网织红细胞多参数在肝硬化中的变化及意义

Clinical significance of varying reticulocyte indexes in patients with hepatocirrhosis

目的探讨网织红细胞各参数在不同程度肝硬化(HC)患者的变化及临床意义。方法收集确诊的90例不同原因引起HC患者:按Child-pugh分级标准分A级25例(A组),B级30例(B组),C级35例(C组);200例体检健康者为正常对照组。在Coulter-Gens全自动化血液分析仪测定红细胞计数(RBC)、血红蛋白(Hgb)、平均红细胞体积(MCV)、红细胞体积分布宽度(RDW)、网织红细胞百分比(RET%)、未成熟网织红细胞指数(IRF)、平均网织红细胞体积(MRV)。并将各组的变化进行比较分析。结果随着肝硬化进程IRF、RDW、RET%显著地升高,而MRV、MCV也升高,但变化不大,RBC、Hgb则较明显地下降;和对照组相比较,A组中其他指标无变化,IRF则显著性升高(P<0.05);与A组相比较,B组和C组中IRF比其他指标(P<0.05和P<0.01)更有显著性变化(P<0.01和P<0.001)。结论网织红细胞参数测定有助于早期判断红细胞的活动度,作为反映肝硬化患者骨髓造血功能的新型指标,而IR F为更灵敏、更早的指标,有助于肝硬化的早期诊断和对贫血的早期治疗。

Objective To understand the clinical significance of varing reticulocyte indexes（IRF） in patients with hepatocirrhosis（HC）. Methods ninety patients with different stages of HC were classified A, B and C group according to Child-pugh categories,with 25 cases of group A, 30 cases of group B, 35 cases of group C. 200 heathy people were acted as the control group; Red blood cell （RBC）, hemoglobin （Hgb）, mean corpuscular volume （MCV）, red blood cell distribution width（RDW）, reticulocyte percent （RET%）, immature reticulocyte index（IRF）, mean reticulocyte volume（MRV） above groups were detected by Beckman-Coulter Gen.S Auto Hematology Analyzer. Results With the development of HC, IRF, RET%, RDW increased sigificantly, MRV, MCV varietied insignificantly, and RBC, Hgb decreased obviously; Compared with the control group, IRF increased clearly （P〈0.05）, but other indexes did not change in A group; IRF of B, C group showed differently significant （P〈0.01 andd P〈0.01） than those of others （P〈0.05 and P〈0.O1） compared with the A group. Conclusions Reticulocyte parameters can be regarded as indexes to bone marrow hemopietic ability, IRF is an earlier and better sensitivity index.