直接测定红细胞平均血红蛋白含量在贫血诊断中的应用

The Direct Measurements of Red Cell Hemoglobin Concentration in the Anemia Diagnosis

目的探讨直接测定红细胞平均血红蛋白含量(celluarHb,CHb)在贫血诊断中的意义。方法通过全自动血液分析仪检测健康人群及不同类型贫血患者的CHb,并进行ROC曲线分析。结果CHb的正常参考范围是27.74～31.21pg;除了正常细胞均一性贫血患者的CHb与健康人群无显著性差异(P>0.05)外,下述四类贫血患者的CHb与健康人群均有极显著性差异(P<0.01):在大细胞均一性贫血诊断时,若以CHb>31.2pg为分界值,其敏感度0.94、特异性0.99、诊断效率0.97;在大细胞不均一性贫血诊断时,以CHb>31.2pg为分界值,其敏感度1.00、特异性0.99、诊断效率0.99;在诊断正常细胞不均一性贫血时,以CHb<29.4pg为分界值:敏感度0.62、特异性0.54、诊断效率0.57;在诊断小细胞性贫血时,以CHb<27.2pg为分界值,诊断敏感度1.00、特异性1.00、诊断效率1.00。结论直接测定能真实反映机体红细胞血红蛋白含量,结合合适的分界值,在各种贫血的诊断与鉴别诊断中,尤其是小细胞性贫血,CHb是一项理想的诊断指标,值得进一步推广应用。

Objectives To study the value of direct measurements of red cell hemoglobin concentration in the anemia diagnosis. Methods CHb were detected in the patient group confirmed with different types of anemia and compaired with the normal control group. The diagnostic evaluation were analyzed with ROC curve assay. Results The normal limits of CHb are 27.74～31.21pg. Except for the normal cell homogeneity, there is a significant difference in the CHb of different groups of anemia patient and that of the normal control group. The detail diagnostic evaluation were analyzed with ROC curve assay. Conclusions The direct measurement is a reliable method for the real cellular CHb detection. Combining with the reasonable cutoff value, the CHb is a valuable maker in diagnosing and differentiating different types of anemia, especially for the screening and diagnosing of microcytic anemia. It can be widely used in clinic pratice.