广州和佛山地区珠蛋白生成障碍性贫血患者红细胞参数方程的多中心研究

A multicenter study of the erythrocyte parameter equation in patients with dysglobinogenic anemia in Guangzhou and Foshan

目的 建立鉴别和筛查广州和佛山地区珠蛋白生成障碍性贫血患者的红细胞参数方程,评估其鉴别和筛查效能。方法 收集2017-2021年在广东广州和佛山三家医院就诊的珠蛋白生成障碍性贫血患者3026例作为珠蛋白生成障碍性贫血组,缺铁性贫血(IDA)患者1044例作为IDA组,门诊普通患者和体检者14638例作为对照组。检测所有受试者的红细胞计数(RBC)、红细胞分布宽度(RDW)、血红蛋白(Hb)、血细胞比容(HCT)、红细胞平均体积(MCV)、红细胞平均血红蛋白(MCH)、红细胞平均血红蛋白浓度(MCHC)。采用多因素Logistic回归分析建立珠蛋白生成障碍性贫血-IDA的鉴别方程(简称GF),计算GF用于鉴别珠蛋白生成障碍性贫血和IDA的准确度、灵敏度和特异度;采用整体鉴别指数(IDI)和净重新分类指数(NRI)指标评价其鉴别效能。采用多因素Logistic回归分析建立珠蛋白生成障碍性贫血-IDA的筛查方程(简称STF),计算STF作为珠蛋白生成障碍性贫血筛查指标时的各种性能指标。结果 拟合的鉴别方程为GF=0.291×MCH-0.135×MCV+0.985×RBC+0.13×RDW+0.491×MCHC。该方程鉴别珠蛋白生成障碍性贫血的最佳临界值为18.73,约登指数为0.597,曲线下面积(AUC)为0.874,与其他文献方程之间的差异有统计学意义(P<0.05),GF的IDI和NRI值均大于其他方程。拟合的筛选方程为STF=5.034×RBC+0.21×Hb+0.187×MCV+0.088×RDW-0.144×MCH-0.062×MCHC-60.2337×HCT,该方程筛查珠蛋白生成障碍性贫血的AUC为0.876,阴性预测值为96.64%。结论 在广州和佛山地区,相比于其他文献的鉴别方程,GF鉴别珠蛋白生成障碍性贫血和IDA的效果更好。STF用于筛查珠蛋白生成障碍性贫血时,漏诊率较低,可作为广州和佛山地区珠蛋白生成障碍性贫血初筛指标。

Objective To establish an erythrocyte parameter equation for the identification and screening of patients with dysglobinogenic anemia in Guangzhou and Foshan,and to evaluate its identification and screening efficiency.Methods A total of 3026 patients with thalassemia from 2017 to 2021 in three hospitals in Guangzhou and Foshan were collected as the thalassemia group,1044 patients with iron deficiency anemia(IDA)as the IDA group,and 14638 outpatient general pattents and examiners served as the control group.The red blood cell count(RBC),red blood cell distribution width(RDW),hemoglobin(Hb),hematocrit(HCT)mean red blood cell volume(MCV),mean red blood cell hemoglobin(MCH)and mean red blood cell hemoglobin concentration(MCHC)of all subjects were detected.Multivariate Logistic regression analysis was used to establish the differential equation of thalassemia-IDA(referred to as GF).Accuracy,sensitivity,and specificity of calculated GF for differentiating thalassemia from IDA.The overall identification index(IDI)and net reclassification index(NRI)were used to evaluate the identification performance.Multivariate Logistic regression analysis was used to establish the screening equation of thalassemia-IDA(referred to as STF),and various performance indicators of STF as a screening index for thalassemia were calculated.Results The fitted discriminant equation was GF=0.291×MCH-0.135×MCV+0.985×RBC+0.13×RDW+0.491×MCHC.The optimal critical value of this equation to identify thalassemia was 18.73,Youden′s index was 0.597,and the area under the curve(AUC)was 0.874,which was significantly different from other equations in literature(P<0.05),the IDI and NRI values of GF were larger than those of the other equations.The fitted screening equation was STF=5.034×RBC+0.21×Hb+0.187×MCV+0.088×RDW-0.144×MCH-0.062×MCHC-60.2337×HCT,the AUC of this equation for screening thalassemia was 0.876,and the negative predictive value was 96.64%.Conclusion In Guangzhou and Foshan,GF is more effective in distinguishing thalassemia and IDA than other literatures.When STF is used to screen thalassemia,the missed diagnosis rate is low,and it can be used as a primary screening index for thalassemia in Guangzhou and Foshan.