联合用药对儿童缺铁性贫血的疗效及低血红蛋白密度对疾病转归的预测价值

Efficacy of combination therapy for children with iron deficiency anemia and the predictive value of low hemoglobin density for disease outcome

目的探讨联合用药对儿童缺铁性贫血(IDA)的疗效及低血红蛋白密度(LHD%)对疾病转归的预测价值。方法选取2018年1月至2019年4月深圳市龙岗区第二人民医院收治的IDA患儿80例,采用随机数字表法将其分为观察组和对照组,每组40例。对照组采用右旋糖酐铁口服液治疗,观察组则给予右旋糖酐铁口服液联合健脾生血颗粒治疗。观察两组患儿治疗4周后的治疗效果及不良反应发生情况,检测治疗前后血红蛋白(Hb)、血清铁蛋白、血清铁、LHD%、红细胞计数(RBC)、平均红细胞血红蛋白浓度(MCHC),并采用受试工作者工作特征曲线(ROC曲线)分析LHD%对IDA患儿转归情况的预测价值。结果观察组患儿治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。两组患儿治疗后的Hb、血清铁蛋白、血清铁、RBC及MCHC明显高于治疗前,而LHD%明显低于治疗前,差异均有统计学意义(P<0.05);观察组治疗后Hb、血清铁蛋白、血清铁、RBC及MCHC明显高于对照组,LHD%明显低于对照组,差异均有统计学意义(P<0.05)。两组患儿不良反应总发生率比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示,LHD%预测IDA转归的曲线下面积为0.852,约登指数为0.626,最佳临界值为37.58%,灵敏度为90.90%,特异度为75.60%。结论相对于单一使用右旋糖酐铁口服液治疗,右旋糖酐铁口服液联合健脾生血颗粒治疗效果更佳,且治疗前LHD%水平可以有效地预测IDA患儿的转归情况。

Objective To explore the efficacy of combination therapy for children with iron deficiency anemia(IDA)and the predictive value of low hemoglobin density(LHD%)level detection for disease outcome.Methods From January 2018 to April 2019,a total of 80 children with IDA admitted to the Second People′s Hospital of Longgang District,Shenzhen City were selected and divided into observation group and control group by random number table method,with 40 children in each group.The control group was treated with iron dextran oral solution,while the observation group was treated with iron dextran oral solution combined with Jianpi Shengxue Granule.After 4 weeks of treatment,the treatment effect of the two groups of patients and the incidence of adverse reactions before and after treatment were observed,the hemoglobin concentration,serum ferritin,serum iron,LHD%,RBC,mean RBC hemoglobin concentration(MCHC)were detected.The author characteristic curve(ROC curve)was used to analyze the predictive value of LHD% on the outcome of children with IDA.Results The total effective rate of the observation group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the levels of hemoglobin,serum ferritin,serum iron,RBC and MCHC in the two groups were significantly higher than before treatment,while LHD% were significantly lower than before treatment,with statistically significant differences(P<0.05).Besides,the levels of hemoglobin,serum ferritin,serum iron,RBC and MCHC after treatment in the observation group were significantly higher than those in the control group,and the LHD% level was significantly lower than that in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P>0.05).The ROC curve results showed that the area under the curve of LHD% in predicting IDA was 0.852,the Yoden index was 0.626,the optimal cut-off value was 37.58%,the sensitivity was 90.90%,and the specificity was 75.60%.Conclusion Compared with the single use of iron dextran oral solution,iron dextran oral solution combined with Jianpi Shengxue Granule is more effective in treatment,and the LHD%before treatment could effectively predict the outcome of IDA children.