网织红细胞多参数分析对肾性贫血患者治疗的应用价值

Application Value of Multi Parameter Analysis of Net and Red Blood Cells in the Treatment of Renal Anemia

目的通过对网织红细胞相关参数进行检测,探讨金湖县人民医院肾性贫血患者治疗前后骨髓红系造血功能的动态变化以及判断药物治疗的疗效。方法采用迈瑞-6900全自动血液细胞分析仪,将54例肾性贫血患者分成三组,分别为肾功能不全代偿组、肾功能不全失代偿组和肾功能衰竭组,与45例正常健康组作对比分析,分别检测网织红细胞百分比(Ret%)、未成熟网织红细胞指数(IRF%)、红细胞(RBC)计数、血红蛋白含量(Hb)、血清肌酐(Cr)和尿素氮(BUN)含量,同时检测治疗前后的红细胞比容(HCT)和Ret%,并通过校正公式计算网织红细胞生成指数(RPI),对结果进行对比分析。结果 Ret%在肾功能不全失代偿组和肾功能衰竭组显著高于对照组(P<0.05);IRF%在肾功能不全代偿期组显著低于对照组(P<0.05),而肾功能不全失代偿组和肾功能衰竭组均显著高于对照组(P<0.05);RBC,Hb水平随着Cr和BUN水平的升高而显著减低,在肾功能不全代偿期组开始显著低于对照组(P<0.05),并随着肾病的严重程度逐渐减低。肾功能不全代偿组治疗前后HCT(%),Ret(%),HFR(%),MFR(%),RPI(%),差异有统计学意义(t=2.103,2.062,2.079,2.354,2.368;均P<0.05),LFR(%)差异无统计学意义(t=1.812,P>0.05);肾功能不全失代偿组治疗前后HCT(%),Ret(%),HFR(%),MFR(%),LFR(%),RPI差异均有统计学意义(t=2.228,2.172,2.894,2.185,2.023,2.455;均P<0.05);肾功能衰竭组HCT(%),Ret(%),HFR(%),MFR(%),RPI(%)治疗前后差异有统计学意义(t=2.148,2.351,2.642,2.086,2.686;P<0.05),LFR(%)差异无统计学意义(t=1.921,P>0.05)。IRF%的ROC面积较其他血液学指标大,在临界值为22.3%时,其诊断灵敏度和特异度分别为88.4%和80.2%。结论网织红细胞中的相关参数能够有效的协助医师对肾性贫血患者进行诊断与治疗,尤其是IRF%和RPI指标较网织红细胞更加敏感,且这些指标更能准确的反映出骨髓造血功能和红系的生长情况,值得在临床中应用。

Objective The dynamic changes of hematopoietic function of bone marrow in patients with renal anemia before and after treatment and the curative effect of drug treatment were discussed through the detection of the related parameters of the red blood cell. Methods Reticulated red cells using Mindray-6900 automatic blood cell analyzer,54 cases of renal anemia patients were divided into three groups, respectively for renal function of compensatory group, renal function insufficiency decompensation group and renal failure group, and 45 cases of normal healthy group for comparison analysis were used to de- tect the reticulocyte percentage （RET）, immature red blood cell index （IRF）, red blood cell （RBC） count, hemoglobin （HB）, serum creatinine （CR） and blood urea nitrogen （BUN） were detected before and after treatment of red blood cell hematocrit （HCT） and RET, and through the correction formula to calculate the net knits red blood cell production index （RPI）. The results were compared and analyzed. Results RET in renal failure compensatory group and renal failure group was significantly higher than that of the control group （P〈0.05） ;IRF% in renal insufficiency compensatory group was sig- nificantly lower than that of control group （P〈0.05）,and renal failure compensatory group and renal failure group were significantly higher than those of the control group （P〈0.05） ;RBC, Hb levels with the levels of bun and Cr increased sig- nificantly reduced,in kidney function not full decompensated group was significantly lower than that of control group （P〈 0.05）, and with the severity of the kidney was decreased gradually. Renal insufficiency compensatory group before and after treatment with HCT（ % ）, Ret（ % ）, HFR（ % ）, MFR（ % ）, RPI the difference was statistically significant （t= 2. 103,2. 062, 2. 079,2. 354,2. 368;all P〈0.05） ,LFR （%） showed no significant difference （t=1. 812,P〉0.05） ;renal insufficiency de- compensation group before and after treatment with HCT（ % ）, Ret（ % ）, HFR（ % ）, MFR（ % ）, LFR（ % ）, HFR showed sig- nificant differences （ t = 2. 228,2.172,2. 894,2.185,2. 023,2.455 ; all P % 0.05） ; renal failure group HCT （ % ）, Ret （% ）,HFR（ % ）, MFR（ % ） HFR was statistically significant differences before and after the treatment （t = 2.148,2.351,2. 642, 2. 086,2. 686 ;all P〈0.05）, LFR（%） showed no significant difference （t = 1. 921, P〉 0.05）. The ROC area of IRF% was larger than other hematological indexes,and its diagnostic sensitivity and specificity were 88.4 % and 80.2%, respectively, when the critical value was 22.3 %. Conclusion Reticulocyte erythrocyte parameters can effectively assist physicians in renal anemia patients for diagnosis and treatment,especially the IRF% and RPI is net woven red cells more sensitive,and the in- dex can more accurately reflect the growth of hematopoietic function of bone marrow and erythroid, worthy of clinical application.