网织红细胞参数对遗传性球形红细胞增多症筛查价值

Screening value of reticulocyte parameters in hereditary spherocytosis

目的探讨各红细胞和网织红细胞参数对遗传性球形红细胞增多症(HS)的筛查诊断价值。方法收集本院2010年1月—2021年12月确诊的HS患者41例,设为HS组,同时收集40例自身免疫性溶血性贫血(AIHA)患者设为AIHA组,50例地中海贫血(THAL)患者设为THAL组,另选取50例健康体检者为正常对照组。运用t检验比较各组各血细胞参数之间的差异,并采用受试者工作特征(ROC)曲线分析各红细胞参数和网织红细胞参数对HS的筛查诊断价值。结果HS组平均红细胞体积(MCV)、平均网织红细胞体积(MRV)、平均球形红细胞体积(MSCV)明显低于AIHA组,而平均血红蛋白浓度(MCHC)则明显高于AIHA组(均P<0.05)。HS组MCV、MRV、MSCV均低于正常对照组,MCHC、Ret百分率则明显高于正常对照组,差异有统计学意义(均P<0.05)。HS组和THAL组比较,除Hb外,其余参数差异均有统计学意义(P<0.05)。HS组MSCV低于MCV,而THAL组MSCV高于MCV。HS组MSCV-MCV与其他3组比较差异均有统计学意义(P<0.05)。ROC曲线分析发现MCHC诊断HS的最佳截断值为338.5 g/L,其灵敏度、特异性分别为94.6%和73.7%;MRV最佳截断值为97.1 fL,其灵敏度为91.9%,特异性为86.9%,MSCV-MCV最佳截断值为-3.4 fL,其灵敏度、特异性为94.6%、89.4%。MRV联合MCHC、MRV联合MSCV-MCV ROC曲线下面积(AUC)分别为0.978、0.988,均大于MCHC、MRV、MSCV-MCV任一指标的AUC。结论MCHC、MRV、MSCV、MSCV-MCV等指标对于HS的鉴别诊断具有重要的参考价值。MCHC不是筛查诊断HS的理想指标,MRV和MSCV-MCV具有较高的预测价值,而联合指标筛查诊断价值要优于单一指标。

Objective To investigate the screening and diagnostic values of the parameters of erythrocyte and reticulocyte for hereditary spherocytosis.Methods A total of 41 patients with HS diagnosed in our hospital from January 2010 to December 2021 were selected.T test was used to compare the differences of HS group with autoimmune hemolytic anemia(AIHA)group,thalassemia(THAL)group and normal control group.Receiver Operator Characteristic(ROC)curve was used to analyze the screening and diagnostic values of the parameters of erythrocyte and reticulocyte for HS.Results MCV,MRV,MSCV and MSCV-MCV in HS group were significantly lower than those in AIHA group(P<0.05),while MCHC was significantly higher than that in AIHA group(P<0.05).ROC curve analysis showed that the cut-off value of MCHC for HS diagnosis was 338.5g/L,with the sensitivity of 94.6%and specificity of 73.7%.The cut-off value of MRV was 97.1fL,with the sensitivity of 91.9%and specificity of 86.9%.The cut-off value of MSCV-MCV was-3.4fL,with the sensitivity of 94.6%and specificity 89.4%.The area under the curve(AUC)of MRV combined with MCHC and MRV combined with MSCV-MCV were 0.978 and 0.988,respectively,which were greater than the AUC of any index of MCHC,MRV and MSCV-MCV.Conclusion MCHC,MRV,MSCV and MSCV-MCV have important reference values for the differential diagnosis of HS.MCHC is not an ideal indicator for screening and diagnosis of HS while MRV and MSCV-MCV have higher predictive values,and the combination of two of them is more effective than the single indicator.