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MCV/RDW结合网织红细胞参数在多种贫血中的鉴别诊断作用 被引量:21

Value of MCV/RDW Combined with Reticulocyte Parameters in Differential Diagnosis of Anemia Diseases
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摘要 目的:评价红细胞平均体积/红细胞分布宽度(MCV/RDW)与网织红细胞参数在再生障碍性贫血(AA)、MDS、巨幼红细胞性贫血(MA)和溶血性贫血(HA)鉴别诊断中的意义,旨在为临床初诊这些疾病提供一定的参考方向。方法:回顾性收集四川大学华西医院2012年1月1日到2014年8月31日确诊的住院和门诊的AA、MDS、MA和HA患者的MCV/RDW和网织红细胞参数数据;同时,收集158例年龄、性别相匹配的健康体检对象作为对照组。评价MCV/RDW和网织红细胞参数在4种贫血性疾病鉴别诊断中的意义;利用ROC曲线分析,确定MCV/RDW和网织红细胞参数在AA和MDS鉴别诊断中的最佳临界值。结果:AA患者158例(急性AA 79例,慢性AA79例),MDS患者107例,MA患者13例和HA患者81例。4种贫血性疾病的MCV/RDW与正常对照组相比,都有不同程度增高,差异具有统计学意义;急性AA患者MCV/RDW明显低于其他3组,且差异有统计学意义。在4种疾病中,急性AA的网织红细胞绝对计数(Ret#)最低,慢性AA、MA和MDS次之,HA最高;与正常对照组相比,4种贫血性疾病的低荧光强度网织红细胞比率(LRF)有不同程度降低,中和高荧光强度网织红细胞比率(MFR和HFR)有不同程度增加,差异具有统计学意义。在慢性AA和MDS的鉴别诊断中,采用ROC曲线分析得出:RDWSD在慢性AA和MDS的鉴别诊断中具有统计学意义(AUCRDW-SD=0.76,P<0.01)。RDW-SD的最佳临界值为:22.75fl;以最佳临界值分析,敏感度和特异度分别为49.5%和98.7%。结论:MCV/RDW和网织红细胞参数可以作为AA、MDS、MA和HA的初步鉴别诊断指标之一。 Objective:To evaluate the value of mean corpuscular volume/RBC distribution width(MCV/RDW)combined with reticulocyte parameters in differential diagnosis of aplastic anemia(AA),myelodysplastic syndrome(MDS),megaloblastic anemia(MA) and hemolytic anemia(HA) in order to provide some laboratorial evidence for clinical doctors in first diagnosis of these diseases.Methods:The data of MCV/RDW and reticulocyte parameters of AA,MDS,MA and HA patients from January 1 of 2011 to August 31 of 2014 were retrospectively collected in West China Hospital of Sichuan University.And 158 healthy unrelated individuals with age-,sex,matched were collected as controls.The value of MCV/RDW and reticulocyte parameters in differentiating diagnosis of above mentioned 4 kinds of anemia diseases was assessed.ROC analysis was used to determine the cutoff value of MCV/RDW and the reticulocyte parameters were performed in differentiating diagnosis of AA and MDS.Results:The average values of MCV/RDW of158 AA patients(79 acute AA patients and 79 chronic AA patients),107 MDS patients,13 MA patients and 81 HA patients increased in variable degrees as compared with the controls,and there was statistical difference between them,the MCV/RDW value of acute AA patients was obviously less than that of other patients.In the 4 kinds of anemia diseases,the reticulocyte absolute count in acute AA patients was the lowest,that of chronic AA,MA and MDS patients was higher,and that of HA patients was highest.The ratio of low fluorescent reticulocyte decreased,and the ratio of moderate and high fluorescent reticulocytes increased in the 4 kinds of anemia diseases,as compared to controls.The difference was statistically significant.The analysis of differential diagnosis of chronic AA and MDS showed that RDWSD could differentiate the chronic AA from MDS.The area under the curve(AUC) of RDW-SD was 0.76(P <0.01).The cutoff value of RDW-SD was 22.75 fl.The sensitivity and specificity of RDW-SD for differential of chronic AA and MDS was 49.5%and 98.7%,respectively.Conclusion:MCV/RDW and reticulocyte parameters can be used as the laboratorial differential diagnostic indicators for AA,MDS,MA and HA diseases.
出处 《中国实验血液学杂志》 CAS CSCD 北大核心 2015年第6期1662-1666,共5页 Journal of Experimental Hematology
基金 国家863课题(JH2013002)
关键词 再生障碍性贫血 MDS MCV/RDW 网织红细胞 aplastic anemia MDS MCV/RDW reticulocvte
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