摘要
目的探讨红细胞参数计算公式对儿童β-地中海贫血(β-TT)诊断的意义及其影响因素分析。方法选择200例小细胞低色素性贫血的临床资料进行回顾性分析。其中β-TT 104例,缺铁性贫血(IDA)96例。将相关的红细胞参数分别代入Green and King指数(GKI)及Mentzer指数(MI)计算得出相应的结果。分别以GKI=65(β-TT≤65,IDA>65)、GKI=73(β-TT≤73,IDA>73)、MI=13(β-TT≤13,IDA>13)为诊断界值,比较这3种方法对于鉴别β-TT和IDA的敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)及约登指数(YI),绘制受试者工作特征(ROC)曲线及计算曲线下面积(AUC),并分析影响鉴别效能较好的计算公式的准确性的可能因素。结果本地区儿童β-TT基因缺陷类型以CD41-42(-TTCT)杂合突变、IVS-Ⅱ-654(C→T)杂合突变和CD17(A→T)杂合突变为主。MI(β-TT≤13,IDA>13)的诊断效能明显高于GKI(β-TT≤65,IDA>65或β-TT≤73,IDA>73),差异均有统计学意义(P<0.05),MI的AUC为0.840;以MI=13为最佳界值,YI=63.06%。年龄≤4个月的患儿使用MI的准确性偏低(P<0.05),性别和检测前是否使用铁剂治疗对MI的准确性无影响(P>0.05)。结论MI(β-TT≤13,IDA>13)对于鉴别β-TT和IDA具有较高的临床价值,为保障MI的准确性,建议适用年龄>4个月,对于年龄≤4个月的患儿建议联合血红蛋白电泳和地中海贫血基因检测以提高检查的准确性。
Objective To investigate the significance and influencing factors of the formula of red blood cell parameters in the diagnosis of β-thalassemia trait(β-TT)in children.Methods Two hundred cases with small cell hypochromic anemia,including 104 β-TT cases and 96 iron deficiency anemia(IDA)cases were selected for retrospective analysis.The corresponding results were calculated by substituting the relevant red blood cell parameters into green and King index(GKI)and Mentzer index(MI),respectively.GKI=65(β-TT≤65,IDA>65),GKI=73(β-TT≤73,IDA>73)and MI=13(β-TT≤13,IDA>13)were used as diagnostic thresholds.The sensitivity(SEN),specificity(SPE),positive predictive value(PPV),negative predictive value(NPV)and Youden index(YI)of these three indexes for distinguishing β-TT from IDA were compared,and the receiver operating characteristic(ROC)curves and the area under the curve(AUC)were calculated and drawn.The factors that influence the accuracy of the formula with better identification efficiency were analyzed.Results The main types of β-TT gene defects in children in the local area are CD41-42(-TTCT)heterozygous mutation,IVS-Ⅱ-654(C→T)heterozygous mutation and CD17(A→T)heterozygous mutation.MI showed significantly higher efficiency for the diagnosis of β-TT than GKI(P<0.05),with AUC of 0.840.MI=13 was the best cut-off value,with YI of 63.06%.The accuracy of MI used in children with age≤4 months was significantly lower(P<0.05),and the accuracy of MI was not affected by gender or iron therapy before detection(P>0.05).Conclusion MI(β-TT≤13,IDA>13)has high clinical value for distinguishing β-TT from IDA.In order to ensure the accuracy of MI,it is recommended that the age of application is more than 4 months.For children with age≤4 months,it is suggested to combine hemoglobin electrophoresis and thalassemia genetic testing to improve the accuracy of the examination.
作者
黄育涛
陈晓榆
张展青
HUANG Yu-tao;CHEN Xiao-yu;ZHANG Zhan-qing(Department of Paediatrics,the People Hospital of Jieyang City,Jieyang 522000,Guangdong,China)
出处
《广东医学》
CAS
2022年第3期376-379,共4页
Guangdong Medical Journal
基金
揭阳市科技计划项目(200807092350782)。
关键词
Β-地中海贫血
儿童
红细胞参数
计算公式
β-thalassemia trait
children
red blood cell parameters
calculation formula
