红细胞指数和HbA_2在轻型α地贫筛查中的临床应用  

Clinical value of RBC parameters and HbA_2 in alpha thalassemia carriers

作　　者：冯桂玲[1] 朱雪莲[2] 王忠英[1] 邓小燕[1] 

机构地区：[1]广州医科大学附属第二医院,广东广州510260 [2]广州医科大学金域检验学院,广东广州510182

出　　处：《热带医学杂志》2015年第8期1069-1072,共4页Journal of Tropical Medicine

摘　　要：目的评价红细胞指数和HbA2在轻型α地中海贫血筛查中临床应用价值,以提高α地中海贫血的筛查率。方法对广州医科大学附属第二医院门诊及住院行地贫筛查的235例病例标本进行回顾性分析。所有病例均采用跨越断裂点PCR(gap-PCR)技术进行α地中海贫血基因确诊实验,同时进行血细胞分析和血红蛋白电泳测定,探讨红细胞平均体积(MCV)、红细胞平均血红蛋白含量(MCH)和HbA2对α地中海贫血的筛查价值。结果轻型α地贫组与对照组之间MCV、MCH检测结果差异均有统计学意义(P<0.01),而HbA2差异无统计学意义(P>0.05);轻型α地贫组MCV、MCH和HbA2的临界值分别为74.9 fl、24.65 pg、2.45%,诊断灵敏度分别为96.7%、94.5%、38.2%,特异度分别为85.4%、87.5%、76.9%,ROC曲线下面积分别为0.962、0.961、0.539。结论 MCV和MCH对轻型α地中海贫血的具有较高的诊断准确性,建议临床使用MCV<74.9 fl、MCH<24.65 pg作为α地贫筛查的标准;HbA2对于α地中海贫血筛查意义较小,不推荐其作为α地中海贫血的独立筛查指标。Objective To evaluate the clinical diagnostic value of erythrocyte index and HbA2 proportion in α-thalassemia carriers screening for improving the positive rate of α-thalassemia screening. Methods Blood samples of 235 cases from The Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed for GAP-PCR for α-thalassemia gene diagnosis, blood complete blood counts（CBC） and hemoglobin electrophoresis. The determination values of MCV, MCH, RDW-CV and HbA2 in α-thalassemia diagnosis were evaluated. Results Compared with control roup, MCV and MCH values showed significant differences（P〈0.01）, but not for HbA2measurement（P〉0.05）. The critical values of MCV,MCH and HbA2 in α-thalassemia carriers group were 74.9 fl,24.65 pg and 2.45%, respectively;the sensitivities were 96.7%, 94.5% and 38.2%, respectively; the specificities were 85.4%, 87.5% and 76.9%,respectively; the areas under ROC curves were 0.962, 0.961 and 0.539, respectively. Conclusion The MCV and MCH values of α-thalassaemia carriers had high diagnostic accuracy. It was suggested to use the cutoff values of MCV〈74.9 fl and MCH 〈24.65 pg for α-thalassemia carriers screening. Since HbA2 value had low diagnostic value for α-thalassemia screening, it was not recommended as α-thalassemia screening index.

关 键 词：Α地中海贫血 HBA2 MCV MCH 

分 类 号：R556.61[医药卫生—血液循环系统疾病]