孕周相关的网织红细胞参数及参考值范围的调查

A survey of parameters and reference ranges of reticulocytes related to gestational age

目的探讨正常妊娠妇女外周血网织红细胞的变化,并建立其参考值范围。方法采用日本Sysmex XN 9000全自动血细胞分析仪对2018年4月至2019年4月中南大学湘雅医学院附属海口医院658例正常妊娠妇女和100例正常非妊娠妇女的外周血网织红细胞进行检测,获得各参数网织红细胞百分比(reticulocyte percentage,RET%)、未成熟网织红细胞指数(immature reticulocyte fraction,IRF)、低荧光网织红细胞(low fluorescence reticulocyte,LFR)、中荧光网织红细胞(medium fluorescent reticulocyte,MFR)、高荧光网织红细胞(high fluorescence reticulocyte,HFR)、网织红细胞血红蛋白(reticulocyte hemoglobin,RET-He)、红细胞血红蛋白(erythrocyte hemoglobin,RBC-He)、网织红细胞生成指数(reticulocyte production index,RPI),并用SPSS 18.0软件进行统计分析结果,采用95%可信区间确定其参考值范围。结果与非妊娠妇女组比较,正常妊娠妇女组Hb、LFR降低,RET%、IRF、MFR、HFR升高,差异均有统计学意义(P<0.05);早、中、晚孕期两两比较IRF、MFR及HFR随着孕期明显升高,而LFR随着孕期明显降低,与孕早期比较,孕中、晚期Hb降低、RET%、RPI升高;与孕晚期比较,孕早、中期RET-He升高;与孕中期比较,孕早、晚期RBC-He降低,差异均有统计学意义(P<0.05);孕周与网织红细胞一些参数有相关性,相关系数由大到小依次为IRF>LFR>MFR>HFR>RET-He>RET%。结论正常妊娠妇女外周血网织红细胞随孕周的发展呈现不同程度的变化,加强对网织红细胞的分析并建立适当的妊娠期网织红细胞各参数的参考值范围有利于妇产科医生评估妊娠妇女孕期健康水平,对妊娠期疾病的诊断及鉴别具有一定的临床意义,可为妇产科的临床诊治提供有价值的参考。

Objective To investigate the changes of peripheral blood reticulocytes in normal pregnant women and establish a range of reference values.Methods The peripheral blood reticulocytes of 658 normal pregnant women and 100 normal non-pregnant women in Affiliated Haikou Hospital of Xiangya Medical College,Central South University from April 2018 to April 2019 were detected with automatic blood cell analyzer(Sysmex XN9000,Japan)to obtain the reticulocytes percentage(RET%),immature reticulocyte index(IRF),low fluorescence reticulocyte(LFR),medium fluorescent reticulocyte(MFR),high fluorescent reticulocyte(HFR),reticulocyte hemoglobin(RET-He),erythrocyte hemoglobin(RBC-He)and reticulocyte production index(RPI).The data were analyzed with SPSS 18.0 software and the reference ranges were determined by the 95%confidence interval.Results Compared with that of the mon-pregnant women,Hb and LFR decreased,RET%,IRF,MFR and HFR increased,and the differences were statistically significant(P<0.05);the pairwise comparison of IRF,MFR,and HFR during early,middle and late pregnancy increased significantly with pregnancy,while LFR decreased significantly with pregnancy.Compared with the first trimester,Hb decreased,RET%and RPI increased in the second and third trimester;RET-He increased in the early and second trimester compared with the third trimester;compared with the second trimester,the RBC-He decreased in the early and late trimester,the differences were statistically significant(P<0.05).There was correlation between the gestational age and some of the reticulocyte parameters with the correlation coefficients from large to small were IRF>LFR>MFR>HFR>RET-He>RET%.Conclusion The peripheral blood reticulocytes of normal pregnant women show varying degrees of change with the development of the gestational week.Strengthening the analysis of reticulocytes and establishing appropriate reference value ranges for the parameters of reticulocytes during pregnancy is helpful for obstetricians and gynecologists to evaluate the health level of pregnant women.It has certain clinical significance for the diagnosis and identification of pregnancy diseases,which can provide valuable reference for clinical diagnosis and treatment of obstetrics and gynecology.