4种方法筛查血红蛋白病的探讨

目的比较4种方法（电泳法、wHPLC、MCV法、一管法）筛查Hb病的检出效能及其准确性，为临床寻求一种较理想的筛查方法，提高实验诊断率。方法选择2007-2008年间在金域医学检验中心进行婚检、孕检、产检及体检标本9203例，同时采用电泳法、wHPLC（弱阳离子交换色谱法）、MCV法（平均红细胞体积测定）、红细胞脆性实验（一管法）进行检测，对1523例疑为Hb病筛查实验结果进行回顾性分析。结果4种方法筛查Hb病的检出率分别为16．5％、16．5％、16．8％、8．3％。准确率分别为90％、92％、96％、52％，4种筛查方法检出率及准确率经统计学分析，差异有统计学意义（P〈0．01）。电泳法、wHPLC法、MCV法对筛查Hb病检出率明显高于一管法。结论联合应用电泳法、wHPLC（弱阳离子交换色谱法）及MCV法，能有效地检出Hb病患者。红细胞脆性实验（一管法）存在一定的漏检率，筛查效能差，不具备单独应用的临床价植。

The comparison of four screening methods for hemoglobinopathies

Objective The purpose of the study was to look for an optimal screening method to improve the diagnostic rate for hemoglobinopathies. To achieve this goal, four methods including liemoglobin（lib） electrophoresis, weak cation exchange HPLC （ wHPLC ）, red cell mean corpuscular volume （ MCV ） test and red cell osmotic fragitity（ one tube method）are compared in the study for the diagnosis of hemoglobinopathies, Antenatal examination. Methods 9203 samples for pre-marital check-ups, maternal screening, and health exams during 2007-2008 in KingMed center were compared with lib electrophoresis, wHPLC, MCV ,red cell osmotic fragitity （one tube method）test at the same time. 1523 samples with suspended hemoglobinopathies were analysed with regression. Results The positive rate of four methods in screening hemoglobinopathies were 16. 5% , 16. 5% , 16.8% and 8.3% , ,while accuracy rate were 90% ,92% ,96% and 52% , respectively. The positive rate and accuracy were different significantly （ P 〈 0.01 ） Positive rate in electrophoresis, wHPLC, and MCV are higher than one tube method. Conclusions Combination with electrophoresis, wHPLC and MCV methods are effectively to screen hemoglobinopathies patients. Red cell osmotic fragility test （ One tube method） consists in higher false negative rate and is limited in independent use in screening hemoglobinopathies.