用ROC曲线评价血液学指标在儿童地中海贫血中的筛查价值

Evaluation the Screening Value of thalasaemia among the children with the ROC curve

目的用ROC曲线评价血液学指标在儿童地中海贫血(以下简称地贫)检测中的筛查价值。方法以SYSMEX-21N血细胞分析仪检测MCV、MCH、MCHC、RDW-CV、RDW-SD、Hb、RBC等红细胞参数;红细胞脆性用一管半定量法;Hb电泳用Helena公司pH8.6缓冲液醋酸纤维薄膜及配套电泳扫描仪;靶形红细胞用显微镜高倍镜观察计数。以Hb电泳结果为金标准,应用ROC曲线分析方法 ,对以上几项血液学指标在儿童地贫中的筛查价值进行分析。结果在儿童的血液学指标中,RDW-CV的筛查价值更大,RDW-CV价值高于MCV;MCH则与健康人的差距较大,基本上不存在重叠,有筛查价值;MCHC、Hb、RBC、RDW-SD、靶形红细胞最佳临界值与正常参考值有重叠,筛查价值不大。红细胞脆性仅在判断β地贫时有差异,且ROC曲线下面积较小,筛查价值不大。结论 RDW-CV、MCH、MCV3项指标均对儿童地贫具有一定的筛查价值,其中以RDW-CV的筛查价值最大,尤其对β地贫,可作为地贫的首选筛查指标,MCH的筛查价值相对次之,MCV相对最低;三者的最佳临界值均与正常参考值没有重叠。当出现RDW-CV>15.75%,MCH<25.05pg时,应充分考虑地贫诊断,如同时具有MCV<73.05fL则其可能性将会大大增加,应进行进一步的检测以确诊。

Objective To evaluate the screening value of hematologic indicators for thalassemia children in Xishuangbanna with the ROC curve. Methods Use SYSMEX-21N hematology analyzer to detect MCV, MCH, MCHC, RDW-CV, RDW-SD, Hb, RBC and other red blood cell parameters;erythrocyte fragility with a semi quantitative method;hemoglobin electrophoresis using Helena s pH8.6 buffer solution and the cellulose acetate membrane electrophoresis and supporting scanners; target shaped cells with a mi croscope high power microscope counting. Application of ROC curve analysis, hemoglobin electrophoresis results as the gold stand ard,the above mentioned several hematological indicators in children the value of thalassemia in the screening analysis. Results In a child＇s hematologic indicators,RDW-CV showed greater screening value. The screening value of RDW-CV was higher than that of MCV,For MCH,the gap between patients and healthy ones was large and basically there is no overlap,and showing screening values;the best critical value of MCHC, Hb,RBC,RDW SD and target shaped cells were overlapped with the normal reference value, indicating limited screening value. Erythrocyte fragility only in determining the β-thalassemia showed difference, and smaller AUC screening of limited value. Conclusion RDW CV, MCH, MCV all have some screening value for children thalassemia,of which the RDW-CV shows the largest screening value, especially for β-thalassemia, which can be used as the preferred screening targets to thalassemia. MCH values are relatively screening followed,MCV is relatively low. The best critical values of the three show no overlap with the normal reference values. When RDW CV〉 15. 75% and MCH 25. 05 pg, we should give full consideration to whether the disease is thalassemia,as both MCV 〈73.05 fL then the possibility will be greatly increased, further tests should be carried out in order to diagnose.