网织红细胞血红蛋白含量测定对小细胞贫血分类的意义

Significance of reticulocyte hemoglobin equivalent (Ret-He) in differential diagnosis of microcytic anemias

目的:研究网织红细胞血红蛋白含量(Ret-He)在缺铁性贫血(IDA)、慢性病贫血(ACD)、ACD伴缺铁(CDID)和地中海贫血等几种小细胞低色素性贫血鉴别诊断中的意义。方法:用Sysmex XT-4000i全自动血细胞分析仪对43例IDA患者、31例ACD患者、66例CDID患者、19例地中海贫血患者及50例正常体检者的抗凝静脉血标本测定Ret-He值。结果:Ret-He均数在IDA组与其他4组间差异均有统计学意义(P<0.05),ACD组、CDID组和地中海贫血组间Ret-He差异无统计学意义(P>0.05),所有小细胞低色素性贫血组与正常对照组间Ret-He差异均有统计学意义(P<0.05)。当临界值为20.9pg时,Ret-He诊断IDA的特异度为83.7%,灵敏度为57.1%;Ret-He和血清铁蛋白(SF)的受试者操作特征曲线(ROC)下面积(AUC)分别为0.759和0.641。结论:在诊断IDA时,Ret-He可辅助可溶性转铁蛋白受体(sTfR)指标作为其诊断依据。在鉴别IDA与ACD、地中海贫血、CDID时,Ret-He可作为较重要的鉴别依据。

Objective To assess the value of reticulocyte hemoglobin equivalent （Ret-He） in the differential diagnosis of microcytic hypochromic anemias,including iron deficiency anemia （IDA）,anemia of chronic disorders （ACD）,iron deficient combined with ACD and thalassemia.Methods Ret-He was measured by Sysmex XT-4000i in 43 IDA patients,31 ACD patients,66 iron deficient combined with ACD patients,19 thalassemia patients,and 50 normal controls.Results The mean value of Ret-He in IDA was below normal value and was also significantly lower than those of the other four groups （P0.05）.Ret-He levels in all the microcytic hypochromic anemia groups were significantly lower than that of normal controls（P0.05）.No significant difference was found in Ret-He levels among ACD group,iron deficient combined with ACD group and thalassemia group （P0.05）.When 20.9 pg was defined as the Ret-He cut off value for diagnosing IDA,the sensitivity was 57.1% and specificity was 83.7%.The area under receiver operating characteristic curve （AUC）of Ret-He and SF was 0.759 and 0.641,respectively.Conclusions Ret-He is an effective assistant parameter for sTfR in diagnosing IDA.It can also be looked as an important index in the differential diagnosis of IDA from ACD,iron deficiency combined with ACD and thalassemia.