红细胞参数对小儿轻型地贫及轻度缺铁性贫血的诊断价值

The value of red cell indices in diagnosis of the mild thalassemia and the mild iron deficiency anemia in children

目的总结小儿轻型地中海贫血(地贫)及轻度缺铁性贫血(IDA)血液学特征,评价红细胞参数对小儿轻型地贫及轻度IDA的诊断价值。方法选取2013年2月至2019年3月潮州市中心医院158例轻型地贫患儿为轻型地贫组,100例轻度IDA患儿为轻度IDA组,215例健康体检儿童为对照组。采用血球分析仪分析各组间红细胞参数:红细胞计数(RBC)、平均红细胞体积(MCV)、红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)及红细胞体积分布宽度(RDW-CV);采用PCR+导流杂交法行α和β地贫基因检测,通过受试者工作特征(ROC)曲线法确定各参数最佳筛查指标和截断值。结果RBC:轻型地贫组>对照组>轻度IDA组,差异有统计学意义(P<0.05);RDW-CV:轻型地贫组>轻度IDA组>对照组,差异有统计学意义(P<0.05);MCV、MCH:对照组>轻度IDA组>轻型地贫组,差异有统计学意义(P<0.05)。RBC曲线下面积(AUC)为84.7%,截断值为4.70×1012/L,RDW-CV AUC为74.6%,截断值为14.25%。结论小儿地贫和IDA红细胞参数分布特征及变化趋势各异,红细胞参数RBC及RDW-CV对小儿轻型地贫和轻度IDA具一定鉴别诊断价值。

Objective To summarize the hematological characteristics of children with mild thalassemia and mild iron deficiency anemia(IDA),and to evaluate the value of erythrocyte parameters in the differential diagnosis of children with mild thalassemia and mild IDA.Methods A total of 158 children with mild thalassemia in Chaozhou Central Hospital from February 2013 to March 2019 were selected as the mild thalassemia group,100 children with mild IDA as the mild IDA group,and 215 healthy children as the control group.RBC(red blood cell count),MCV(mean red blood cell volume),MCH(mean red blood cell hemoglobin),MCHC(mean red blood cell hemoglobin concentration)and RDW-CV(red blood cell volume distribution width)were analyzed by blood cell analyzer.PCR+diversion hybridization was used to detectαandβthalassemia genes.The optimal screening indexes and cut-off values of each parameter were determined by ROC curve method.Results RBC:mild thalassemia group>control group>mild IDA group;RDW-CV:mild thalassemia group>mild IDA group>control group;MCV and MCH:control group>mild IDA group>mild thalassemia group;There were statistically significant differences in RBC,RDW-CV,MCV and MCH among these three groups(P<0.05).The area under the curve(AUC)of RBC was 84.7%and the cut-off value was 4.70×1012/L,the AUC of RDW-CV was 74.6%and the cut-off value was 14.25%.Conclusion RBC and RDW-CV are valuable in the differential diagnosis of children with mild thalassemia and mild IDA.