网织红细胞血红蛋白含量在诊断妇女铁缺乏的临床应用

Application of reticulocyte hemoglobin content in diagnosis of iron deficiency in premenopausal women

目的探讨网织红细胞血红蛋白含量（reticulocyte hemoglobin content，CHr）在诊断女性铁缺乏的应用价值。方法采用ADVIA120全自动血液分析仪及配套试剂对缺铁非贫血和缺铁贫血患者进行CHr、Hb、平均红细胞体积（MCV）和红细胞体积分布宽度（RDW）检测，同时，采用生化方法对所有入选者的转铁蛋白饱和度（TS）和铁蛋白（SF）进行检测。通过统计学方法ROC曲线对CHr和其他贫血指标进行评价。结果缺铁非贫血组的CHr为（28．2±2．2）pg，低于正常对照组的（32．0±2．7）pg，并高于缺铁贫血组的（23．4±3．5）pg，差异有统计学意义（P均〈0．01）。慢性病贫血组CHr为（28．6±3．7）pg，高于缺铁贫血组，差异有统计学意义（P〈0．01）。ROC曲线显示，缺铁非贫血组的CHr面积为0．872、SF为0．798、RDW为0．721、MCV为0．713、Hb为0．677，差异有统计学意义（P〈0．01），可见CHr在诊断缺铁非贫血方面比SF、RDW、MCV、Hb更有价值。缺铁贫血组Hb、RDW、CHr、SF和MCV的ROC曲线面积分别为1．000、0．969、0．958、0．953和0．926。结论CHr是诊断育龄女性铁缺乏的早期、敏感的指标，尤其适用于缺铁非贫血患者的诊断。

Objective To examine the application value of reticulocyte hemoglobin content （CHr） for diagnosing iron deficiency in premenopansal women. Methods The levels of CHr, hemoglobin （ Hb）, mean cellular volume （MCV）, red cell distribution width （RDW） were measured on the ADVIA 120 （ Bayer Diagnostics ） automated hematology analyzer. Transferrin saturation （ TS ） and ferritin （ SF ） were measured on chemistry analyzer. Results CHr in iron deficiency without anemia group were significantly lower than that in the healthy control group （P 〈0. 01 ） and significantly higher than that in iron deficiency anemia group（ P 〈0. 01 ）. CHr in anemia of chronic disease group were significantly higher than that in iron deficiency anemia group（ P 〈0. 01 ）. Receiver operator characteristic curve （ROC） analysis in diagnosis of iron difieieney without anemia demonstrated that the area under the curve for CHr, SF, RDW, MCV, Hb were 0. 872, 0. 798, 0. 721, 0. 713, 0. 677 , respectively （ P 〈 0. 01 ）. So CHr has a better overall sensitivity than SF, Hb, MCV and RDW in the diagnosis of iron deficiency without anemia. ROC also showed that the area under the curve for Hb, RDW, CHr, SF and MCV was 1.000, 0.969, 0.958, 0.953 and 0. 926, respectively （P 〈 0. 01 ） in iron deficiency anemia. Conclusion CHr is the early and sensitive predictor of iron deficiency in premenopausal women, especially for the diagnosis of iron deficiency without anemia.