肿瘤相关慢性炎症性贫血和肿瘤相关缺铁性贫血红细胞相关参数及铁代谢指标的比较

Comparison of red blood cell and iron metabolism parameters between cancer related anemia of chronic disease and cancer related anemia of iron deficiency

目的:分析与比较肿瘤相关慢性炎症性贫血(CRA-ACD)和肿瘤相关缺铁性贫血(CRA-IDA)红细胞相关参数及铁代谢指标,以明确两种贫血的临床特征并探讨红细胞相关参数及铁代谢指标在两者鉴别诊断中的意义。方法:选取初治确诊14例CRA-IDA及16例CRA-ACD患儿进行红细胞参数[平均红细胞容积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)]和铁代谢指标[血清铁(SI)、总铁结合力(TIBC)、转铁蛋白饱和度(TS)与血清铁蛋白(SF)]检测,并与20例同期健康对照组比较,对结果进行统计学分析。结果:两个研究组MCV[CRA-IDA组(77.53±6.78)fL,CRA-ACD组(80.12±4.83)fL]均小于对照组(90.01±2.90)fL],差异均有统计学意义(P<0.01);且CRA-IDA组小于CRA-ACD组,差异有统计学意义(P<0.05)。两个研究组的MCH、MCHC、SI、TS及TIBC均低于对照组,差异有统计学意义(P<0.01)。两个研究组SF含量均高于对照组,差异有统计学意义(P<0.01);组间比较差异无统计学意义(P>0.05)。两组MCV、SI、TS及TIBC异常率均相当,差异无统计学意义(P>0.05)。CRA-IDA组有7例、CRA-ACD组有11例SF高于200μg/L,差异有统计学意义(P<0.05);CRA-ACD组全部高于30μg/L,而CRA-IDA组仅5例低于30μg/L,差异无统计学意义(P>0.05)。结论:本研究CRA-IDA和CRA-ACD的红细胞参数(MCV下降)及常规铁代谢指标(SI、TS和TIBC下降,SF升高)相似,故不能简单地采用上述指标对CRA进行病因分析,需寻找新的生物学指标更好地鉴别CRA-IDA和CRA-ACD。

Objective:To analyze and compare the parameters of red blood cell(RBC)and iron metabolism in the children with cancer related anemia of chronic disease(CRA-ACD)and cancer related iron-deficiency anemia(CRA-IDA),in order to make clear the features of two kinds of anemia and the significance of the parameters of iron metabolisms and RBC in the differential diagnosis.Methods:A total of 14 cases of CRA-IDA and 16 cases of CRA-ACD were selected,and another 20 healthy children were enrolled into the control group.The RBC parameters(MCV,MCH,and MCHC)and iron metabolism parameters(SI,TIBC,TS,and SF)were detected and compared between the three groups.Results:MCV in CRA-IDA group([77.53±6.78]fL)and CRA-ACD group([80.12±4.83]fL)was smaller than that in control group([90.01±2.90]fL)(P<0.01).MCH,MCHC,SI,TS,and TIBC in CRA-IDA group and CRA-ACD group were lower than in control group(P<0.01).SF in CRA-IDA group and CRA-ACD group was higher than that in control group(P<0.01),but the above parameters showed no significance difference between CRA-IDA group and CRA-ACD group(P>0.05).The abnormal rates of MCV,SI,TS,and TIBC were similar in the two groups(P>0.05).SF value of 7 cases in CRA-IDA group and 11 cases in CRA-ACD group were higher than 200μg/L(P<0.05).None of the CRA-ACD group had an SF level lower than 30μg/L,and only 5 cases of CRA-IDA group were found with low SF level(P>0.05).Conclusion:The clinical manifestations of CRA-IDA and CRA-ACD are similar in this study.Red blood cell parameters such as MCV,SI,TS,and TIBC could not be simply used to analyze the etiology of CRA,and novel biological indicators should be found to identify the CRA-IDA and CRA-ACD.