网织红细胞血红蛋白含量测定早期筛查铁缺乏

Reticulocyte hemoglobin content used for early screening iron deficiency

目的:研究网织红细胞血红蛋白含量(CHr)在早期筛查铁缺乏中的价值。方法:应用ADVIA120血细胞分析仪检测常用血液学指标,包括CH(单个红细胞血红蛋白含量)、MCH、HGB、MCV、RDW和CHr;同时采用生物化学法或化学发光免疫法测定铁代谢指标,包括血清铁(SI)、血清总铁结合力(TIBC),血清转铁蛋白饱和度(TfS)、血清铁蛋白(SF)和急性时相反应标志物-血清C反应蛋白(CRP)。结果:CHr低于临界值(<28.5pg)患者的CH、HGB、MCH、MCV、SI和TfS降低,RDW和TIBC增高,SF呈不规则变化。血清CRP增高患者与不增高的患者相比CHr及常规血液学指标无差异,但CRP增高患者SF显著增高(P<0.05)。CHr<CH比CHr>CH患者的TfS显著减低(P=0.021)。健康人CHr和CH的参考范围分别为30.4～35.8pg、28.8～33.8pg。结论:CHr低于临界值的患者符合小细胞低色素性贫血和铁缺乏时的铁代谢变化。CHr可常规应用于临床铁缺乏的诊断和早期铁缺乏(CHr<CH)的筛查,且不受机体急性时相反应干扰。

Objective To study clinical value of reticulocyte hemoglobin content（CHr） used for early screening iron deficiency.Methods The routine hematologic indices including red cell hemoglobin（CH） ,mean corpuscular hemoglobin（MCH） ,hemoglobin（HGB） ,mean corpuscular volume（MCV） ,red cell volume distribution width（RDW） and CHr were measured by the ADVIA 120 hematology analyzer.Iron metabolism indices,including serum iron（SI） ,serum total iron-binding capacity（TIBC） ,serum transferrin saturation（TfS） ,serum ferritin（SF） and acute phase reactive marker（serum C-reactive protein,CRP） were detected by the biochemical method or the chemiluminescent immunoassay.Results Among patients with CHr lower than cutoff value（28.5 pg） ,the CH,HGB,MCH,MCV,SI and TfS decreased;RDW and TIBC increased;SF was indeterminate.CRP concentration was not relevant to routine hematological indices and CHr.Patients with higher CRP had an increase in SF level（P〈0.05） .The TfS of patients with CHrCH（P=0.021） .The reference ranges of CHr and CH were 30.4-35.8 pg and 28.8-33.8 pg respectively.Conclusions Patients with CHr less than cutoff value（28.5 pg） were in accord with iron metabolism of microcytic hypochromic anemia and iron deficiency.CHr can be used for clinical diagnosis of iron deficiency and screening of early iron deficiency（CHr〈CH）,and not affected by acute phase reaction.