血清铁蛋白在儿童嗜血细胞综合征诊断中应用价值

Ferritin in the diagnosis of hemophagocytic lymphohistiocytosis in children

目的检测儿童嗜血细胞综合征(hemophagocytic lymphohistiocytosis,HLH)和非HLH患儿血清铁蛋白水平,探讨血清铁蛋白对儿童HLH的诊断价值。方法血清铁蛋白≥500μg/L的患儿409例,其中HLH患儿58例为HLH组,非HLH患儿351例为非HLH组,记录患儿临床检测结果。采用化学发光微粒子免疫检测技术检测患儿血清铁蛋白水平;绘制ROC曲线,分析血清铁蛋白在儿童HLH诊断中的最佳截断值。结果HLH组患儿年龄大于非HLH组(P<0.05),血清D-二聚体、三酰甘油水平高于非HLH组(P<0.05),白细胞计数、中性粒细胞计数、淋巴细胞计数、血小板计数、纤维蛋白原和总蛋白水平均低于非HLH组(P<0.05)。HLH组患儿血清铁蛋白水平[9854.00(4760.00,40000.00)μg/L]明显高于非HLH组[1222.00(701.40,2891.00)μg/L](P<0.05);血清铁蛋白诊断儿童HLH的最佳截断值为4427.00μg/L,灵敏度为75.86%,特异度为88.03%,AUC为0.88(95%CI:0.82~0.93,P<0.001)。结论与原有诊断标准(血清铁蛋白≥500μg/L)相比,较高的铁蛋白临界值(4427.00μg/L)对儿童HLH诊断有更高的特异度。

Objective To detect the level of serum ferritin in children with hemophagocytic lymphohistiocytosis(HLH)and to investigate the value of serum ferritin level to the diagnosis of HLH in children.Methods Totally 409 children with serum ferritin value≥500μg/L were divided into HLH group(n=58)and non-HLH group(n=351).The clinical laboratory examination results were recorded.Chemiluminescence microparticle immunoassay was used to detect the level of serum ferritin.ROC was drawn to analyze the optimal cut-off value of serum ferritin to the diagnosis of HLH in children.Results The children were older,and the levels of D-Dimer and triacylglycerol were higher in HLH group than those in non-HLH group(P<0.05).The white blood cell count,neutrophil count,lymphocyte count,platelet count,fibrinogen and total protein were significantly lower in HLH group than those in non-HLH group(P<0.05).The serum ferritin level was higher in HLH group(9854.00(4760.00,40000.00)μg/L)than that in non-HLH group(1222.00(701.40,2891.00)μg/L)(P<0.05).When the optimal cut-off value of serum ferritin was 4427.00μg/L,the AUC for diagnosing HLH in children was 0.88(95%CI:0.82-0.93,P<0.001),the sensitivity was 75.86%and the specificity was 88.03%.Conclusion Compared with the original diagnostic standard(≥500μg/L),the cut-off value of serum ferritin level of 4427.00μg/L has higher specificity in the diagnosis of HLH in children.