孕妇人群中无创式血红蛋白检测准确性研究

Non-invasive haemoglobin measurement in pregnant women

目的探讨孕妇人群中无创式检测血红蛋白(Hb)结果与静脉血结果的差异和临床意义,为孕妇的贫血筛查提供参考依据。方法采用无创式脉搏血氧血红蛋白仪Or Sense NBM-200检测2014年1月同济大学附属第一妇婴保健院180例孕妇血红蛋白(脉搏血氧血红蛋白,Sp Hb),并同时检测其静脉血红蛋白(venous Hb,v Hb),将结果进行比较,评估其准确性、相关性及一致性。结果在180例孕妇中Sp Hb与v Hb的差异无统计学意义(P=0.463)。Peason相关分析显示,Sp Hb与v Hb相关系数为0.789(P<0.001),表明两种方式检测结果有明显相关关系。用Bland-Altman分析Sp Hb与v Hb的差值,结果显示在不贫血孕妇中,平均偏倚为6.6 g/L,95%的一致性界限中的最大差值15.2 g/L为两方式的均值120.0 g/L的12.7%;轻度贫血孕妇中,平均偏倚为7.0 g/L,95%的一致性界限中的最大差值16.6 g/L为两方式的均值108.1 g/L的15.4%;中度贫血孕妇中,平均偏倚为6.2 g/L,95%的一致性界限中的最大差值20.2 g/L为两方式的均值95.6 g/L的21.1%,表明两种检测方法在不同贫血程度的孕妇中均具有良好的一致性,但其准确性随着贫血程度的加重而降低。结论使用NBM-200检测仪得到的Sp Hb与v Hb具有较好的一致性和相关性,虽然准确性有待进一步提升改进,但其具有无创伤和快速的优点,可以更好地为孕妇进行贫血筛查。

Objective To investigate the difference and clinical significance between the results of non- invasive detection of hemoglobin（Hb） and venous blood results in pregnant women, and provide reference for screening for anemia in pregnant women. Methods Totally 180 pregnant women were enrolled in this prospective, controlled study.Non-invasive NBM- 200 Hb（Sp Hb） values were recorded. Then we compared Sp Hb with laboratory Hb values from venous blood samples（v Hb） drawn at baseline to assess the accuracy, relevance and consistency.Results There was no significant difference between Sp Hb and v Hb（P=0.463）. Pearson correlation analysis displayed significant relativity between Sp Hb and v Hb（r=0.789, P〈0.001）.Bland-Altman analysis of difference between Sp Hb and v Hb showed that in the normal pregnant women, the average bias was 6.6 g/L, and the maximum difference（15.2 g/L） in 95% CI was12.7% of the mean; in mild anemia pregnant women, the average bias was 7.0 g/L, the maximum difference（16.6 g/L） in95%CI being 15.4% of the mean; in moderate anemia pregnant women, the average bias was 6.2 g/L,and the maximum difference（20.2 g/L） in 95%CI was 21.1% of the mean.There was no clinical significance of the difference between Sp Hb and v Hb,which showed that two kinds of detection methods had good consistency in different degree of anemia in pregnant women, but the accuracy reduced with the aggravation of the severity of anemia.Conclusion There is relevance and consistency between Sp Hb and v Hb. Although the accuracy needs to be further improved,its advantages of being non-invasive and fast will make it an important monitor to assess maternal Hb in pregnant women.