缺铁性贫血与慢性病贫血的鉴别诊断

The differential diagnosis of iron deficiency anemia and anemia of chronic disease

目的探讨红细胞相关参数和铁代谢检验项目鉴别诊断缺铁性贫血(IDA)与慢性病贫血(ACD)的临床价值。方法分析30例IDA和29例ACD患者的红细胞(RBC)相关参数与铁代谢检测结果;比较总铁结合力(TIBC)、血清铁(SI)、红细胞分布宽度(RDW)的ROC曲线特性。结果 RBC、TIBC、铁蛋白浓度(SF)、平均红细胞体积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)和RDW两组患者间差异有统计学意义(P<0.01),SI、HCT两组患者间差异无统计学意义(P>0.05);TIBC、SI、RDW用于诊断IDA的ROC曲线下分别为0.986、0.457和0.905,对应的最优截断点分别为3.23 mg/L,95.5μg/L和15.56%,其灵敏度为93.3%,86.7%和76.7%,特异性为100%,31.0%和93.1%;TIBC的阳性预测值和阴性预测值分别为100%和93.5%。结论RBC、TIBC、SF、MCV、MCH、MCHC和RDW对诊断IDA非常有临床价值;TIBC、RDW鉴别诊断IDA与ACD时都有很好的准确性、灵敏度和特异性,TIBC优于RDW。

Objective To explore the clinical value in the diagnosis of iron deficiency anemia（IDA） and anemia of chronic disease（ACD） with red blood cells and iron metabolism testing items. Methods The test results were analyzed of the red blood cells and iron metabolism items in 30 patients with IDA and 29 patients with ACD. The characteristics were compared with ROC curve of TIBC, SI, and RDW. Results There were significant differences of RBC, TIBC,SF, MCV, MCH, MCHC and RDW between IDA and ACD group（P0.01）; there was no statistical difference of SI and HCT between IDA and ACD group（P 〈0.05）; The area under ROC curve（AUC） of the determination of TIBC,SI and RDW between IDA and ACD group were 0.986, 0.457 and 0.905,respectively; the optimal cut off value were3.23 mg / L,95.5 μg / L and 15.56%,respectively. The sensitivity were 93.3%,86.7% and 76.7%, respectively.The specificity were 100%,31.0% and 93.1%, respectively. PPV and NPV of TIBC were 100% and 93.5%, respectively.Conclusion Application of clinical identification of IDA has good screening tests with RBC, TIBC, SF, MCV, MCH,MCHC and RDW. There were good accuracy, sensitivity and specificity of TIBC and RDW in the differential diagnosis of IDA and ACD. And TIBC was better than RDW.