四川自贡地区缺铁性贫血和β地中海贫血鉴别诊断公式的应用

doi:10.3969/j.issn.1673-8640.2017.09.011

摘要/Abstract

摘要：

目的评价缺铁性贫血（IDA）和β地中海贫血（β-TT）的鉴别诊断公式在四川自贡地区人群中的应用价值。方法选取760例来自四川自贡地区患者,其中β-TT 255例、IDA505例,应用红细胞（RBC）参数计算出10个鉴别公式（分别为Shine and Lal公式、Green and King公式、Mentzer公式、RDWI公式、Srivastava公式、Ricerca公式、England and Fraser公式、Ehsani公式、Sirdah公式和Huber-Herklotz公式）的敏感度（SEN）、特异度（SPE）、阳性预测值（PPV）、阴性预测值（NPV）、约登指数（YI）,并绘制受试者工作特征（ROC）曲线。结果 Mentzer公式的诊断价值最高,其YI最高（80.1%）,诊断IDA的SEN为97.0%,SPE为83.1%,曲线下面积（AUC）最高（0.971）;其次为RDWI公式,YI、SEN、SPE、AUC分别为72.8%、95.2%、77.6%、0.961。结论在四川自贡地区人群中Mentzer公式和RDWI公式具有较好的鉴别诊断IDA和β-TT的能力。

关键词: 缺铁性贫血, β, 地中海贫血, 鉴别诊断公式

Abstract:

Objective To evaluate discrimination formulas for the differential diagnosis of iron deficiency anemia（IDA） and beta thalassemia trait（β-TT） in Sichuan Zigong. Methods A total of 760 patients from Zigong were enrolled,including 255 cases of β-TT and 505 cases of IDA. Red blood cell（RBC） indices were used to calculate the sensitivities(SEN),specificities(SPE),positive predictive values(PPV),negative predictive values(NPV),and Youden's indices(YI) of 10 discrimination formulas,including Shine and Lal,Green and King,Mentzer,RDWI,Srivastava,Ricerca,England and Fraser,Ehsani,Sirdah and Huber-Herklotz. Receiver operating characteristic（ROC） curve was drawn. Results Mentzer was the most reliable index,as it had the highest YI（80.1%）,the SEN was 97.0%,the SPE was 83.1%,and area under curve（AUC） was 0.971. The YI,SEN,SPE and AUC for RDWI were 72.8%,95.2%,77.6% and 0.961,respectively.Conclusions Mentzer and RDWI can be used for the differential diagnosis fo IDA and β-TT.

Key words: Iron deficiency anemia, Beta thalassemia trait, Discrimination formula

中图分类号:

R446.1

章梁君, 陈章鑫, 钟辉秀. 四川自贡地区缺铁性贫血和β地中海贫血鉴别诊断公式的应用[J]. 检验医学, 2017, 32(9): 796-800.

Zigong ZHANG Liangjun, CHEN Zhangxin, ZHONG Huixiu. Discrimination formulas for the differential diagnosis of iron deficiency anemia and beta thalassemia trait in Sichuan[J]. Laboratory Medicine, 2017, 32(9): 796-800.

图/表 4

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名称	公式	判定标准
Shine and Lal 公式^[6]	MCV×MCV×MCH/100	β-TT<1 530 IDA >1 530
Green and King 公式^[7]	MCV×MCV×RDW／ Hb×l00	β-TT<72 IDA >72
Mentzer公式^[8]	MCV／RBC	β-TT<13 IDA >13
RDWI公式^[9]	MCV×RDW／RBC	β-TT<220 IDA >220
Srivastava公式^[10]	MCH／RBC	β-TT<3.8 IDA >3.8
Ricerca公式^[11]	RDW／RBC	β-TT<4.4 IDA >4.4
England and Fraser公式^[12]	MCV-5×Hb-RBC	β-TT<0 IDA >0
Ehsani公式^[13]	MCV-10×RBC	β-TT<15 IDA >15
Sirdah公式^[14]	MCV-RBC-3×Hb	β-TT<27 IDA >27
Huber-Herklotz 公式^[15]	MCH×RDW×0.1/ RBC+RDW	β-TT <21 IDA >21

名称	公式	判定标准
Shine and Lal 公式^[6]	MCV×MCV×MCH/100	β-TT<1 530 IDA >1 530
Green and King 公式^[7]	MCV×MCV×RDW／ Hb×l00	β-TT<72 IDA >72
Mentzer公式^[8]	MCV／RBC	β-TT<13 IDA >13
RDWI公式^[9]	MCV×RDW／RBC	β-TT<220 IDA >220
Srivastava公式^[10]	MCH／RBC	β-TT<3.8 IDA >3.8
Ricerca公式^[11]	RDW／RBC	β-TT<4.4 IDA >4.4
England and Fraser公式^[12]	MCV-5×Hb-RBC	β-TT<0 IDA >0
Ehsani公式^[13]	MCV-10×RBC	β-TT<15 IDA >15
Sirdah公式^[14]	MCV-RBC-3×Hb	β-TT<27 IDA >27
Huber-Herklotz 公式^[15]	MCH×RDW×0.1/ RBC+RDW	β-TT <21 IDA >21

组别	例数	RBC（×10¹²/L）	Hb（g/L）	HCT（%）	MCV（fL）	MCH（pg）	MCHC（g/L）	RDW（%）
IDA组	505	3.50±0.95	8.03±2.74	26.67±7.37	75.05±5.93	22.64±4.57	291.64±24.13	18.40±3.22
β-TT组	255	5.94±0.78	10.58±1.72	40.98±5.31	68.91±3.68	21.18±1.45	306.71±11.62	16.76±1.55
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	RBC（×10¹²/L）	Hb（g/L）	HCT（%）	MCV（fL）	MCH（pg）	MCHC（g/L）	RDW（%）
IDA组	505	3.50±0.95	8.03±2.74	26.67±7.37	75.05±5.93	22.64±4.57	291.64±24.13	18.40±3.22
β-TT组	255	5.94±0.78	10.58±1.72	40.98±5.31	68.91±3.68	21.18±1.45	306.71±11.62	16.76±1.55
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

公式	SEN（%）	SPE（%）	PPV（%）	NPV（%）	YI（%）	AUC
Shine and Lal
IDA	38.4	100.0	100.0	45.0	38.4	0.677
β-TT	100.0	38.4	45.0	100.0	38.4	0.677
Green and King
IDA	97.4	67.1	85.4	92.9	64.5	0.958
β-TT	67.1	97.4	92.9	85.4	64.5	0.958
Mentzer
IDA	97.0	83.1	91.9	93.3	80.1	0.971
β-TT	83.1	97.0	93.3	91.9	80.1	0.971
RDWI
IDA	95.2	77.6	89.4	89.1	72.8	0.961
β-TT	77.6	95.2	89.1	89.4	72.8	0.961
Srivastava
IDA	92.9	69.0	85.6	83.1	61.9	0.935
β-TT	69.0	92.9	83.1	85.6	61.9	0.935
Ricerca
IDA	72.5	98.0	98.6	64.3	70.5	0.953
β-TT	98.0	72.5	64.3	98.6	70.5	0.953
England and Fraser
IDA	98.4	50.2	79.6	94.1	48.6	0.965
β-TT	50.2	98.4	94.1	79.6	48.6	0.965
Ehsani
IDA	95.4	74.9	88.3	89.2	70.3	0.955
β-TT	74.9	95.4	89.2	88.3	70.3	0.955
Sirdah
IDA	97.8	65.9	85.0	93.8	63.9	0.962
β-TT	65.9	97.8	93.8	85.0	63.9	0.962
Huber-Herklotz
IDA	97.0	19.2	70.4	76.4	16.2	0.908
β-TT	19.2	97.0	76.4	70.4	16.2	0.908