MCH、MCV、RDW-CV、HbA_2和红细胞脆性试验在地中海贫血和缺铁性贫血鉴别诊断中的应用  

Application of MCH, MCV, RDW-CV, HbA_2 and Rrythrocyte Fragility Test in Thalassemia and Iron Deficiency Anemia in Identification

作　　者：张卫云[1] 杨雄攀 李林海[1] 孙朝晖[1] 石玉玲[1] 

机构地区：[1]广州军区广州总医院检验科,广东广州510010

出　　处：《生物技术通讯》2016年第2期244-248,共5页Letters in Biotechnology

摘　　要：目的:探讨平均红细胞血红蛋白量(MCH)、平均红细胞体积(MCV)、红细胞分布宽度变异系数(RDW-CV)、血红蛋白A_2(Hb A_2)和红细胞脆性试验在地中海贫血和缺铁性贫血鉴别中的价值。方法:以地中海贫血基因诊断和血清铁蛋白测定作为确诊地中海贫血和缺铁性贫血的分组依据,选择2012年1月1日至2014年12月31日广州军区总医院经分子生物学和血清铁蛋白检测的156例患者为研究对象,将其分为地中海贫血组115例(其中α地中海贫血77例,β地中海贫血37例,α地中海贫血复合β地中海贫血1例)和缺铁性贫血组41例;比较患者的MCH、MCV、RDW-CV、Hb A_2和红细胞脆性等血液学指标,采用ROC曲线评价鉴别地中海贫血和缺铁性贫血的血液学指标,试找出最适合鉴别这2种贫血的截断值(cut-off值),以截断值计算上述血液学指标鉴别这2种贫血的灵敏度、特异性、预测值与准确率。结果:地中海贫血患者与缺铁性贫血患者的MCH、MCV和红细胞脆性差异有统计学意义(P<0.05),RDW-CV差异无统计学意义(P>0.05)。MCH、MCV和红细胞脆性的ROC曲线下面积依次为0.641、0.654、0.778,其最佳截断值分别为23.65 pg、72.8 f L、43.5%;MCH、MCV和红细胞脆性试验在鉴别地中海贫血和缺铁性贫血中的灵敏度分别为89.84%、83.94%、80.42%。Hb A_2在α地中海贫血患者与缺铁性贫血患者间差异无统计学意义(P>0.05);Hb A_2在β地中海贫血患者与缺铁性贫血患者间差异有统计学意义(P<0.001),Hb A_2在ROC曲线下面积为0.925,最佳截断值为2.93%,鉴别β地中海贫血和缺铁性贫血的灵敏度为92.50%。结论:用MCH、MCV、Hb A_2、红细胞脆性试验最佳截断值对鉴别地中海贫血和缺铁性贫血有一定的价值;Hb A_2在鉴别α地中海贫血和缺铁性贫血中无意义;Hb A2鉴别β地中海贫血和缺铁性贫血的灵敏度高。Objective： To investigate the value of MCH, MCV, HbA_2, RDW- CV and erythrocyte fragility test（EFT） in the identification of Mediterranean anemia and iron deficiency anemia. Methods： With Mediterraneananemia gene and serum ferritin as confirmed the Mediterranean anemia and iron deficiency anemia, and as the ba-sis for the group. A total of 156 cases of patients by molecular biology and serum ferritin detection as the re-search object, from January 1, 2012 to December 31, 2014 General Hospital of Guangzhou Military Region, itcould be divided into the Mediterranean anemia group 115 cases, among them according to the Mediterranean ane-mia type was divided into 77 cases of α-thalassaemia, 37 cases of β-thalassemia trait, α-thalassaemia compositeβ- Mediterranean anemia in 1 case, iron deficiency anemia group of 41 cases. Compared patients MCH, MCV,HbA_2, RDW- CV and EFT of hematological parameters, and the hematological indexes were evaluated by ROCcurve, trying to find the most suitable for identification of MCH, MCV, HbA_2, RDW-CV and EFT cutoff value.The sensitivity, specificity, predictive value and accuracy of MCH, HbA_2, MCV, RDW-CV and EFT for the identification of the two kinds of anemia were calculated by the cutoff value. Results： Iron deficiency anemia patientsand Mediterranean anemia patients had significant differences in MCH, MCV and EFT（P〉0.05）, but in RDW-CVhad no difference（P〈0.05）. MCH, MCV and EFT under the ROC curve area respectively were 0.641, 0.654,0.778, its cutoff values respectively were 23.65 pg, 72.8 f L, 43.5%, its sensitivity in the identification of thalasse-mia and iron deficiency anemia respectively were 89.84%, 83.94% and 80.42%. HbA_2 had no difference betweenα-thalassemia patients and iron deficiency anemia patients（P〉0.05）. HbA_2 had significant differences between β-thalassemia patients and iron deficiency anemia patients（P〈0.001）. The area of HbA_2 in the ROC curve was0.925, the cutoff value was 2.93%, the sensitivity of differential β-Med

关 键 词：地中海贫血 缺铁性贫血 平均红细胞血红蛋白量 平均红细胞体积 红细胞分布宽度变异系数 血红蛋白A2 红细胞脆性试验 ROC曲线 

分 类 号：R446[医药卫生—诊断学]