单个网织红细胞血红蛋白量在诊断儿童缺铁性贫血中的意义

Clinical utility of reticulocyte hemoglobin content for the diagnosis of iron deficiency anemia in children

目的研究网织红细胞血红蛋白量(CHr)在诊断儿童缺铁性贫血(IDA)中的意义。方法 100例1～6岁IDA患儿和50例正常儿童(对照组)作为研究对象。采用血细胞分析仪检测CHr、Hb、RBC、平均红细胞容积(MCV)等红细胞参数;采用放射免疫双抗体法检测血清铁蛋白(SF);采用ELISA方法测定转铁蛋白受体(sTfR)。结果 IDA组的Hb和CHr分别为100±6 g/L和18±5 pg,低于对照组(126±8 g/L,31±3 pg;P<0.01)。IDA组的SF(11±4μg/L)低于对照组(59±36μg/L;P<0.01);sTfR则高于对照组(4.8±2.1 mg/L vs1.4±0.6 mg/L;P<0.01)。对照组、IDA组的CHr与Hb呈正相关(r分别为0.540,0.734,P<0.01);IDA组的CHr与SF呈正相关(r=0.464,P<0.01);IDA组的CHr与sTfR呈负相关(r=-0.450,P<0.01)。当CHr的临界值为27.8 pg时,诊断小儿IDA的敏感度和特异度分别为88.0%和90.0%,ROC曲线下面积为0.948。结论 CHr可以作为诊断儿童IDA的指标。

Objective To study the clinical utility of measuring reticulocyte hemoglobin content（CHr） in the diagnosis of iron deficiency anemia（IDA） in children. Methods One hundred children with IDA at ages of 1 to 6 years and 50 healthy children were enrolled.Red blood cell parameters,CHr,hemoglobin（Hb）,red blood count（RBC） and mean corpusular volume（MCV）,were determined using the Blood Cell Analyzer.Serum ferritin（SF） levels were determined using radioimmunoassay double antibody techique.Soluble serum transferrin（sTfR） levels were determined using ELISA. Results The values of Hb（100±6 g/L vs 126±8 g/L） and CHr（18±5 pg vs 31±3 pg） in the IDA group were significantly lower than normal controls（P〈0.01）.SF levels（11±4 μg/L） in the IDA group were also lower than normal controls（59±36 μg/L）（P〈0.01）.In contrast,the values of sTfR in the IDA group were significantly higher than normal controls（4.8±2.1 mg/L vs 1.4±0.6 mg/L;P〈0.01）.In both groups,there was a positive correlation between the values of CHr and Hb [r=0.540（control group）,r=0.734（IDA group）;P〈0.01].In the IDA group,CHr was positively correlated with SF（r=0.464;P〈0.01） and negatively correlated with sTfR（r=-0.450;P〈0.01）.When the cut-off value of CHr was 27.8 pg,the sensitivity and specificity for the diagnosis of IDA were 88.0% and 90.0%,respectively and the area under the ROC curve was 0.948. Conclusions CHr can be used as an index for the diagnosis of IDA in children.