血液学筛查指标在不同年龄组地中海贫血的诊断价值评价

目的:用诊断性实验指标评价平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、红细胞体积分布宽度标准差(RDW-SD)在不同年龄人群地中海贫血(以下简称地贫)检测中的价值。方法:选择不同年龄筛查人群5 564例,疑似地贫患者1 166例,其中成人780例,儿童260例,新生儿126例,地贫基因成人确诊336例,儿童确诊110例,新生儿确诊21例,MCV、RDW-SD、MCH用SYSMEX SF-3000检测,α、β地贫基因诊断分别用GAP-PCR法和PCR结合反向斑点杂交法(RDB)法。应用诊断性实验指标,以基因诊断结果为金标准,对以上几项血液学参数在不同年龄组对地中海贫血的诊断价值进行分析。结果:①在判断地贫时,MCV、MCH、RDW-SD ROC曲线下面(AUCROC)在成人组分别为0.917、0.895、0.869;在儿童组分别为0.965、0.956、0.778;在新生儿组分别为0.873、0.806、0.774;②MCV、MCH、RDW-SD判断地贫最佳临界值在成人组分别为75.45 fl,23.65 pg,36.76 fl;儿童组分别为68.95 fl,21.70 pg,33.75 fl;新生儿组分别为96.30 fl,32.85 pg,55.45 fl。③MCV,MCH,RDW-SD判断地贫阴性预测值在成人组分别为99.3%、99.2%、97.5%;儿童组分别为99.5%、99.3%、97.0%;新生儿组分别为99.0%,99.4%、99.0%。阳性似然比成人组分别为15.1,11.0,9.53;儿童组分别为17.3、17.2、13.8;新生儿组分别为16.3、20.8、13.5。阴性似然比成人组分别为0.08、0.10、0.28;儿童组分别为0.06、0.12、0.35;新生儿组分别为0.31、0.20、0.30。结论:①MCV,MCH,RDW-SD对不同年龄组地贫的诊断价值均较高,其中MCV诊断价值最大;②在诊断地贫时,新生儿,儿童,成人MCV、MCH、RDW-SD最佳临界值明显不同。

Evaluation of value of hematological parameters in diagnosis of thalassemia in different age groups

Objective:To evaluate the values of mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH) and standard deviation of red blood cell volume distribution width(RDW-SD) in detection of thalassemia in different age groups by diagnostic laboratory parameters.Methods:5 564 cases in different age groups were selected,and 1 166 cases were suspected of thalassemia,including 780 adults,260 children and 126 neonates;336 adults,110 children and 21 children were diagnosed as thalassemia definitely by gene diagnos...