检验医学 ›› 2019, Vol. 34 ›› Issue (4): 318-321.DOI: 10.3969/j.issn.1673-8640.2019.04.006

• 临床应用研究·论著 • 上一篇    下一篇

HbA2筛查地中海贫血诊断界值的建立及其与MCV、MCH联合筛查的价值

陈雅斌, 蒋燕成, 陈紫萱, 杨伟, 张志珊   

  1. 福建医科大学附属泉州第一医院检验科,福建 泉州 362000
  • 收稿日期:2018-05-29 出版日期:2019-04-30 发布日期:2019-05-17
  • 作者简介:null
    作者简介:陈雅斌,女,1984年生,硕士,技师,主要从事临床检验和分子生物学诊断研究。

Diagnostic cut-off value of HbA2 for screening thalassemia and the combined determination of HbA2,MCV and MCH

CHEN Yabin, JIANG Yancheng, CHEN Zixuan, YANG Wei, ZHANG Zhishan   

  1. Department of Clinical Laboratory,Quanzhou First Affiliated Hospital of Fujian Medical University,Quanzhou 362000,Fujian,China
  • Received:2018-05-29 Online:2019-04-30 Published:2019-05-17

摘要:

目的 探讨血红蛋白(Hb)A2与红细胞平均体积(MCV)、平均红细胞血红蛋白含量(MCH)筛查方案在地中海贫血(简称地贫)筛查中的应用价值。方法 检测α-地贫、轻型β-地贫和体检健康者(健康对照组)HbA2水平,比较3组HbA2水平的变化。绘制受试者工作特征(ROC)曲线,评价HbA2筛查地贫的性能。另外选取322例疑似地贫患者,用于筛查方案的性能评价。结果 α-地贫组、轻型β-地贫组HbA2水平与健康对照组比较,差异有统计学意义(P<0.05)。静止型α-地贫组、标准型α-地贫组、中间型α-地贫组之间及与健康对照组之间HbA2水平差异均无统计学意义(P>0.05)。选用HbA2<3.05%及HbA2>3.90%分别作为筛查α-地贫及轻型β-地贫的诊断界值。MCV+MCH+HbA2地贫筛查方案的敏感性、特异性、阳性预测值、阴性预测值、符合率分别为76.33%、58.82%、67.19%、69.23%和68.10%。结论 MCV<82.1 fL和(或)MCH<27.3 pg联合HbA2<3.05%或HbA2>3.90%筛查方案在地贫筛查中具有较好的性能,可用于大规模人群筛查,对于疑似α-地贫患者的诊断需结合相关辅助检查,或直接进行地贫基因检测。

关键词: 血红蛋白A2, 地中海贫血, 受试者工作特征曲线

Abstract:

Objective To study the role of hemoglobin(Hb) A2,mean corpuscular volume(MCV) and mean corpuscular hemoglobin(MCH) combined determination scheme for screening thalassemia. Methods The HbA2 levels of α-thalassemia group,light β-thalassemia group and healthy subjects(healthy control group) were determined,and the results were analyzed comparatively. The efficiency of HbA2 for screening thalassemia was evaluated by receiver operating characteristic(ROC) curve. The performance of the scheme was evaluated through screening 322 clinical suspected cases of thalassemia. Results The HbA2levels in α-thalassemia group,light β-thalassemia group and healthy control group had statistical significance(P<0.05),but there was no statistical significance among stationary type,standard type and intermediate type α-thalassemia groups and healthy control group(P>0.05). The diagnostic cut-off values for screening α-thalassemia and light β-thalassemia were HbA2<3.05% and HbA2>3.90%,respectively. The sensitivity,specificity,positive predictive value,negative predictive value and consistency rate were 76.33%,58.82%,67.19%,69.23% and 68.10%,respectively. Conclusions The scheme,MCV<82.1 fL and(or) MCH<27.3 pg with HbA2<3.05% or HbA2>3.90%,has a good performance for screening thalassemia. It should carry on relevant auxiliary determination or detect thalassemia gene directly for suspected α-thalassemia patients.

Key words: Hemoglobin A2, Thalassemia, Receiver operating characteristic curve

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