C,Chiandetti L,et al.Automated reticulocyte counting:state of the art and Clinical applications in the evaluation of erythropoiesis[J].Clin Chem Lab Med,2010,48(10):1369-1380.
[5] 钟玉钗,凌东波,尹惠芬,等.ADVIA2120网织红细胞参数在贫血中鉴别诊断的价值探讨[J].实验与检验医学,2015,33(6):758-760.
[6] 丛玉隆,李顺义,卢兴国.中国血细胞诊断学[M].北京:人民军医出版社,2010:411-412.
[7] Brugnara C.A hematologic “gold standard” for iron-deficiengt states?[J].Clin Chem,2002,48(7):981-982.
[8] Kuehn D,Roberts SS,Olsen CH,et al.Reticulocyte hemoglobin content testing for iron deficiency in toddlers[J].Mil Med,2012,177(10):91-95.
[9] Lorenz L,Arand J,Buchner K,et al.Reticulocyte hemoglobin content as a marker of iron deficiency[J].Arch Dis Child Fetal Neonatal Ed,2015,100(3):198-202.
[10] 陈哲周,李美岩.网织红细胞血红蛋白含量诊断妊娠妇女铁缺乏的临床应用研究[J].中国全科医学杂志,2017,20(5):609-612.
[11] 王小钦,林果为.重新认识网织红细胞参数的临床价值[J].中华血液学杂志,2014,35(1):1-3.
[12] Karagulle M,Gunduz E,Sahin Mutlu F,et al.Clinical significance of reticulocyte hemoglobin content in the diagnosis of iron deficiency anemia[J].Turk J Haematol,2013,30(2):153-156.
[13] 胡宗海,杨欢欢,胡娟.肝硬化患者红细胞参数及网织红细胞生成指数分析[J].四川医学,2007,28(1):33-34.
[14] 杨学敏,尹亚兰,李光迪,等.Sysmex XE-5000血细胞分析仪各新参数在血液学检验中的应用[J].国际检验医学杂志,2011,32(17):1979-1981.
[15] 梁艳梅.血液网织红细胞的多参数分析在贫血患者临床鉴别诊断中的价值[J].中国实用医刊,2013,40(8):99-100.