检测血液参数在常见小细胞性贫血患者中诊断鉴别的意义

基础医学与临床 ›› 2020, Vol. 40 ›› Issue (1): 105-109.

检测血液参数在常见小细胞性贫血患者中诊断鉴别的意义

张若曦, 李红敏, 伍洁, 韩冰^*

中国医学科学院北京协和医学院北京协和医院血液科, 北京 100730

收稿日期:2019-10-10 修回日期:2019-11-22 出版日期:2020-01-05 发布日期:2019-12-27
通讯作者: ^*hanbing_li@sina.com.cn
基金资助:
中国国家重点研究和发展计划 (2016YFC0901500);北京自然科学基金 (7192168);中国医学科学院医学创新基金(2016-I2M-3-004)

Clinical significance of testing blood parameters on the diagnosis of common microcytic anemia patients

ZHANG Ruo-xi, LI Hong-min, WU Jie, HAN Bing^*

Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China

Received:2019-10-10 Revised:2019-11-22 Online:2020-01-05 Published:2019-12-27
Contact: ^*hanbing_li@sina.com.cn

摘要/Abstract

摘要： 目的明确不同检测血液参数在常见小细胞性贫血患者鉴别诊断中的意义。方法获取2017年10月至2018年9月在北京协和医院就诊的铁代谢相关疾病患者的血液标本,进行常规化验检查,同时检测网织红细胞血红蛋白含量(CHr)、铁蛋白(SF)、可溶性转铁蛋白受体(sTfR)、铁调素(hepcidin)等铁代谢相关指标,并比较其在不同疾病中表达的异同。结果缺铁性贫血(IDA)26例,慢性病性贫血(ACD)12例,地中海贫血(TA)12例,伴环形铁粒幼细胞增多的难治性贫血(RARS)12例。另有17名健康对照(NC)。平均红细胞体积(MCV):IDA和TA明显低于对照(P＜0.01),且TA更低。平均红细胞血红蛋白浓度(MCHC):ACD、IDA、TA、RARS均显著低于NC(P＜0.01),其中IDA最低。网织红细胞计数:除RARS外,其他3者均显著高于NC(P＜0.01),TA相较于ACD、IDA升高更为明显。CHr:ACD、IDA、TA较NC显著下降(P＜0.01)。SF在IDA患者中较NC显著下降(P＜0.01)且低于其他3种贫血,而ACD、RARS较NC显著升高(P＜0.01)。转铁蛋白饱和度(TS)中:ACD、IDA、TA相对NC降低(P＜0.01),而RARS相对NC显著升高(P＜0.01),且高于其他3种贫血。sTfR和sTfR指数(sTfR/log SF)在IDA患者中相较于NC显著升高(P＜0.01),且相对ACD、TA、RARS更高。ROC曲线分析显示:SF、sTfR指数对鉴别诊断IDA和ACD、TA、RARS具有较高的诊断准确性。结论综合利用外周血检测的常规指标及铁代谢参数指标可以初步区分不同类型的小细胞贫血并辅助鉴别诊断。

关键词: 小细胞性贫血, 常规化验检测, 铁代谢参数, 鉴别诊断

Abstract: Objective To evaluate the clinical significance of different hematology parameters on microcytic anemia patients. Methods Blood samples from patients in PUMCH with different microcytic anemia from October 2017 to September 2018 were tested for routine blood tests, cellular hemoglobin of reticulocytes (CHr), serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin and other iron metabolism parameters. Data from different diseases were analyzed and compared. Results Twenty-six iron deficiency anemia (IDA), 12 anemia of chronic disease (ACD), 12 thalassemia (TA), 12 refractory anemia with ring sideroblast (RARS) and 17 normal controls (NC) were tested. The level of MCV (mean corpuscular volume) in IDA and TA group were lower than that of control(P＜0.01). MCV level in TA group was even lower than that in IDA. The concentrations of mean corpuscular hemoglobin concentration(MCHC) in ACD, IDA, TA, RARS groups were lower than that in NC (P＜0.01), among which IDA had the lowest level. All types of anemia, except RARS, had higher level of reticulocyte counts than NC(P＜0.01), among them, TA group had the highest level. The level of CHr in ACD, IDA and TA groups was lower than that of NC(P＜0.01). SF concentration in IDA group was significantly lower than NC (P＜0.01), and was also lower than other 3 groups. ACD and RARS had higher concentrations of SF than NC(P＜0.01). As for the levels of transferrin saturation (TS), ACD, IDA, and TA groups were lower than NC (P＜0.01), while RARS was significantly higher than NC(P＜0.01) and also higher than the other 3 types of anemia. The level of sTfR and sTfR index(sTfR/log SF) in IDA group was significant higher than that in NC(P＜0.01), also higher than ACD, TA and RARS groups.ROC curve showed that SF and sTfR index facilitated differentiating IDA from other types of microcytic anemia. Conclusions Routine tests and iron metabolism related parameters from the peripheral blood tests may support the preliminary identification of different kinds of microcytic anemia and further differential diagnosis.

Key words: microcytic anemia, routine test, iron metabolism parameters, differential diagnosis

中图分类号:

R552

张若曦, 李红敏, 伍洁, 韩冰. 检测血液参数在常见小细胞性贫血患者中诊断鉴别的意义[J]. 基础医学与临床, 2020, 40(1): 105-109.

ZHANG Ruo-xi, LI Hong-min, WU Jie, HAN Bing. Clinical significance of testing blood parameters on the diagnosis of common microcytic anemia patients[J]. Basic & Clinical Medicine, 2020, 40(1): 105-109.

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