吉林大学学报(医学版) ›› 2023, Vol. 49 ›› Issue (6): 1554-1560.doi: 10.13481/j.1671-587X.20230619

• 临床研究 • 上一篇    下一篇

贫血患者网织红细胞血红蛋白水平变化及其诊断价值

沈忠军1,谢世顺2,肖贺欣3,赵丽艳1()   

  1. 1.吉林大学第二医院输血科,吉林 长春 130041
    2.吉林大学药学院实验药理与毒理学教研室,吉林 长春 130021
    3.吉林大学第二医院检验科,吉林 长春 130041
  • 收稿日期:2022-12-06 出版日期:2023-11-28 发布日期:2023-12-22
  • 通讯作者: 赵丽艳 E-mail:zhaoliy@jlu.edu.cn
  • 作者简介:沈忠军(2000-),男,安徽省阜阳市人,在读硕士研究生,主要从事肿瘤和血栓形成机制方面的研究。
  • 基金资助:
    吉林省科技厅科技发展计划项目(20200801023GH)

Change of hemoglobin level in reticulocytes in patients with anemia and its diagnostic value

Zhongjun SHEN1,Shishun XIE2,Hexin XIAO3,Liyan ZHAO1()   

  1. 1.Department of Blood Transfusion, Second Hospital, Jilin University, Changchun 130041, China
    2.Department of Experimental Pharmacology and Toxicology, School of Pharmacy, Jilin University, Changchun 130021, China
    3.Department of Clinical Laboratory, Second Hospital, Jilin University, Changchun 130041, China
  • Received:2022-12-06 Online:2023-11-28 Published:2023-12-22
  • Contact: Liyan ZHAO E-mail:zhaoliy@jlu.edu.cn

摘要:

目的 探讨网织红细胞血红蛋白(RET-He)水平在不同程度和不同类型贫血患者中的变化,分析其对小细胞低色素性贫血的辅助诊断价值。 方法 收集369例贫血患者和40名健康体检者的临床资料,按照血红蛋白(Hb)水平将患者分为轻度贫血组125例、中度贫血组163例和重度贫血组81例,40名健康体检者作为对照组;按照贫血形态学类型分为大细胞性贫血组91例、正细胞性贫血组108例、单纯小细胞性贫血组23例和小细胞低色素性贫血组147例。检测各组研究对象红细胞计数、Hb水平、血细胞比容(HCT)、平均红细胞体积(MCV)、平均红细胞Hb水平(MCH)、平均红细胞Hb浓度(MCHC)和RET-He水平。绘制受试者工作特征(ROC)曲线并获取疾病诊断截断值,计算曲线下面积(AUC)、灵敏度和特异度。 结果 与对照组比较,中度贫血组和重度贫血组患者RET-He水平均明显降低(P<0.01);与轻度贫血组比较,中度和重度贫血组患者RET-He水平均明显降低(P<0.01)。大细胞性贫血、正细胞性贫血、单纯小细胞性贫血和小细胞低色素性贫血组患者RET-He水平呈逐渐降低趋势(P<0.01);与对照组比较,单纯小细胞性贫血组和小细胞低色素性贫血组患者RET-He水平均明显降低(P<0.01);与轻度大细胞性贫血组比较,轻度正细胞性贫血组、轻度单纯小细胞性贫血组和轻度小细胞低色素性贫血组患者RET-He水平均明显降低(P<0.01);与轻度正细胞性贫血组比较,轻度单纯小细胞性贫血组和轻度小细胞低色素性贫血组患者RET-He水平明显降低(P<0.01);与中度大细胞性贫血组比较,中度正细胞性贫血组、中度单纯小细胞性贫血组和中度小细胞低色素性贫血组患者RET-He水平明显降低(P<0.05或P<0.01);与中度正细胞性贫血组比较,中度小细胞低色素性贫血组患者RET-He水平明显降低(P<0.01);与重度大细胞性贫血组和重度正细胞性贫血组比较,重度小细胞低色素性贫血组患者RET-He水平均明显降低(P<0.01)。与中度单纯小细胞性贫血组比较,重度单纯小细胞性贫血组患者RET-He水平明显升高(P<0.01);与轻度小细胞低色素性贫血组比较,中度和重度小细胞低色素性贫血组患者RET-He水平均明显降低(P<0.01);与中度小细胞低色素性贫血组比较,重度小细胞低色素性贫血组患者RET-He水平明显降低(P<0.01)。RET-He水平诊断小细胞低色素性贫血的截断值为27.25 pg,灵敏度为91.2%,特异度为90.5%,AUC为0.968[95%置信区间(CI):0.952~0.984],提示RET-He水平可辅助诊断小细胞低色素性贫血。 结论 RET-He水平可以辅助诊断不同形态学类型和不同程度的贫血,对小细胞低色素性贫血的诊断具有一定临床应用价值。

关键词: 网织红细胞血红蛋白, 贫血, 血细胞比容, 受试者工作特征曲线, 血红蛋白

Abstract:

Objective To discuss the change of reticulocyte hemoglobin (RET-He) level of the anemic patients with different degrees and different types of anemia, and to analyze its auxiliary diagnostic value in microcytic hypochromic anemia. Methods The clinical data of 369 anemic patients and 40 healthy physical examination individuals were collected. The patients were divided into mild anemia group (125 cases), moderate anemia group (163 cases), and severe anemia group (81 cases) based on the hemoglobin (Hb) level,and 40 healthy physical examination individuals were regarded as control group. The patients were also divided into macrocytic anemia group (91 cases), normocytic anemia group (108 cases), simple microcytic anemia group (23 cases), and microcytic hypochromic anemia group (147 cases) based on the morphological types of anemia. The red blood cell count, Hb level, blood cell specific volume (HCT), mean red blood cell volume (MCV), mean red blood cell Hb level (MCH),mean red blood cell Hb concentration (MCHC), and RET-He level of the subjects in various groups were detected;the receiver operating characteristic (ROC) curve was drawn to obtain the diagnostic cutoff value for the disease; the area under curve (AUC), sensitivity, and specificity were calculated. Results Compared with control group, the RET-He levels of the patients in moderate and severe anemia groups were significantly decreased (P<0.01); compared with mild anemia group, the RET-He levels of the patients in moderate and severe anemia groups were significantly decreased(P<0.01). The RET-He levels of the patients in macrocytic anemia, normocytic anemia, simple microcytic anemia, and microcytic hypochromic anemia groups showed a decreasing trend (P<0.01); compared with control group, the RET-He levels of the patients in simple microcytic anemia and microcytic hypochromic anemia groups were significantly decreased (P<0.01); compared with mild macrocytic anemia group, the RET-He levels of the patients in mild normocytic anemia, mild simple microcytic anemia, and mild microcytic hypochromic anemia groups were significantly decreased (P<0.01). Compared with mild normocytic anemia group, the RET-He levels of the patients in mild simple microcytic anemia group and mild microcytic hypochromic anemia group were significantly decreased (P<0.01). Compared with moderate macrocytic anemia group, the RET-He levels of the patients in moderate normocytic anemia group, moderate microcytic anemia group, and moderate microcytic hypochromic anemia group were significantly decreased (P<0.05 or P<0.01);compared with moderate normocytic anemia group, the RET-He level of the patients in moderate microcytic hypochromic anemia group was significantly decreased (P<0.01); compared with severe macrocytic anemia group and severe normocytic anemia group, the RET-He level of the patients in severe microcytic hypochromic anemia group was significantly decreased (P<0.01);compared with moderate simple microcytic anemia group, the RET-He level of the patients in severe simple microcytic anemia group was significantly increased (P<0.01); compared with mild microcytic hypochromic anemia group, the RET-He levels of the patients in moderate microcytic hypochromic anemia group and severe microcytic hypochromic anemia group were significantly decreased (P<0.01);compared with moderate microcytic hypochromic anemia group, the RET-He level of the patients in severe microcytic hypochromic anemia was significantly decreased (P<0.01).The cutoff value of RET-He level for diagnosing microcytic hypochromic anemia was 27.25 pg, and the sensitivity was 91.2%, the specificity was 90.5%, and the AUC was 0.968[95% confidence interval (CI):0.952—0.984], suggesting that the RET-He level could make an auxiliary diagnosis for microcytic hypochromic anemia. Conclusion The RET-He level can assist in the diagnosis of anemia with different morphological types and degrees, and has certain clinical application value for the diagnosis of microcytic hypochromic anemia.

Key words: Reticulocyte hemoglobin, Anemia, Hematocrit, Receiver operating characteristic curve, Hemoglobin

中图分类号: 

  • R446