低血红蛋白密度对铁缺乏状态的临床应用评价

Clinical application of low hemoglobin density in iron deficiency diagnosis

目的探讨低血红蛋白密度(low hemoglobin density,LHD)对铁缺乏不同阶段的评价,明确LHD在不同病因贫血鉴别诊断的临床应用价值。方法回顾性分析2016年5月-2016年7月吉林大学第一医院就诊的铁缺乏、肾性贫血、肿瘤性贫血的低血红蛋白密度及铁代谢等检验结果,以同期我院健康体检者为对照组。比较实验组内(铁缺乏组、肾性贫血组、肿瘤性贫血组)及实验组间(健康体检组)LHD和铁代谢参数,比较LHD在不同阶段铁缺乏状态的水平,绘制各参数对铁缺乏评估的ROC曲线,分析LHD与铁代谢指标的相关性。全部检验数据采用SPSS23.0进行统计学处理。结果 LHD在铁缺乏组(37.4±23.4)%显著高于肾性贫血组(5.4±4.9)%、肿瘤性贫血组(3.9±3.7)%,P<0.01,肾性贫血组、肿瘤性贫血组与对照组比较无统计学差别,P>0.05;LHD在铁缺乏组内中,ID组、IDE组和IDA组分别为(9.3±7.4)%、(31.0±25.4)%、(63.9±21.5)%;LHD对铁缺乏诊断的ROC曲线下面积(AUC)为0.998、敏感度为94.8%、特异度为98%,优于铁代谢指标,血清铁(SI)AUC为0.958,敏感度为90.2%,特异度为89.3%;转铁蛋白(Tf)AUC为0.636,敏感度为38.5%,特异度为95.7%;转铁蛋白饱和度(TS)AUC为0.905,敏感度为80.8%,特异度为95.7%;LHD与铁代谢指标的相关性较低,LHD与SI、TIBC、TS的r值分别为-0.419,0.320,-0.599。结论 LHD作为血常规检验中的新参数,能够在铁缺乏筛查早期、敏感地反映机体铁缺乏状态,并随着铁缺乏严重程度的增加LHD值随之升高。

Objective To investigate the clinical application of low hemoglobin density in different programs iron deficiency and differential diagnosis of iron deficiency anemia.Methods The results of low hemoglobin density and iron metabolism in patients with iron deficiency,renal anemia and anemia of cancer in No.1Hospital of Jilin University from May 2016 to July 2016 were analyzed retrospectively.60 healthy persons were observed as control group.LHD and iron metabolism indexes were compared within experimental group and between experimental group and control group.The ROC curve of each parameter was calculated and the correlation between LHD and iron metabolism indexes was analyzed.All the data was analyzed by SPSS 23.0.Results LHD was（37.4±23.4）%in iron deficiency group,which was significantly higher than（5.4±4.9）%in renal anemia group,（3.9±3.7）%in tumor anemia group,P0.01.Compared with the control group,renal anemia and tumor anemia were not higher than it,P0.05;Receiver operating characteristic（ROC）curve analysis for LHD in diagnosis of iron deficiency：AUC 0.958,sensitivity 94.8%,specificity100%.The sensitivity and specificity were higher than other indexes：Serum iron（SI）AUC 0.958,the sensitivity90.2%,specificity 89.3%;transferrin（Tf）AUC 0.636,the sensitivity 38.5%,specificity 95.7%;transferrin saturation（TS）of AUC 0.905,the sensitivity 80.8%,specificity 95.7%;The correlation between LHD and SI,r=-0.419,LHD and TIBC,r=0.320,LHD and TS,r=-0.599;Conclusion LHD was a new red blood cell parameter,which can be used in the diagnosis of iron deficiency early and sensitively.With the increase of iron deficiency,the LHD increased.