小红细胞贫血因子和低血红蛋白密度在献血人群铁缺乏中的诊断价值

Utility of microcytic anemia factor and low hemoglobin density in the diagnosis of iron deficiency in blood donors

目的探讨新红细胞参数小红细胞贫血因子(MAF)和低血红蛋白密度(LHD%)在筛查献血人群铁缺乏中的诊断价值。方法采用分层抽样,按照性别不同随机抽取2022年1月1日至2月28日在福建省血液中心进行单采血小板捐献的400名献血者,年龄36(28,46)岁,其中男女各200名。根据《血液病诊断及疗效标准》第4版,将其分为健康组299例,储铁缺乏(ID)组54例和缺铁性红细胞生成(IDE)组47例,检测血常规指标血红蛋白(HGB)、平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)和铁代谢指标血清铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)、转铁蛋白饱和度(TS)、不饱和铁结合力(UIBC),并通过公式计算MAF和LHD%。单因素方差分析或Kruskal-Wallis H检验分析健康组、ID组和IDE组指标之间的差异,Spearman法评估MAF和LHD%与铁代谢指标的相关性,采用受试者操作特征(ROC)曲线评价MCH、MCHC、MAF和LHD%对献血者铁缺乏的诊断价值。结果ID组的MAF为11.81±0.81,高于IDE组的10.69±0.95,低于健康组的13.17±1.24,3组比较差异具有统计学意义(F=110.784,P<0.001),组间两两比较差异均具有统计学意义(P<0.01);ID组的LHD%为2.61(1.87,3.91)%,低于IDE组的5.60(2.99,8.02)%,高于健康组的1.74(1.22,2.73)%,3组比较差异具有统计学意义(H=62.166,P<0.001),组间两两比较差异均具有统计学意义(P<0.01)。Spearman相关性分析显示,101例铁缺乏组中,MAF与SF、SI和TS呈正相关(r=0.426,P<0.01;r=0.547,P<0.01;r=0.566,P<0.01),LHD%与SF、SI和TS呈负相关(r=-0.397,P<0.01;r=-0.400,P<0.01;r=-0.479,P<0.01)。MCH、MCHC、MAF和LHD%诊断ID的ROC曲线下面积分别是0.745、0.646、0.819和0.646,此时当MAF临界值取12.56,敏感度为67.90%,特异度为83.30%;各对应指标诊断IDE的ROC曲线下面积分别是0.901、0.834、0.941和0.834,此时当MAF临界值取11.73,敏感度为87.60%,特异度为87.20%。结论MAF对铁缺乏尤其是IDE具有较高的诊断价值,可作为无偿献血者铁缺乏的筛查指标。

Objective The study was planned to evaluate the clinical utility of microcytic anemia factor(MAF)and low hemoglobin density(LHD%)in the screening of iron deficiency in blood donors.Methods A total of 400 blood donors,200 male and 200 female,were randomly admitted to Fujian Blood Center from January1,2022 to February 28,2022 by the way of stratified sampling.According to the fourth edition of Diagnostic and therapeutic criteria for hematological diseases,the patients were divided into three groups:normal group(N=299),iron depletion group(ID,n=54)and iron deficient erythropoiesis group(IDE,n=47),Blood routine indexes including hemoglobin(HGB),mean corpuscular volume hemoglobin(MCV),mean corpuscular hemoglobin content(MCH),mean corpuscular hemoglobin concentration(MCHC)and iron metabolism indexes including serum ferritin(SF),serum iron(SI),total iron binding capacity(TIBC),transferrin saturation(TS)and unsaturated iron binding capacity(UIBC)were measured,MAF and LHD%were calculated by formula.One-way ANOVA or Kruskal-Wallis H tests were used to analyze the differences among three groups.Spearman correlation analysis was used to analyze the correlation between MAF and LHD%and iron metabolism indexes.The Receiver Operating Characteristic(ROC)curve was used to evaluated the diagnostic value of MCH,MCHC,MAF and LHD%for iron deficiency in blood donors.Results MAF in ID group which was 11.81±0.81 were higher than the IDE group which was 10.69±0.95 and lower than the healthy group which was 13.17±1.24,the total difference among the three groups was statistically significant(F=110.784,P<0.001),the difference between two groups was statistically significant(P<0.01);LHD%in ID group which was 2.61(1.87,3.91)%were lower than the IDE group which was5.60(2.99,8.02)%and higher than the healthy group which was1.74(1.22,2.73)%,the total difference among the three groups was statistically significant(H=62.166,P<0.001),the difference between two groups was statistically significant(P<0.01).In 101 iron deficiency blood donors,Spearman correlation analysis showed that MAF was positively correlated with SF,SI and TS(r=0.426,P<0.01;r=0.547,P<0.01;r=0.566,P<0.01);contrarily,LHD%was negatively correlated with SF,SI and TS(r=-0.397,P<0.01;r=-0.400,P<0.01;r=-0.479,P<0.01).The areas under the ROC curve of MCH,MCHC,MAF and LHD%diagnostic ID were 0.745,0.646,0.819 and 0.646,respectively;the cut-off value of MAF was 12.56,with a sensitivity of 67.90%and a specificity of 83.30%.While the areas under the ROC curve of MCH,MCHC,MAF and LHD%diagnostic IDE were 0.901,0.834,0.941 and 0.834,respectively;the cut-off value of MAF was 11.73,with a sensitivity of 87.60%and a specificity of 87.20%.Conclusions MAF performed a high diagnostic value of iron deficiency,especially IDE,and can be used as a marker in the diagnosis of iron deficiency in blood donors.