RBC、Ret-He与HbA2联合检测对地中海贫血的临床价值

目的:探讨小细胞或低色素人群中Ret-He和RBC在地中海贫血中的分布情况及联合HbA2对地中海贫血检测的价值。方法:选取本院2018年5月-2019年12月门诊检测出或住院的小细胞或低色素患者145例,将其分为地贫组(68例)及非地贫组(77例),并同时按贫血程度将患者分为非贫血、轻度贫血、中度贫血及重度贫血共4组,对患者进行Ret-He、RBC、RDW-CV及HbA2检测,比较各项参数的分布情况,并分析RBC、Ret-He与HbA2联合检测以辅助诊断地中海贫血的灵敏度特异度。结果:在小细胞或低色素患者中,根据贫血程度分级,Ret-He从非贫血组至重度贫血组逐渐下降(P<0.05);而RDW-CV则从轻度贫血组至重度贫血组逐渐上升(P<0.05);RBC及Ret-He在地贫组患者中均较非地贫组明显升高(P<0.05),而RDW-CV则在地贫组中较非地贫组明显降低(P<0.05);同时Ret-He在α-地贫中较β-地贫明显升高(P<0.05)。进行ROC曲线分析,Ret-He以19.25 pg为截断值,RBC以4.95×10^12/L为截断值时,联合HbA2,特异度为93.51%,灵敏度为66.18%,阳性预测值为90%,阴性预测值为75.189%。结论:在小细胞或低色素患者中,RBC、Ret-He及RDW-CV在地贫组及非地贫组的分布存在差异,并受贫血程度影响。加入Ret-He及RBC可提高小细胞或低色素患者依靠HbA2进行地中海贫血初筛时的特异度。

The Clinical Value of Combined Detection of RBC,Ret-He and HbA2 for Thalassemia

Objective:To investigate the distribution of Ret-He and RBC in thalassemia and the value of combining HbA2 in the detection of thalassemia among patients with microcytic or hypochromic.Methods:145 patients with microcytic or hypochromic outpatient or hospitalization in our hospital from May 2018 to December 2019 were selected and were divided into the thalassemia group(68 cases)and the non-thalassemia group(77 cases),and at the same time,the patients were divided into four groups of the non-anemia,mild anemia,moderate anemia and severe anemia group according to the degree of anemia.The Ret-He,RBC,RDW-CV and HbA2 in patients were detected,and the distribution of these parameters were compared,and the joint detection of Ret-He,RBC and HbA2 about its sensitivity,specific and other indicators of auxiliary diagnosis of thalassemia were analyzed.Results:Among patients with microcytic or hypochromic,according to the anemia grade Ret-He gradually decreased from the non-anemia group to the severe anemia group(P<0.05);while RDW-CV was increased gradually from the mild anemia group to the severe anemia group(P<0.05);both RBC and Ret-He were increased in the thalassemia group as compared with the nonthalassemia group(P<0.05);while RDW-CV was decreased in the thalassemia group as compared with the nonthalassemia group(P<0.05);meanwhile Ret-He in theα-thalassemia group was higher than that in theβ-thalassemia group.ROC curve analysis showed that combined with HbA2,the specificity was 93.51%,the sensitivity was 66.18%,the positive predictive value was 90%and the negative predictive value was 75.189%when Ret-He was truncated with 19.25 pg and RBC was truncated with 4.95×10^12/L.Conclusion;Among patients with microcytic or hypochromic,the distribution of RBC,Ret-He and RDW-CV was different in the thalassemia group and the non-thalassemia group,and was also affected by the degree of anemia.Combined Ret-He and RBC could improve the diagnostic specificity for thalassemia,which were screened by HbA2 in patients with microcytic or hypochromic.