摘要
目的探讨红细胞相关参数以及测量不确定度在中年人群(40～55岁)缺铁性贫血(iron-deficiency anemia,IDA)与非IDA诊断中的应用。方法回顾性分析2013年1月～2018年6月IDA患者200例和非IDA患者41例,另选同期健康体检者200例作为对照组。所有研究对象进行红细胞相关参数(包括MCV,MCH,MCHC,RDW,SLI,Ehsani,SI,MI,Sirdah,LHD,RBC,EFI,RDWI,MAF,GKI,HB,HCT和RI)检测并绘制各参数对IDA诊断的受试者工作特征曲线(receiver operating characteristic curve,ROC),并以17例IDA和21例非IDA验证Cut-off值。以2017～2018年6月份的室内质控数据以及2016～2018年共50次室间质量评价(external quality assessment,EQA)数据计算红细胞参数的测量不确定度。结果 IDA组RDW,LHD,RBC和HCT高于非IDA组,仅HB差异无统计学意义(t=2.02,P=0.09),其他红细胞参数差异均有统计学意义(P<0.05);与对照组相比,IDA组RDW,LHD,EFI,RDWI,GKI和RI高于健康人群组,仅RDWI无统计学差异(P<0.05),其他红细胞参数差异均有统计学意义(P=0.09);ROC曲线下面积由大到小的排序MCV(AUC=0.979)>SLI(AUC=0.978)>Ehsani(AUC=0.975)>SI(AUC=0.974)>MCH(AUC=0.972)>MI(AUC=0.966)>Sirdah(AUC=0.958)>LHD(AUC=0.936)>MCHC(AUC=0.936)>RBC(AUC=0.931)>EFI(AUC=0.917)>RDW(AUC=0.861)>RDWI(AUC=0.843)>MAF(AUC=0.809)>GKI(AUC=0.684)>HB(AUC=0.631)>HCT(AUC=0.585)>RI(AUC=0.551)。验证数据80%达到了一致。计算Cut-off值的测量不确定度,通过四格表计算得到一段区间范围的敏感度、特异度和准确度。结论红细胞参数MCV,SLI,Ehsani,SI和MCH对中年人群IDA与非IDA有较好的鉴别诊断效能。
Objective To explore the application of red blood cell parameters and measurement uncertainty in the diagnosis of iron deficiency anemia(IDA)and non-IDA in middle-aged people(40~55years old).Methods A retrospective analysis was made on 200IDA patients and 41non-IDA anemia patients from January 2013to June 2018.Another 200healthy people in the same period were selected as control group.All subjects were tested for erythrocyte-related parameters(including MCV,MCH,MCHC,RDW,SLI,Ehsani,SI,MI,Sirdah,LHD,RBC,EFI,RDWI,MAF,GKI,HB,HCT and RI)and drew receiver operating characteristic curve(ROC)for IDA diagnosis.Cut-off values were validated by 17IDA cases and 21non-IDA cases.The measurement uncertainty of erythrocyte parameters was calculated from the data of indoor quality control from 2017 to June 2018and 50external quality assessment(EQA)data from 2016to 2018.Results RDW,LHD,RBC and HCT in IDA group were higher than those in non-IDA group,only HB had no statistical difference(t=2.02,P=0.09),and other erythrocyte parameters had statistical difference(P<0.05).Compared with control group,RDW,LHD,EFI,RDWI,GKI and RI in IDA group were higher than those in healthy group,but RDWI had no statistical difference(t=1.97,P=0.26),and other erythrocyte parameters had statistical difference(P<0.05).The area under ROC curve was ranked from large to small:MCV(AUC=0.979)>SLI(AUC=0.978)>Ehsani(AUC=0.975)>SI(AUC=0.974)>MCH(AUC=0.972)>MI(AUC=0.966)>Sirdah(AUC=0.958)>LHD(AUC=0.936)>MCHC(AUC=0.936)>RBC(AUC=0.931)>EFI(AUC=0.917)>RDW(AUC=0.861)>RDWI(AUC=0.843)>MAF(AUC=0.809)>GKI(AUC=0.684)>HB(AUC=0.631)>HCT(AUC=0.585)>RI(AUC=0.551).80%of the validation data were consistent.The measurement uncertainty of cut-off value was calculated,and the sensitivity,specificity and accuracy of an interval range were obtained by four-grid table calculation.Conclusion Erythrocyte parameters MCV,SLI,Ehsani,SI and MCH are effective in differentiating IDA from non-IDA in middle-aged people.
作者
陈龙梅
刘万超
张丽丽
杨振华
CHEN Long-mei;LIU Wan-chao;ZHANG Li-li;YANG Zhen-hua(Department of Clinical Laboratory,the Baoshan District Traditional Chinese and Western Medicine Hospital,Shanghai 201999,China)
出处
《现代检验医学杂志》
CAS
2019年第2期109-114,118,共7页
Journal of Modern Laboratory Medicine
基金
上海市宝山区中西医结合医院院级科研基金项目(院201701)
