儿童β-珠蛋白生成障碍性贫血与缺铁性贫血的鉴别研究
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摘要
目的分析儿童小细胞性贫血的各种血液学指标,以期找到鉴别诊断β-珠蛋白生成障碍性贫血(β-TT)和缺铁性贫血(IDA)的可靠指标。方法选择该院年龄2～15岁的患儿100例[排除合并2种疾病的患儿,IDA患儿接受口服铁剂治疗16周,治疗后作血红蛋白A2(HbA2)检查],分析其血红蛋白为8.7～11.4g/dL的12个鉴别指标:红细胞计数(RBC)、红细胞分布宽度(RDW)指数、Mentzer指数、Shine and Lal指数、England and Fraser指数、Srivastava and Bevington指数、Green and King指数、Ricerca指数、Sirdah指数、Ehsani指数、每升血平均血红蛋白(MDHL)密度、平均红细胞血红蛋白(MCHD)密度。结果 Mentzer指数是综合诊断价值最高的指标,其鉴别诊断β-TT和IDA的灵敏度为97.9%,特异度为82.6%,约登指数为80.5%。结论 Mentzer指数有望成为鉴别β-TT和IDA的可靠指标。
Objective To find some better markers to differential diagnosis the beta thalassemia trait(β-TT)and iron deiciency anemia(IDA)of children.We retrospectively evaluated the reliability of various indices for differential diagnosis ofβ-TT and IDA.Methods A total of 100 children aged 2-15 years were evaluated.We calculated 12 discrimination indices in all patients with hemoglobin(Hb)values of 8.7-11.4 g/dL.None of the subjects had a combined case of IDA andβ-TT.All children with IDA received oral iron for 16 weeks,and HbA2 screening was performed after iron therapy.The patient were evaluated according to red blood cell(RBC)count;red blood distribution width index;the Mentzer,Shine and Lal,England and Fraser,Srivastava and Bevington,Green and King,Ricerca,Sirdah,and Ehsani indices;mean density of hemoglobin/liter of blood;and mean cell density of hemoglobin.Results The Mentzer index was the most reliable index,as it had the highest sensitivity(97.9%),speciicity(82.6%),and Youden′s index(80.5%)for detectingβ-TT and IDA.Conclusion The Mentzer index provids the highest reliabilities for differentiatingβ-TT from IDA.
Objective To find some better markers to differential diagnosis the beta thalassemia trait(β-TT)and iron deiciency anemia(IDA)of children.We retrospectively evaluated the reliability of various indices for differential diagnosis ofβ-TT and IDA.Methods A total of 100 children aged 2-15 years were evaluated.We calculated 12 discrimination indices in all patients with hemoglobin(Hb)values of 8.7-11.4 g/dL.None of the subjects had a combined case of IDA andβ-TT.All children with IDA received oral iron for 16 weeks,and HbA2 screening was performed after iron therapy.The patient were evaluated according to red blood cell(RBC)count;red blood distribution width index;the Mentzer,Shine and Lal,England and Fraser,Srivastava and Bevington,Green and King,Ricerca,Sirdah,and Ehsani indices;mean density of hemoglobin/liter of blood;and mean cell density of hemoglobin.Results The Mentzer index was the most reliable index,as it had the highest sensitivity(97.9%),speciicity(82.6%),and Youden′s index(80.5%)for detectingβ-TT and IDA.Conclusion The Mentzer index provids the highest reliabilities for differentiatingβ-TT from IDA.
引文
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[12]BUTTARELLO M.Laboratory diagnosis of anemia:are the old and new red cell parameters useful in classification and treatment,how?[J].Int J Lab Hematol,2016,38(Suppl 1):123-132.
[13]BORDBAR E,TAGHIPOUR M,ZUCCONI B E.Reliability of different RBC indices and formulas in discriminating betweenβ-Thalassemia minor and other microcytic hypochromic cases[J].Mediterr J Hematol Infect Dis,2015,7(1):e2015022.
[14]HOTL T,HOANG N T T,LEE J.Determining mean corpuscular volume and red blood cell count using electrochemical collision events[J].Biosens Bioelectron,2018,7(1):155-159.
[15]FERRARA M,CAPOZZI L,RUSSO R,et al.Reliability of red blood cell indices and formulas to discriminate between beta thalassemia trait and Iron deficiency in children[J].Hematology,2010,15(2):112-115.
[16]ALFADHLI S M,AL-AWADHI A M,ALKHALDI D.Validity assessment of nine discriminant functions used for the differentiation between Iron deficiency anemia and thalassemia minor[J].J Trop Pediatr,2007,53(2):93-97.
[17]EHSANI M A,SHAHGHOLI E,RAHIMINEJAD M S,et al.A new index for discrimination between Iron deficiency anemia and beta-thalassemia minor:results in 284patients[J].Pak J Biol Sci,2009,12(5):473-475.
[2]GUPTA P M,PERRINE C G,MEI Z G,et al.Iron,anemia,and Iron deficiency anemia among young children in the United States[J].Nutrients,2016,8(6):330-333.
[3]HABIB M A,BLACK K,SOOFI S B,et al.Prevalence and predictors of Iron deficiency anemia in children under five years of age in Pakistan,a secondary analysis of National nutrition survey data 2011―2012[J].PLoS One,2016,11(5):e0155051.
[4]SCHOORL M,SCHOORL M,VAN PELT J,et al.Application of innovative hemocytometric parameters and algorithms for improvement of microcytic anemia discrimination[J].Hematol Rep,2015,7(2):52-55.
[5]JAMEEL T,BAIG M,AHMED I.Differentiation of beta thalassemia trait from iron deficiency anemia by hematological indices[J].Pak J Med Sci,2017,56(3):665-669.
[6]CHATTERJEE T,CHAKRAVARTY A,CHAKRAV-ARTY S.Population screening and prevention strategies for thalassemias and other hemoglobinopathies of eastern India:experience of 18,166cases[J].Hemoglobin,2015,39(6):384-388.
[7]VEHAPOGLU A,OZGURHAN G,DEMIR A D,et al.Hematological indices for differential diagnosis of Beta thalassemia trait and Iron deficiency anemia[J].Anemia,2014,11(3):576-638.
[8]BRANCALEONI V,DI PIERRO E,MOTTA I,et al.Laboratory diagnosis of thalassemia[J].Int J Lab Hematol,2016,38(Suppl 1):32-40.
[9]SINGH S A,SARANGI S,APPIAH-KUBI A.Hb Adana(HBA2or HBA1:c.179G>A)and alpha thalassemia:Genotype-phenotype correlation[J].Pediatr Blood Cancer2018,5(11):e27220.
[10]CHEN Y M,TIAN JH,GENG J H,et al.A computer program for receiver operation characteristic curve analysis and dianostic cut-off choice[J].Chin J Med Imaging Technol,2004,20(4):614-617.
[11]PORNPRASERT S,PANYA A,PUNYAMUNG M,et al.Red cell indices and formulas used in differentiation ofβ-thalassemia trait from Iron deficiency in Thai school children[J].Hemoglobin,2014,38(4):258-261.
[12]BUTTARELLO M.Laboratory diagnosis of anemia:are the old and new red cell parameters useful in classification and treatment,how?[J].Int J Lab Hematol,2016,38(Suppl 1):123-132.
[13]BORDBAR E,TAGHIPOUR M,ZUCCONI B E.Reliability of different RBC indices and formulas in discriminating betweenβ-Thalassemia minor and other microcytic hypochromic cases[J].Mediterr J Hematol Infect Dis,2015,7(1):e2015022.
[14]HOTL T,HOANG N T T,LEE J.Determining mean corpuscular volume and red blood cell count using electrochemical collision events[J].Biosens Bioelectron,2018,7(1):155-159.
[15]FERRARA M,CAPOZZI L,RUSSO R,et al.Reliability of red blood cell indices and formulas to discriminate between beta thalassemia trait and Iron deficiency in children[J].Hematology,2010,15(2):112-115.
[16]ALFADHLI S M,AL-AWADHI A M,ALKHALDI D.Validity assessment of nine discriminant functions used for the differentiation between Iron deficiency anemia and thalassemia minor[J].J Trop Pediatr,2007,53(2):93-97.
[17]EHSANI M A,SHAHGHOLI E,RAHIMINEJAD M S,et al.A new index for discrimination between Iron deficiency anemia and beta-thalassemia minor:results in 284patients[J].Pak J Biol Sci,2009,12(5):473-475.