网织红细胞平均血红蛋白含量在缺铁性贫血及其严重程度的诊断效能分析

摘要/Abstract

摘要：

目的：评价网织红细胞平均血红蛋白含量（mean reticulated hemoglobin content, Mchr）在诊断缺铁性贫血（iron deficiency anemia, IDA）及其严重程度中的价值。方法：选取2021年1月至2021年12月开云网页登录医学院附属瑞金医院（北部院区）、新华医院和瑞金医院的302例IDA患者，其中轻度贫血118例，中度贫血159例和重度贫血25例，365例非IDA患者（包括地中海贫血、巨细胞性贫血、纯红细胞再生障碍性贫血、溶血性贫血、再生障碍性贫血），以及138名健康体检者。采集所有患者的静脉血样本，检测血红蛋白（hemoglobin, Hb）、红细胞压积（hematocrit, HCT）、Mchr、平均红细胞体积（mean corpuscular volume, MCV）、平均红细胞血红蛋白（mean corpuscular hemoglobin,MCH）、平均红细胞血红蛋白浓度（mean corpuscular hemoglobin concentration, MCHC）、血清铁（serum iron, Fe）、铁饱和度（the saturability of iron, TS）、铁蛋白（Ferritin）和总铁结合力（total iron-binding capacity,TIBC）。比较IDA患者组与非IDA患者组以及IDA不同严重程度之间的Mchr水平，绘制受试者操作特征（Receiver operating characteristic， ROC）曲线，评估Mchr在IDA中的诊断价值。结果：与非IDA组相比，IDA组的Mchr、Hb、MCV、MCH、MCHC、HCT、Fe、TS、Ferritin水平显著降低，而TIBC显著升高，差异均有统计学意义（P<0.05）。IDA组的Mchr与Hb、MCV、MCH、MCHC、HCT、Fe、TS、Ferritin呈正相关，与TIBC呈负相关。轻度、中度、重度IDA患者的Mchr水平依次减低，3组间差异有统计学意义（P<0.05）。ROC曲线分析结果显示，Mchr诊断IDA的最佳临界值为<26.7 pg，诊断灵敏度为80.00%，特异度为93.38%，曲线下面积（the area under the curve, AUC）为0.933 8（95%CI为0.915 7~0.951 8），Mchr+Fe+Ferritin+TIBC联合诊断IDA（各项目的临界值分别为Mchr <26.7pg，Fe <5.7 μmol/L, Ferritin <7.1 ng/mL,TIBC >65.8 μmol/L）的灵敏度为90.76%，特异度为94.70%，AUC为0.983 9（95%CI为0.977 2~0.990 5）。结论：Mchr可作为诊断筛查IDA及其严重程度的潜在临床指标，其联合铁代谢指标诊断IDA更具有诊断价值，能够为选择是否需要进行侵入性诊断提供有力依据。

关键词:平均网织红细胞血红蛋白含量,缺铁性贫血,诊断效率,曲线下面积

Abstract:

ObjectiveTo evaluate the value of mean reticulated hemoglobin content (Mchr) in diagnosing iron deficiency anemia (IDA) and assessing its severity.MethodsThis study included 302 patients with IDA from January 2021 to December 2021, recruited from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (North), Xinhua Hospital, and Ruijin Hospital. The cohort comprised 118 patients with mild anemia, 159 with moderate anemia, and 25 with severe anemia. In addition, 365 non-IDA patients (encompassing those with thalassemia, megaloblastic anemia, pure red cell aplastic anemia, hemolytic anemia, and aplastic anemia) and 138 healthy controls were included. Venous blood samples were collected from all participants for analysis of hemoglobin (Hb), hematocrit (HCT), Mchr, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum iron (Fe), transferrin saturation (TS), ferritin, and total iron-binding capacity (TIBC). Mchr levels were compared between the IDA and non-IDA patient groups and between different degrees of IDA severity. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of Mchr in IDA.ResultsCompared with the non-IDA group, the IDA cohort exhibited significantly reduced levels of Mchr, Hb, MCV, MCH, MCHC, HCT, Fe, TS, and ferritin, while TIBC was markedly elevated, with all differences being statistically significant (P<0.05). Mchr demonstrated positive correlations with Hb, MCV, MCH, MCHC, HCT, Fe, TS, and Ferritin, and a negative correlation with TIBC in the IDA group. Mchr levels decreased sequentially with increasing severity of IDA, with significant differences observed among the three groups (P<0.05). The ROC curve analysis revealed that the cut-off value of Mchr for diagnosing IDA was <26.7 pg, with a sensitivity of 80.00% and specificity of 93.38%, yielding an area under the curve (AUC) of 0.9338(95%CI: 0.9157-0.9518). The sensitivity and the specificity of Mchr+Fe+Ferrit+TIBC in diagnosing IDA (Fe<5.7 μmol/L, Ferritin<7.1 ng/mL, TIBC>65.8 μmol/L) were 90.76% and 94.70% respectively, and the AUC was 0.9839(95%CI: 0.9772-0.9905).ConclusionsMchr can serve as a potential clinical marker for screening IDA and its severity. Its combination with iron metabolism indicators adds diagnostic value for IDA, providing a strong basis for whether further invasive diagnosis is needed.

Key words:Mean reticulocyte hemoglobin content,Iron deficiency anemia,Diagnosis efficiency,Area under the curve

中图分类号:

丁宁, 刘琳, 金佩佩, 王芳, 王天凯. 网织红细胞平均血红蛋白含量在缺铁性贫血及其严重程度的诊断效能分析[J]. 诊断学理论与实践, 2024, 23(03): 318-323.

DING Ning, LIU Lin, JIN Peipei, WANG Fang, WANG Tiankai. Diagnostic efficacy analysis of mean reticulated hemoglobin content for diagnosing iron deficiency anemia and its severity[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(03): 318-323.

图/表5

表1

研究对象的基本特征和血液检测指标水平的差异分析

Indice	Non-IDA	IDA	Control	F/χ²value	Pvalue
No. of participants, N(%)	365(45.34%)	302(37.52%)	138(17.14%)
Gender				142.4	<0.000 1
Male, N (%)	163 (44.66%)	29 (9.60%)	84(60.87%)
Female, N (%)	202 (55.34%)	273 (90.40%)	54(39.13%)
Age(years), mean (SD)	51.96 ± 19.43	49.96 ± 14.71	50.74 ± 11.07	1.224	0.295 0
Laboratory results mean (SD)
Mchr（pg）	31.51 ± 6.69	21.07 ± 3.65^*,#	31.42 ± 1.68	506.8	<0.000 1
MCV（fL）	88.98 ± 13.92^▽	71.44 ± 8.74^*,#	90.29 ± 4.14	253.6	<0.000 1
MCH（pg）	28.95 ± 5.45^▽	20.96 ± 3.37^*,#	30.92 ± 1.77	386.6	<0.000 1
MCHC（g/L）	324.3 ± 16.7^▽	292.6 ± 17.6^*,#	342.4 ± 7.85	567.3	<0.000 1
HCT（%）	27.58 ± 5.58^▽	28.76 ± 4.53^*,#	43.36 ± 4.35	515.6	<0.000 1
Hb（g/L）	88.84 ± 19.33^▽	84.41 ± 15.72^*,#	148.6 ± 16.55	710.6	<0.000 1
Fe（μmol/L）	10.91 ± 7.38^▽	3.54 ± 1.83^*,#	19.96 ± 6.87	389.0	<0.000 1
TIBC（μmol/L）	54.09 ± 16.18^▽	76.61 ± 10.17^*,#	38.58 ± 10.99	446.7	<0.000 1
Ferritin（ng/mL）	106.7 ± 217.1^▽	3.86 ± 2.35^*,#	147.1 ± 147.4	52.16	<0.000 1
TS（%）	21.93 ± 14.86^▽	4.82 ± 2.98^*,#	34.88 ± 13.40	362.6	<0.000 1

表1

Group	Cases	Mchr (pg)
Mild anemia	118	21.91 ± 3.382
Moderate anemia	159	20.97 ± 3.575
Severe anemia	25	17.78 ± 3.445
F值		14.64
P值		<0.001

表2

表3

各指标诊断IDA的灵敏度、特异度及ROC曲线分析结果

Indice	AUC（95%CI）	Sensitivity	Specificity	The cut-off value
Mchr（pg）	0.933 8（0.915 7-0.951 8）	80.00%	93.38%	26.7
MCV（fL）	0.853 4（0.823 7-0.883 1）	73.97%	89.74%	82.7
MCH（pg）	0.881 6（0.855 2-0.908 0）	76.71%	92.05%	25.5
MCHC（g/L）	0.905 0（0.882 7-0.927 4）	76.99%	90.07%	314
HCT（%）	0.554 7（0.511 2-0.598 1）	52.05%	52.32%	29.3
Hb（g/L）	0.594 8（0.552 0-0.637 5）	52.88%	63.25%	92
Ferritin（ng/mL）	0.923 5（0.903 4-0.943 6）	77.09%	92.38%	7.1
TIBC（μmol/L）	0.877 6（0.851 0-0.904 3）	76.71%	88.41%	65.8
Fe（μmol/L）	0.853 6（0.824 1-0.883 1）	74.79%	90.40%	5.7
TS（%）	0.901 6（0.877 4-0.925 8）	79.45%	91.72%	8.1
Mchr+Fe+Ferritin+TIBC	0.983 9（0.977 2-0.990 5）	90.76%	94.70%	-

表3

图1

图2

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