网织红细胞血红蛋白水平在巨幼红细胞性贫血鉴别诊断中的应用

Application of reticulocyte hemoglobin content for the diagnosis of megaloblastic anemia

目的探讨网织红细胞血红蛋白水平(Ret-He)对巨幼红细胞性贫血(MA)的鉴别诊断价值。方法检测并比较53例不同类型MA患者、13例骨髓异常增生综合征难治性贫血亚型(MDS-RA)患者和50例健康者Ret-He水平;绘制受试者工作特征曲线(ROC曲线),计算Ret-He诊断MA的灵敏度、特异度、阳性预测值和阴性预测值。结果单纯MA组、伴血小板减少MA组与健康对照组比较,单纯MA组、伴血小板减少MA组与MDS-RA组比较,Ret-He水平差异均有统计学意义(P<0.05),MDS-RA组与健康对照组Ret-He水平差异无统计学意义(P>0.05)。当Ret-He临界值为36.45pg时,诊断MA的灵敏度为64.9%、特异度为92.3%、阳性预测值为96.0%、阴性预测值为48.0%、ROC曲线下面积为0.811。结论 Ret-He对MA具有一定的鉴别诊断价值,可为进一步阐明贫血形态学分类提供信息。

Objective To investigate the value of reticulocyte hemoglobin content （Ret-He） for the differential diagnosis of meg- alohlastic anemia（MA）. Methods Ret-He level in 53 patients with varieties of MA,13 patients with myelodysplastic syndrome re fractory anemia subtype（MDS-RA） and 50 healthy subjects was detected and statistically compared. Sensitivity,specificity,positive predictable value and negative predictable value of Ret-He for the diagnosis of MA were estimated by receiver operating characteris- tic curve（ROC curve）. Results MA group（pure MA and MA along with thrombocytopenia） and healthy control group had statisti- cal difference in Ret-He level（P〈0.05）, MA group and MDS-RA group had statistical difference（P〈0.05）, and MDS-RA group and healthy control group had no significant difference（P〈0.05）. With the threshold limit value at 36.45 pg,the sensitivity, speci- ficity,positive predictable value and negative predictable value of Ret-He for the diagnosis of MA were 64.9%,92.3% ,96.0% and 48.0% ,and the area under ROC curve was 0. 811. Conclusion Ret-He might be with certain application value in diagnosing MA, and could be utilized to demonstrate anemia morphology classification by providing extra information.