红细胞参数在慢性胃炎分型中的临床价值研究

Clinical Value of Red Blood Cell Parameters in Chronic Gastritis

目的探讨慢性胃炎类型与红细胞参数异常之间的关系。方法选取2011年10月—2015年2月在石河子市人民医院消化内科住院诊断为慢性胃炎患者160例,其中慢性萎缩性胃炎(慢性萎缩性胃炎组)75例,慢性非萎缩性胃炎(慢性非萎缩性胃炎组)85例。对患者进行幽门螺杆菌(H.pylori)感染测定,并抽取血液进行血细胞分析,检测红细胞参数:红细胞计数(RBC)、血红蛋白(Hb)、血细胞比容(HCT)、平均红细胞容积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)、红细胞体积分布宽度(RDW)。以慢性萎缩性胃炎分组为金标准,绘制ROC曲线,寻找可以诊断慢性萎缩性胃炎的红细胞参数指标。结果慢性非萎缩性胃炎组H.pylori感染率为25.9%(22/85),低于慢性萎缩性胃炎组的53.3%(40/75),差异有统计学意义(χ2=12.65,P<0.01)。慢性非萎缩性胃炎组红细胞参数RBC、Hb、HCT、MCV、MCH、MCHC、RDW均在参考范围;慢性萎缩性胃炎组RBC、MCV、MCH、RDW在参考范围,Hb、HCT、MCHC低于参考值下限。慢性萎缩性胃炎组RBC、Hb、HCT、MCV、MCH、MCHC低于慢性非萎缩性胃炎组,RDW高于慢性非萎缩性胃炎组,差异均有统计学意义(P<0.05)。慢性非萎缩性胃炎组H.pylori阳性与H.pylori阴性患者RBC、Hb、HCT、MCV、MCH、MCHC、RDW比较,差异均无统计学意义(P>0.05)。慢性萎缩性胃炎组H.pylori阳性患者RBC、Hb、HCT低于H.pylori阴性患者,差异有统计学意义(P<0.05),H.pylori阳性与H.pylori阴性患者MCV、MCH、MCHC、RDW比较,差异均无统计学意义(P>0.05)。以慢性萎缩性胃炎分组为金标准,绘制RBC、Hb、HCT、MCV、MCH、MCHC、RDW诊断慢性萎缩性胃炎的ROC曲线,其中7个参数中只有RBC、Hb、HCT AUC值>0.8,当慢性胃炎患者外周红细胞参数RBC≤3.9×1012/L,Hb≤119.5g/L,HCT≤36.2%时,提示可能发展为慢性萎缩性胃炎。结论慢性胃炎类型与红细胞参数异常密切相关,慢性萎缩性胃炎患者可以出现轻度贫血,慢性萎缩性胃炎及H.pylori感染与红细胞形态变化密切相关;H.pylori感染是引起慢性萎缩性胃炎患者红细胞形态学异常和轻度贫血的主要病因。慢性胃炎患者外周红细胞Hb≤119.5 g/L、HCT≤36.2%、RBC≤3.9×1012/L,提示可能发展为慢性萎缩性胃炎。

Objective To investigate the relation between chronic gastritis and red blood cell parameter abnormality.Methods We enrolled 160 patients with chronic gastritis who were admitted into the Department of Gastroenterology of Shihezi People＇s Hospital from October 2011 to February 2015. Among the patients,75 patients with chronic atrophic gastritis（ CAG）were assigned into CAG group and 85 patients with chronic non- atrophic gastritis（ CNAG） were assigned into CNAG group.H. pylori infection was detected, and blood samples were taken to conduct blood cell analysis. The measured red blood cell parameters included RBC,Hb,HCT,MCV,MCH,MCHC and RDW. Taking the grouping of CAG as the golden standard,ROC curves were made to identify red blood cell parameters that could be used to diagnose CAG. Results The H. pylori infection rate of CNAG group was 25. 9%（ 22 /85）,lower than that of CAG group,which was 53. 3%（ 40 /75）,and the two groups were significantly different（ χ2= 12. 65, P〈0. 01）. RBC, Hb, HCT, MCV, MCH, MCHC and RDW of CNAG group remained in normal range; RBC, MCV, MCH and RDW of CAG group were in normal range; Hb, HCT, MCHC of CAG group were below normal range. CAG group was lower in RBC,Hb,HCT,MCV,MCH and MCHC and higher in RDW than CNAG group（ P〈0. 05）. In CNAG group, H. pylori positive patients and H. pylori negative patients were not significantly different in RBC,Hb,HCT,MCV,MCH,MCHC and RDW（ P〈0. 05）. In CAG group, H. pylori positive patients was lower than H. pylori negative patients in RBC,Hb and HCT（ P〈0. 05）,and H. pylori positive patients and H. pylori negative patients were not significantly different in MCV,MCH,MCHC and RDW（ P〈0. 05）. With the grouping of CAG as the golden standard,the ROC curves of RBC,Hb,HCT,MCV,MCH,MCHC and RDW diagnosing CAG were made,and RBC,Hb and HCT were found to have AUC 0. 8; when chronic gastritis patients had RBC≤3. 9 × 1012/ L,Hb≤119. 5 g / L and HCT≤36. 2%,CAG was more likely to occur. Conclusion The chronic gastritis typing is closely related to abnormal red blood cell parameters,and the patients with CAG may have mild anemia; CAG and H. pylori infection are closely related to the RBC morphology change. H. pylori infection is the main cause for RBC morphology abnormality and mild anemia. Hb ≤119. 5 g / L,HCT≤36. 2% and RBC≤3. 9 × 1012/ L of the red blood cells in chronic gastritis patients may lead to the development of CAG.