红细胞参数及运算公式在广东深圳地区儿童地中海贫血与缺铁性贫血鉴别诊断中的效能评价

Evaluation of Red Blood Cell Indices and Parameter Formulas in Differential Diagnosis of Thalassemia Trait and Iron Deficiency Anemia for Children in Shenzhen Area of Guangdong Province in China

目的:评价红细胞参数及运算公式在广东深圳地区儿童地中海贫血(thalassemia trait,TT)和缺铁性贫血(iron deficiency anemia,IDA)鉴别诊断中的效能。方法:选取849例来自广东深圳地区的儿童患者,其中TT 536例,IDA 313例。应用5个红细胞参数[分别为红细胞计数(RBC)、红细胞平均体积(MCV)、平均红细胞血红蛋白量(MCH)、红细胞平均血红蛋白浓度(MCHC)和红细胞分布宽度(RDW)]及10个红细胞参数运算公式(分别为Mentzer公式、Green and King公式、Srivastava公式、Ricerca公式、RDWI公式、Sirdah公式、Huber-Herklotz公式、Ehsani公式、Shine and Lal公式和England and Fraser公式),对其敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)以及约登指数(YI)进行分析,绘制受试者工作特征(ROC)曲线。结果:Green and King公式的鉴别诊断价值最高,其YI最高(63.7%),诊断TT的SEN为82.5%,SPE为81.2%,ROC曲线下面积(AUC)最高,为0.875;其次是RDWI公式,其YI、SEN、SPE以及AUC分别为62.8%、79.1%、83.7%及0.870。结论:在广东深圳地区儿童群体中,Green and King公式和RDWI公式具有较好地鉴别诊断TT和IDA的能力。

Objective:To evaluate the efficiency of red blood cell indices and fomulas for the differential diagnosis of the thalassemia trait(TT)and iron deficiency anemia(IDA)for children in Shenzhen area of Guangdong Province in China.Methods:A total of 849 child patients from Shenzhen were enrolled,including 536 cases of TT and 313 cases of IDA.The sensitivity(SEN),specificity(SPE),positive predictive values(PPV),negative predictive value(NPV),and Youden’s indices(YI)were analyzed using five red blood cell indices[including red blood cell count,average red blood cell volune(MCV),average amount of red blood cell hemoglobin(CMH),red blood hemoglobin cancentration(MCHC),red blood cell distribution width(RDW)]and 10 red blood cell paramter formulas including Mentzer,Green and King,Srivastava,Ricerca,RDWI,Sirdah,Huber-Herklotz,Ehsani,Shine and Lal,and England and Fraser.Receiver operating characteristic(ROC)curve was drawn.Results:Green and King was the most reliable index,as it had the highest YI(63.7%)and area under ROC curve(AUC)(0.875),the SEN and SPE was 82.5%and 81.2%.The YI,SEN,SPE,and AUC for RDWI were 62.8%,79.1%,83.7%,and 0.870,respectively.Conclusion:The formulas of Green and King and RDWI can be used for the differential diagnosis of TT and IDA,suitable for chidren in Shenzhen,China.