贫血的实验室鉴别诊断探讨  

Differential diagnosis in anemia

作　　者：李亚红[1] 陈映慧[1] 岑妙珍[1] 

机构地区：[1]南方医科大学附属顺德第一人民医院检验科,广东顺德528300

出　　处：《国际输血及血液学杂志》2007年第3期218-221,共4页International Journal of Blood Transfusion and Hematology

摘　　要：目的 探讨缺铁性贫血与地中海贫血及慢性病贫血的实验室鉴别诊断方法。方法 做以上三种贫血患者标本的血常规红细胞参数检测，骨髓穿刺细胞学检查，地中海贫血基因分析以及铁代谢指标血清铁（SI）、血清铁蛋白（SF）测定。对已明确诊断的84例地贫组，76例IDA组以及62例慢性病贫血组进行红细胞参数（RBC、Hb、HCT、MCV、MCH、MCHC、RDW和RET）测定以及铁代谢指标SF、SI结果的比较。结果 IDA组与地贫组比较，地贫组和IDA组的红细胞参数MCV、MCH均明显减低，而RET则明显增高,与正常对照组比较，均有显著性差异（P均〈0．01）。地贫组MCV减低较IDA组明显，两者之间有显著性差异（P〈0．01），而RET在两者间却无显著性差异（P〉0．05）。IDA组SF减低，而地贫组SF增高，两者之间有显著性差异（P〈0．01）。IDA组与慢性病贫血组比较，慢性病贫血组的MCV和MCH无改变，与正常对照组比较，均无显著性差异（P均〉0．05）。慢性病贫血组的RET明显减低，与正常对照组比较有显著性差异（P〈0．01）。IDA组MCV降低而慢性病贫血组MCV正常，IDA组SF降低而慢性病贫血组SF增高，两者之间均有显著性差异（P均〈0．01）。MCV降低诊断IDA和地贫的敏感性分别为92．1％和97．6％；而SF降低诊断IDA的敏感性为98．0％，特异性可达到100．0％。结论 MCV结合SF检测，可作为IDA与地贫及慢性病贫血鉴别诊断的简便有价值的指标。Objective The purpose of this study was to investigate the methods for differential diagnosis among iron deficiency anemia, thalassemia, and anemia of chronic disease. Methods Haematological routine,bone marrow smear,thalassemia gene analysis, serum iron （SI） test, and serum ferritin test were done for all the patients. Values of RBC,Hb, HCT,MCV,MCH MCHC,RET ,RDW ,SI, and SF were used for comparative study of iron deficiency anemia （n= 76）, alpha- and beta-thalassemia （n = 84）, and anemia of chronic disease （n = 62）. Results Compared with the normal group, MCV and MCH in IDA and thalassemia groups were significantly decreased and RET significantly increased （P〈 0. 01 ）. The MCV in thalassemia group was significantly lower than that in IDA group （P〈0. 01）. No significantly difference was found for RET between IDA hnd thalassemia groups （P〉0.05）. SF in IDA group was obviously lower than that in the control （P〈0. 01） but SF in thalassemia group obviously higher than that in the control （P〈0.01） . Compared with the normal control, there were no significantly difference（P〉0.05） in respect of MCV and MCH in ACD group ,but RET in ACD group was significantly decreased （P〈0.01） . A significant decrease of MCV in IDA group was observed （P〈0. 01） while no changes of MCV in ACD group. The decrease of SF in IDA group and increase of SF in ACD group showed significantly differences （P〈0.01）. In addition,the sensitivity of MCV was 92.1 % in diagnosing IDA and 97.6% in diangnosing thalassemia. In diagnosing IDA, the sensitivity and specificity of SF was 98. 0% and 100. 0%, respectively. Conclusion The combination of MCV test and SF test may be a simple and effective laboratory means for differential diagnosis among iron deficiency anemia, thalassemia, and anemia of chronic disease.

关 键 词：贫血 平均红细胞体积 铁蛋白 

分 类 号：R5[医药卫生—内科学]