红细胞参数及公式在遵义地区β地中海贫血和缺铁性贫血鉴别诊断中的效能评价

Evaluation of the efficacy of red blood cell parameters and formula betweenβ-thalassemia minor and iron deficiency anemia differential diagnosis in Zunyi area

目的探讨红细胞参数及公式在β-地中海贫血(β-thalassemia minor,β-TT)和缺铁性贫血(iron deficiency anemia,IDA)鉴别诊断中的效能,评价β-TT和IDA的11个鉴别公式在遵义地区的应用价值,并确定适用于本地区的最佳临界值。方法纳入2018年11月—2019年10月首次就诊于遵义市第一人民医院的213例β-TT和IDA患者,回顾分析2组患者血常规红细胞参数;计算每个鉴别公式的敏感度、特异性、阳性预测值、阴性预测值、约登指数及正确识别率;根据受试者工作曲线(receiver operating characteristic curve,ROC曲线)得出鉴别公式的最佳临界值(cut-off value)。结果β-TT组患者Hb、HCT、MCHC高于IDA组,差异均有统计学意义(P<0.05);MCV、RDW明显低于IDA组,差异均有统计学意义(P<0.05);2组患者的RBC差异无统计学意义(P>0.05)。RDW、Green and king公式(GK)和England and Fraser公式(EF)曲线下面积(AUC)分别为0.993,0.961和0.954,具有较好的鉴别性能,Shine and Lal公式(SL)和RBC的AUC分别为0.637和0.128,不适合作为本地区鉴别β-TT和IDA的公式。确定不同于原始值的新cut-off值为临界值。结论红细胞参数对鉴别诊断β-TT与IDA有较好的临床价值;RDW、GK和EF公式适合作为遵义地区β-TT和IDA患者的鉴别公式;新cut-off值可能更适合遵义地区鉴别β-TT和IDA。

Objective To know the value of red blood cell parameters in the diagnosis betweenβ-Thalassemia Minor(β-TT)and Iron Deficiency Anemia(IDA)and evaluating of the application of eleven discriminant formulas betweenβ-TT and IDA for getting the best cut-off value of Zunyi area.Methods 213 patients enrolled eitherβ-TT or IDA from November 2018 to October 2019 treated at the First People’s Hospital of Zunyi and retrospective analysis of the red blood cell parameters between two groups of patients.Calculating the sensitivity,specificity,positive predictive value,negative predictive value,Youden index and correctly identified cases to establish the best cut-off value of discriminant formula according to receiver operating characteristic curve(ROC).Results 1.Hb,HCT,MCH and MCHC ofβ-TT group are higher than IDA group,and the differences are statistically significant,P<0.05.MCV and RDW ofβ-TT group are lower than IDA group(P<0.01).And there is no statistically significant of Red blood cell count in both groups,P>0.05.2.The AUC of RDW,Greenking(GK)England and Fraser(EF)are 0.993,0.961 and0.954,respectively.They have better diagnostic performance.The AUC of Shine,Lal(SL)and RBC are 0.637 and 0.128,respectively,which are not suitable for the identification betweenβ-TT and IDA in Zunyi area.3.The new cut-off value more suitable for distinguishing the two diseases are different from the original one.Conclusion Red blood cell parameters have good clinical value in the diagnosis betweenβ-TT and IDA.The formulas of RDW,GK and EF are suitable for differentiatingβ-TT and IDA in Zunyi area.The new best cut-off values are more suitable for identificatingΒ-TT and IDA in Zunyi area.