遗传性球形红细胞增多症与自身免疫性溶血性贫血实验室特征比较

Comparison of laboratory characteristics between hereditary spherocytosis and autoimmune hemolytic anemia

目的:比较遗传性球形红细胞增多症(HS)与自身免疫性溶血性贫血(AIHA)患者的实验室特征,为辅助鉴别2类疾病的诊断提供帮助。方法:回顾性分析2016-10—2017-11收治的85例疑诊HS或AIHA患者的实验室检查结果,比较2类疾病实验室指标的差异,分析指标之间的关系。结果:85例患者包括:疑诊HS者57例,全部表现为直接抗人球蛋白试验(DAT)阴性和红细胞渗透脆性试验(EOFT)、酸化甘油溶血试验(AGLT)阳性;疑诊AIHA者28例,全部表现为DAT阳性,其中20例EOFT阳性,23例AGLT阳性。前者EOFT开始溶血浓度和完全溶血浓度高于后者(均P<0.05)。疑诊HS者与疑诊AIHA者相比,呈现较低的网织红细胞比值(Ret)、平均红细胞体积(MCV)水平和较高的平均红细胞血红蛋白浓度(MCHC)、血清间接胆红素(IBIL)水平(均P<0.05)。MCHC、IBIL与EOFT开始溶血浓度呈正相关性,与AGLT呈负相关性;MCV与EOFT开始溶血浓度呈负相关性;MCV、Ret与AGLT呈正相关性(均P<0.05)。结论:HS与AIHA相比,EOFT和AGLT结果异常程度不同,MCHC、MCV、IBIL、Ret水平存在差异,且2组指标间存在密切关系,对HS和AIHA的辅助鉴别具有潜在意义。

Objective:To compare the laboratory characteristics between hereditary spherocytosis(HS)and autoimmune hemolytic anemia(AIHA)and further explore their potential significance in differential diagnosis of the two diseases.Method:Laboratory indexes of 85 suspected HS or AIHA patients were analyzed retrospectively and statistical method was applied to analyze the relationship between these indexes.Result:The 85 patients included 57 suspected HS patients with negative result of direct antiglobulin test(DAT)and positive results of erythrocyte osmotic fragility test(EOFT)and acidified glycerol hemolysis test(AGLT),and 28 suspected AIHA patients with positive result of DAT,among whom 20 were positive for EOFT and 23 were positive for AGLT.Compared with suspected AIHA patients,suspected HS patients showed more serious result of EOFT,lower level of reticulocyte ratio(Ret)and mean corpuscular volume(MCV),and higher level of mean corpuscular hemoglobin concentration(MCHC)and serum indirect bilirubin(IBIL)(P<0.05).Positive correlations were found between MCHC,IBIL and EOFT result,and between MCV,Ret and AGLT result,while negative correlations were found between MCHC,IBIL and AGLT result,and between MCV and EOFT result(P<0.05).Conclusion:HS and AIHA have different characteristics in EOFT and AGLT results,and showe different levels of MCHC,MCV,IBIL and Ret.There is a close relationship between the two groups of indexes above.Our results might have potential significance for assistant identification of HS and AIHA.