儿童珠蛋白生成障碍性贫血的红细胞参数筛查截断值探讨

Discussion on the cutoff value of red blood cell parameters on screening thalassemia in children

目的了解平均红细胞体积（MCV）、平均血红蛋白浓度（MCH）、红细胞容积分布宽度（RDW）等在儿童珠蛋白生成障碍性贫血中的筛查截断值及其应用价值。方法对云南省德宏州傣族、景颇族、德昂族、阿昌族7岁以下儿童共2 171例进行了血液分析、血红蛋白电泳检测,并进行统计学分析。结果 MCV〈80 fL、MCH〈27pg、RDW〈16%为截断点均偏高,准确性太低,如果选择MCV 65 fL、MCH 20 pg、RDW 12%,其灵敏度可达86.6%~99.3%,假阳性率只有0.7%~10.4%。结论截断值定得太高,会导致灵敏度高,特异度低,误诊率高,作为高发地区的筛查准确率至关重要,截断值的准确性好,对控制珠蛋白生成障碍性贫血可起到事半功倍的效果。

Objective To understand the cutoff value and clinical value of MCV,MCH,RDW on screening thalassemia in children.Methods 2 171 blood samples from children under 7 years old in Dehong of Yunnan were tested by blood cell automatic analysis and hemoglobin electrophoresis.Results MCV 80 fL,MCH27 pg,RDW16% as the cut-off points was high,the accuracy was too low,when we chose 65 fL of MCV,20 pg of MCH,12% of RDW,the sensitivity was 86.6%-99.3%,and the false positive rate only was 0.7%-10.4%.Conclusion There are high sensitivity,low specificity and misdiagnosis if the cutoff value set is too high,and the control of thalassemia can play a half times the effect of feats if the cutoff value set good in a high accuracy rate of screening in areas critical.