摘要
目的:研究红细胞参数单独诊断及红细胞多参数联合诊断对我国高水平运动员非贫血性铁缺乏的评价作用,以期降低检测成本,为运动员早期缺铁的及时发现和诊断提供筛查手段.方法:回顾性研究2015年至2021年本实验室进行血常规及血清铁蛋白项目测试的国家队运动员血液样本,选取铁贮备正常运动员样本358例、非贫血性铁缺乏运动员样本335例(早期储铁缺乏247例,Ⅰ组;中晚期储铁缺乏88例,Ⅱ组)按3︰1比例随机组成训练集和验证集.绘制红细胞参数[红细胞计数(RBC)、红细胞压积(HCT)、红细胞分布宽度(RDW)、平均红细胞体积(MCV)、平均血红蛋白含量(MCH)、平均血红蛋白浓度(MCHC)、低血红蛋白密度(LHD)、小红细胞贫血因子(MAF)]受试者工作特征曲线(ROC),Logistic二元回归建立多参数联合诊断模型,以联合预测概率值绘制ROC曲线,通过ROC曲线下面积(AUC)评估各方法的筛查价值,通过准确度、Kappa值检验各方法的准确性和一致性.结果:(1)单一红细胞参数ROC曲线显示:早期非贫血性铁缺阶段,男性运动员RDW的AUC值大于0.7,女性运动员各红细胞参数均小于0.7;中晚期非贫血性铁缺乏阶段,男性运动员MCH、MAF的AUC值大于0.85,女性运动员MCH的AUC值大于0.85.(2)Logistic回归分析构建红细胞多参数联合诊断模型:Logistic(P_(RDW+MCH),Ⅰ组男)=-9.713+1.621×RDW-0.422×MCH;Logistic(P_(LHD+MCH),Ⅰ组女)=8.539+0.121×LHD-0.295×MCH;Logistic(P_(RDW+MCH),Ⅱ组男)=7.364+1.328×RDW-0.932×MCH;Logistic(P_(RDW+MCH),Ⅱ组女)=9.26+1.489×RDW-0.984×MCH.(3)红细胞多参数联合预测概率值ROC曲线显示:早期非贫血性铁缺乏阶段,男性运动员P_(RDW+MCH)的AUC值(0.803)高于RDW单独诊断AUC值但仍然小于0.85,女性运动员P_(LHD+MCH)的AUC值小于0.7;中晚期非贫血性铁缺乏阶段,男性运动员P_(RDW+MCH)的AUC值(0.855)大于0.85,但与MCH、MAF单独诊断AUC值相比并无提高,女性运动员P_(RDW+MCH)的A
Objective To explore the value of erythrocyte parameters in the diagnosis of non-anaemic iron deficiency(NAID)among Chinese high-level athletes,so as to reduce the testing cost and provide a screening method for early detection and diagnosis of iron deficiency in athletes.Methods The blood samples of high-level athletes from the national team for blood routine and serum ferritin tests in National Research Institute of Sports Medicine between 2015 and 2021 were studied retrospectively.Totally 358 athletes with normal iron storage and 335 NAID ones including 247 with the earlystage NAID(groupⅠ)and 88 with mid-to late-stage NAID(groupⅡ),were randomly divided into a training set and verification set in the ratio of 3︰1.The receiver operating characteristic curves(ROC)of red blood cell parameters[including the red blood cell(RBC),hematocrit(HCT),red blood cell distribution width(RDW),mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),mean corpuscular hemoglobin concentration(MCHC),low hemoglobin density(LHD),microcytic anaemia factor(MAF)]were drawn.The multi-parameter combined diagnostic model was established by binary logistic regression and its ROC curve was drawn based on the combined predicted probability value.The screening value of each index was evaluated by the area under ROC Curve(AUC),while the accuracy and consistency of different indics were tested by accuracy rating and Kappa value.Results(1)The AUC value of RDW was greater than 0.7 for male athletes with the early-stage NAID,while that of all erythrocyte parameters were less than 0.7 for female athletes with the same condition.However,for those with mid-to late-stage NAID,the AUC values of MCH and MAF of male athletes,as well as that of MCH for female athletes,were greater than 0.85.(2)The multi-parameter combined diagnostic model based on the binarylogistic regression went as follows:Logistic(P_(RDW+MCH),groupⅠMale)=-9.713+1.621×RDW-0.422×MCH;Logistic(P_(LHD+MCH),groupⅠFemale)=8.539+0.121×LHD-0.295×MCH;Logistic(P_(RDW+MCH),grou
作者
谭秋实
常雅珊
阚朝勃
王启荣
Tan Qiushi;Chang Yashan;Kan Zhaobo;Wang Qirong(National Institute of Sports Medicine,Beijing 100029,China)
出处
《中国运动医学杂志》
CAS
CSCD
北大核心
2022年第9期694-703,共10页
Chinese Journal of Sports Medicine
基金
国家体育总局国家队备战奥运会专项基金(2021年度)。
关键词
红细胞参数
联合诊断
高水平运动员
非贫血性铁缺乏
erythrocyte parameters
combined diagnostic
elite athletes
non-anaemic iron deficiency
