血细胞与血红蛋白分析在地中海贫血筛查中的应用价值研究  

The application value research of screening for thalassemia by hemocyte and haemoglobin analysis

作　　者：张雪梅 

机构地区：[1]简阳市妇幼计划生育服务中心地贫办,四川简阳641400

出　　处：《当代医学》2017年第19期13-15,共3页Contemporary Medicine

摘　　要：目的探究血细胞与血红蛋白(Hb)分析在地中海贫血筛查中的应用价值。方法选取本院2015年1月~2015年12月期间就诊的138例患者,根据检查结果将确诊为地贫基因携带者的60例患者设为观察组(α型有35例,β型22例,αβ复合型3例),78例未携带者设为对照组。分别检测MCH(平均红细胞血红蛋白含量)、MCV(平均红细胞体积)和HbA2,评估其诊断价值。结果 MCH用于三地贫的灵敏度分别为93.5%、98.8%、91.7%,特异度为54.8%、阴性预测值为93.5%、阳性预测值为62.7%、诊断准确率为72.8%;MCV上述值分别为87.8%、98.4%、100.0%、65.2%、90.6%、67.7%、76.9%;HbA2上述值分别为28.2%、96.7%、100.0%、77.6%、67.1%、65.1%、66.4%;在筛查地贫中MCH、MCV、HbA2的特异度和灵敏度两两对比,差异均有统计学意义(P<0.05);MCH+MCV+HbA2联合检测的特异度和阳性预测值优于MCH+MCV,而在灵敏度、阴性预测值和诊断准确度等方面则明显低于MCH+MCV检测方案,差异有统计学意义(P<0.05)。结论 MCH+MCV用于地中海贫血初筛具有较好的效果,而在诊断α-地贫时,HbA2作为单项指标其灵敏度低,可适当放宽判定标准,从而增加临床诊断的灵敏度和准确率,提高优生优育。Objective To explore the application value of screening for thalassemia by hemocyte and haemoglobin analysis.Methods To selected 138 cases of patients at our hospital from the January to December,2015,to divided the 60 cases of patients confirmed that with the gene of thalassemia as per the inspection result into the treatment group(α-type was 35 cases,β-type was 22 cases,compound type of αβ was 3 cases),the 78 cases of patients without the gene of thalassemia as the control group.To detected the MCH,MCV and HbA2 of them,and assessed the diagnostic value.Results The sensitivity of MCH that used for the three groups of thalassemia was 93.5%,98.8% and 91.7%,the specificity was 54.8%,the negative predictive value was 93.5%,the positive predictive value was 62.7%,the accuracy rate of diagnosis was 72.8%.The value of above of the MCV was87.8%,98.4%,100.0%,65.2%,90.6%,67.7% and 76.9%.The value of above of the HbA2 was 28.2%,96.7%,100.0%,77.6%,67.1%,65.1% and66.4%.To compared each other of the specificity and sensitivity of the MCH,MCV and HbA2 of the screening for thalassemia,there was statistical significance(P<0.05).The specificity and positive predictive value of the joint detection of MCH+MCV+HbA2 was better than the MCH+MCV,but the sensitivity,negative predictive value and diagnostic accuracy was significantly lower than the MCH+MCV,there was statistical significance(P<0.05).Conclusion That has better effect of screening for thalassemia by MCH+MCV,but in the α-thal-1 inspection,the HbA2 as the single index that with low sensitivity,able to appropriately loosing the requirement,so that to increase the sensitivity and accuracy rateof the clinical diagnosis,to increase the bear and rear better children.

关 键 词：血细胞 血红蛋白 地中海贫血 

分 类 号：R556.61[医药卫生—血液循环系统疾病]