用ROC曲线评价血液学指标对孕期地中海贫血的诊断价值

ROC curve in evaluation of hematologic parameter for diagnosing thalassemia of gestation period

目的 用ROC曲线评价MCV、RDW、红细胞脆性在产前地中海贫血检测中的价值。方法 疑似贫血孕妇 2 89例 ,MCV、RDW用SYSMEXSF - 30 0 0检测 ,红细胞脆性用一管定量法 ,α、β地贫基因诊断分别用GAP -PCR法和PCR结合反向斑点杂交法 (RDB)法。应用ROC曲线分析方法 ,以基因诊断结果为金标准 ,对以上几项血液学参数在产前地中海贫血诊断中的价值进行分析。结果 1 在判断α地贫时 ,ROC曲线下面积 (AUCROC)MCV(0 .818)最大 ,其次为RDW -SD(0 .782 ) ,红细胞脆性 (0 .74 6 ) ,最佳临界值分别为MCV(75fl) ,RDW -SD(37) ,红细胞脆性 (5 0 % ) ,该临界值的敏感度分别为MCV(93.5 % ) ,RDW-SD(92 .3% ) ,红细胞脆性 (95 .2 % ) ,特异度分别为MCV(70 .0 % ) ,RDW -SD(6 6 .1% ) ,红细胞脆性 (5 2 .4 % )。 2、在判断 β地贫时 ,AUCROCRDW -SD(0 .933)最大 ,其次为MCV(0 .885 ) ,红细胞脆性 (0 .770 ) ,最佳临界值分别为RDW -SD(33) ,MCV(75fl)红细胞脆性 (40 % ) ,该临界值的敏感度分别为RDW -SD(82 .1% ) ,MCV(83.6 % ) ,红细胞脆性 (6 8.2 % ) ,特异度分别为RDW -SD(90 .0 % ) ,MCV(78.3% ) ,红细胞脆性 (71.4 % )。结论 CV对于地贫的诊断价值明显大于红细胞脆性 ,而RDW -SD对 β地贫的诊断价值明显优于其他二项?

Objective: To evaluate the value of hematologic parameter in diagnosing thalassemia of gestation period.Methods: 289gravida with suspscted anemia were studied,MCV,RDW-SD were detected by sysmex SF-3000 blood counting instrument, erythrocyte fragility experiment was detected by simple tube quantitative test, Gene diagnosis ofα,βthalassemia were by Gap-PCR and PCR-RDB method,respectively.By gene diagnosis as gold standrd of thalassemia,we compared the diagnositic powers in the diagnosis of thalassemia for MCV,RDW-SD, erythrocyte fragilitas experiment by analyzing the area under ROC(AUC ROC ). Results: 1.AUC ROC for MCV,RDW-SD,erythrocyte fragilitas experiment in determiningαthalassemia were 0.818, 0.782,and 0.746,respectively.The best point were MCV(75fl), RDW-SD(37),erythrocyte fragility(50%),the sensitivity of the best point were MCV(93.5%), RDW-SD(92.3%),erythrocyte fragility(95.2%),the specificity of the best point were MCV(70.0%), RDW-SD(66.1%),erythrocyte fragility(52.4%), respectively.2. AUC ROC for RDW-SD,MCV ,erythrocyte fragilitas experiment in determining β thalassemia were 0.933, 0.885,and 0.770,respectively.The best point were RDW-SD(33),MCV(75fl),erythrocyte fragility(40%),the sensitivity of the best point were RDW-SD(82.1%),MCV(83.6%)erythrocyte fragility(68.2%),the specificity of the best point were RDW-SD(90.0%),MCV(78.3%)erythrocyte fragility(71.4%), respectively. Conclusion: MCV is a better parameter in determing αorβthalassemia than erythrocyte fragilitas experiment,RDW-SD is best parameter determing βthalassemia than MCV and erythrocyte fragilitas experiment.