诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (03): 318-323.doi: 10.16150/j.1671-2870.2024.03.010
收稿日期:
2023-02-04
接受日期:
2024-04-16
出版日期:
2024-06-25
发布日期:
2024-06-25
通讯作者:
王天凯 E-mail:tkai_wang@163.com基金资助:
DING Ning1, LIU Lin1, JIN Peipei2, WANG Fang2, WANG Tiankai1()
Received:
2023-02-04
Accepted:
2024-04-16
Published:
2024-06-25
Online:
2024-06-25
摘要:
目的:评价网织红细胞平均血红蛋白含量(mean reticulated hemoglobin content, Mchr)在诊断缺铁性贫血(iron deficiency anemia, IDA)及其严重程度中的价值。方法:选取2021年1月至2021年12月上海交通大学医学院附属瑞金医院(北部院区)、新华医院和瑞金医院的302例IDA患者,其中轻度贫血118例,中度贫血159例和重度贫血25例,365例非IDA患者(包括地中海贫血、巨细胞性贫血、纯红细胞再生障碍性贫血、溶血性贫血、再生障碍性贫血),以及138名健康体检者。采集所有患者的静脉血样本,检测血红蛋白(hemoglobin, Hb)、红细胞压积(hematocrit, HCT)、Mchr、平均红细胞体积(mean corpuscular volume, MCV)、平均红细胞血红蛋白(mean corpuscular hemoglobin,MCH)、平均红细胞血红蛋白浓度(mean corpuscular hemoglobin concentration, MCHC)、血清铁(serum iron, Fe)、铁饱和度(the saturability of iron, TS)、铁蛋白(Ferritin)和总铁结合力(total iron-binding capacity,TIBC)。比较IDA患者组与非IDA患者组以及IDA不同严重程度之间的Mchr水平,绘制受试者操作特征(Receiver operating characteristic, ROC)曲线,评估Mchr在IDA中的诊断价值。结果:与非IDA组相比,IDA组的Mchr、Hb、MCV、MCH、MCHC、HCT、Fe、TS、Ferritin水平显著降低,而TIBC显著升高,差异均有统计学意义(P<0.05)。IDA组的Mchr与Hb、MCV、MCH、MCHC、HCT、Fe、TS、Ferritin呈正相关,与TIBC呈负相关。轻度、中度、重度IDA患者的Mchr水平依次减低,3组间差异有统计学意义(P<0.05)。ROC曲线分析结果显示,Mchr诊断IDA的最佳临界值为<26.7 pg,诊断灵敏度为80.00%,特异度为93.38%,曲线下面积(the area under the curve, AUC)为0.933 8(95%CI为0.915 7~0.951 8),Mchr+Fe+Ferritin+TIBC联合诊断IDA(各项目的临界值分别为Mchr <26.7pg,Fe <5.7 μmol/L, Ferritin <7.1 ng/mL,TIBC >65.8 μmol/L)的灵敏度为90.76%,特异度为94.70%,AUC为0.983 9(95%CI为0.977 2~0.990 5)。结论:Mchr可作为诊断筛查IDA及其严重程度的潜在临床指标,其联合铁代谢指标诊断IDA更具有诊断价值,能够为选择是否需要进行侵入性诊断提供有力依据。
中图分类号:
丁宁, 刘琳, 金佩佩, 王芳, 王天凯. 网织红细胞平均血红蛋白含量在缺铁性贫血及其严重程度的诊断效能分析[J]. 诊断学理论与实践, 2024, 23(03): 318-323.
DING Ning, LIU Lin, JIN Peipei, WANG Fang, WANG Tiankai. Diagnostic efficacy analysis of mean reticulated hemoglobin content for diagnosing iron deficiency anemia and its severity[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(03): 318-323.
表1
研究对象的基本特征和血液检测指标水平的差异分析
Indice | Non-IDA | IDA | Control | F/χ2 value | P value |
---|---|---|---|---|---|
No. of participants, N(%) | 365(45.34%) | 302(37.52%) | 138(17.14%) | ||
Gender | 142.4 | <0.000 1 | |||
Male, N (%) | 163 (44.66%) | 29 (9.60%) | 84(60.87%) | ||
Female, N (%) | 202 (55.34%) | 273 (90.40%) | 54(39.13%) | ||
Age(years), mean (SD) | 51.96 ± 19.43 | 49.96 ± 14.71 | 50.74 ± 11.07 | 1.224 | 0.295 0 |
Laboratory results mean (SD) | |||||
Mchr(pg) | 31.51 ± 6.69 | 21.07 ± 3.65*,# | 31.42 ± 1.68 | 506.8 | <0.000 1 |
MCV(fL) | 88.98 ± 13.92▽ | 71.44 ± 8.74*,# | 90.29 ± 4.14 | 253.6 | <0.000 1 |
MCH(pg) | 28.95 ± 5.45▽ | 20.96 ± 3.37*,# | 30.92 ± 1.77 | 386.6 | <0.000 1 |
MCHC(g/L) | 324.3 ± 16.7▽ | 292.6 ± 17.6*,# | 342.4 ± 7.85 | 567.3 | <0.000 1 |
HCT(%) | 27.58 ± 5.58▽ | 28.76 ± 4.53*,# | 43.36 ± 4.35 | 515.6 | <0.000 1 |
Hb(g/L) | 88.84 ± 19.33▽ | 84.41 ± 15.72*,# | 148.6 ± 16.55 | 710.6 | <0.000 1 |
Fe(μmol/L) | 10.91 ± 7.38▽ | 3.54 ± 1.83*,# | 19.96 ± 6.87 | 389.0 | <0.000 1 |
TIBC(μmol/L) | 54.09 ± 16.18▽ | 76.61 ± 10.17*,# | 38.58 ± 10.99 | 446.7 | <0.000 1 |
Ferritin(ng/mL) | 106.7 ± 217.1▽ | 3.86 ± 2.35*,# | 147.1 ± 147.4 | 52.16 | <0.000 1 |
TS(%) | 21.93 ± 14.86▽ | 4.82 ± 2.98*,# | 34.88 ± 13.40 | 362.6 | <0.000 1 |
表3
各指标诊断IDA的灵敏度、特异度及ROC曲线分析结果
Indice | AUC(95%CI) | Sensitivity | Specificity | The cut-off value |
---|---|---|---|---|
Mchr(pg) | 0.933 8(0.915 7-0.951 8) | 80.00% | 93.38% | 26.7 |
MCV(fL) | 0.853 4(0.823 7-0.883 1) | 73.97% | 89.74% | 82.7 |
MCH(pg) | 0.881 6(0.855 2-0.908 0) | 76.71% | 92.05% | 25.5 |
MCHC(g/L) | 0.905 0(0.882 7-0.927 4) | 76.99% | 90.07% | 314 |
HCT(%) | 0.554 7(0.511 2-0.598 1) | 52.05% | 52.32% | 29.3 |
Hb(g/L) | 0.594 8(0.552 0-0.637 5) | 52.88% | 63.25% | 92 |
Ferritin(ng/mL) | 0.923 5(0.903 4-0.943 6) | 77.09% | 92.38% | 7.1 |
TIBC(μmol/L) | 0.877 6(0.851 0-0.904 3) | 76.71% | 88.41% | 65.8 |
Fe(μmol/L) | 0.853 6(0.824 1-0.883 1) | 74.79% | 90.40% | 5.7 |
TS(%) | 0.901 6(0.877 4-0.925 8) | 79.45% | 91.72% | 8.1 |
Mchr+Fe+Ferritin+TIBC | 0.983 9(0.977 2-0.990 5) | 90.76% | 94.70% | - |
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