血红蛋白电泳、红细胞渗透脆性和血常规检测在诊断珠蛋白生成障碍性贫血的临床价值
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摘要
目的探究血红蛋白(Hb)电泳、红细胞渗透脆性和血常规检测在诊断珠蛋白生成障碍性贫血(又称地中海贫血)的临床价值。方法选取2016年5月至2018年4月该院收治的缺铁性贫血患者200例作为缺铁性贫血组,选取同期该院建档并确诊的地中海贫血育龄期夫妇200例作为地中海贫血组;对两组患者进行Hb电泳、红细胞渗透脆性和血常规检测;观察两组患者红细胞体积(MCV)、Hb、红细胞平均血红蛋白浓度(MCHC)、红细胞平均血红蛋白含量(MCH)及红细胞体积分布宽度(RDW)的差异;比较两组患者红细胞脆性的差异;统计地中海贫血组中Hb电泳。统计3种检测方法单独及联合检测对地中海贫血的诊断效能。结果与缺铁性贫血组患者相比,地中海贫血组患者的MCV及MCH显著降低(P<0.05),但Hb、MCHC及RDW两组间相比差异无统计学意义(P>0.05);与缺铁性贫血组相比,地中海贫血组患者红细胞脆性显著降低(t=54.370,P=0.000);β-地中海贫血患者HbA2的水平显著高于α-地中海贫血患者(t=16.110,P=0.000);MCV、MCH、红细胞脆性及Hb电泳4项联合检测对地中海贫血诊断的灵敏度、特异度、准确度、阳性预测率及阴性预测率分别达到97.81%、72.48%、97.00%、96.96%及97.06%,与各项指标单独检测相比,差异有统计学意义(P<0.05),具有一定的临床诊断价值。结论地中海贫血患者的MCV、MCH水平显著降低,红细胞脆性显著降低,MCV、MCH、红细胞脆性及Hb电泳4项联合检测对地中海贫血诊断的临床效能较高,具有一定的临床诊断价值。
Objective To explore the clinical value of hemoglobin electrophoresis and erythrocyte fragility combined with routine blood detection in diagnosis of thalassemia.Methods A total of 200 cases of patients with iron-deficiency anemia and who treated in our hospital from May 2016 to Apr 2018 were selected as iron deficiency anemia group,other 200 cases of couples of childbearing age with thalassemia and who recorded and diagnosed in our hospital in the same period were selected as the thalassemia group.Two groups of patients were given the hemoglobin electrophoresis and erythrocyte fragility combined with routine blood detection.Then,the differences of MCV,Hb,MCHC,MCH and RDW of two groups of patients were observed,the difference of erythrocyte fragility of two groups of patients were compared.And the hemoglobin electrophoresis in the thalassemia group were counted,and the diagnostic efficiency of three detection methods of single and combined detection for thalassemia were statistically analyzed.Results Compared with the iron deficiency anemia group,the MCV and MCH in the thalassemia group was significantly lower(P<0.05).But there was no significant difference in Hb,MCHC and RDW between the two groups(P>0.05).Compared with the iron deficiency anemia group,the erythrocyte fragility in the thalassemia group was significantly lower(t=54.370,P=0.000).The content of HbA2 in theβthalassemia was significantly higher than that in patients withα-thalassemia(t=16.110,P=0.000).The sensitivity,specificity,accuracy,positive predictive rate and negative predictive rate of four combined detection of MCV,MCH,erythrocyte fragility and hemoglobin electrophoresis in diagnosis of thalassemia were 97.81%,72.48%,97.00%,96.96%and 97.06%,respectively,and it had certain clinical diagnostic value.Conclusion The MCV and MCH levels of globin-producing anemia patients were significantly decreased,and the erythrocyte fragility was significantly decreased.The four combined detection of MCV,MCH,erythrocyte fragility and hemoglobin electrophoresis was more effective in the diagnosis of globin-producing anemia.Clinical diagnostic value.
Objective To explore the clinical value of hemoglobin electrophoresis and erythrocyte fragility combined with routine blood detection in diagnosis of thalassemia.Methods A total of 200 cases of patients with iron-deficiency anemia and who treated in our hospital from May 2016 to Apr 2018 were selected as iron deficiency anemia group,other 200 cases of couples of childbearing age with thalassemia and who recorded and diagnosed in our hospital in the same period were selected as the thalassemia group.Two groups of patients were given the hemoglobin electrophoresis and erythrocyte fragility combined with routine blood detection.Then,the differences of MCV,Hb,MCHC,MCH and RDW of two groups of patients were observed,the difference of erythrocyte fragility of two groups of patients were compared.And the hemoglobin electrophoresis in the thalassemia group were counted,and the diagnostic efficiency of three detection methods of single and combined detection for thalassemia were statistically analyzed.Results Compared with the iron deficiency anemia group,the MCV and MCH in the thalassemia group was significantly lower(P<0.05).But there was no significant difference in Hb,MCHC and RDW between the two groups(P>0.05).Compared with the iron deficiency anemia group,the erythrocyte fragility in the thalassemia group was significantly lower(t=54.370,P=0.000).The content of HbA2 in theβthalassemia was significantly higher than that in patients withα-thalassemia(t=16.110,P=0.000).The sensitivity,specificity,accuracy,positive predictive rate and negative predictive rate of four combined detection of MCV,MCH,erythrocyte fragility and hemoglobin electrophoresis in diagnosis of thalassemia were 97.81%,72.48%,97.00%,96.96%and 97.06%,respectively,and it had certain clinical diagnostic value.Conclusion The MCV and MCH levels of globin-producing anemia patients were significantly decreased,and the erythrocyte fragility was significantly decreased.The four combined detection of MCV,MCH,erythrocyte fragility and hemoglobin electrophoresis was more effective in the diagnosis of globin-producing anemia.Clinical diagnostic value.
引文
[1]RUND D.Thalassemia 2016:modern medicine battles an ancient disease[J].Am J Hematol,2016,91(1):15-21.
[2]SRIVASTAVA A,SHAJI R V.Cure for thalassemia major-from allogeneic hematopoietic stem cell transplantation to gene therapy[J].Haematologica,2017,102(2):214-223.
[3]CHEN P Q,LIANG Q N,HUANG T S,et al.A simple,rapid,and highly sensitive electrochemical DNA sensor for the detection ofα-andβ-thalassemia in China[J].JClin Lab Anal,2016,30(5):719-726.
[4]张艳芳,谢丰华,万志丹,等.血红蛋白电泳联合地中海贫血基因检测对地中海贫血患者的诊断价值[J].中国优生与遗传杂志,2017,25(5):29-31.
[5]黄昭前,姚红霞,林丽娥,等.血常规检测对地中海贫血与缺铁性贫血患者感染的临床诊断分析[J].中华医院感染学杂志,2016,26(15):3447-3449.
[6]裴元元,冉健,李高驰,等.单个或联合血液学指标检测在地中海贫血筛查中的应用价值研究[J].中国优生与遗传杂志,2015,23(7):24-25.
[7]MATHEWS V,SRIVASTAVA A,CHANDY M.Allogeneic stem cell transplantation for thalassemia major[J].Hematol Oncol Clin North Am,2014,28(6):1187-1190.
[8]黄利华,刘冬霞,李伟明,等.广东省清远地区人群α-地中海贫血基因型及临床表型特点[J].第三军医大学学报,2017,39(6):584-588.
[9]张卫云,杨雄攀,李林海,等.MCH、MCV、RDW-CV、HbA2和红细胞脆性试验在地中海贫血和缺铁性贫血鉴别诊断中的应用[J].生物技术通讯,2016,27(2):244-248.
[10]成明,李健,郭奇伟,等.厦门地区3 715例地中海贫血基因检测结果分析[J].中国妇幼保健,2015,30(12):1870-1872.
[11]吕荣钰,飞球,陈小文,等.常规基因检测阴性的地中海贫血疑似病例再行进一步基因检测仍有7%的阳性发现[J].中国循证儿科杂志,2014,9(4):274-277.
[12]黄燕婷.平均红细胞体积和红细胞脆性及血红蛋白电泳联合检测在珠蛋白生成障碍性贫血中的应用[J].检验医学与临床,2014(z1):93-94.
[13]唐仁强,李彬,李辉.平均红细胞含量、平均红细胞体积及红细胞体积分布宽度在缺铁性贫血与地中海贫血鉴别诊断中的意义[J].中国临床医生杂志,2016,44(8):60-62.
[14]朱晓洁,刘宇鹏,刘瑞玉,等.惠州市同型地中海贫血夫妇的胎儿产前地中海贫血基因诊断分析[J].中国妇幼保健,2015,30(19):3270-3273.
[15]AMREEN K,KUMAR A S.Electrochemical redox signaling of hemoglobin in human whole blood and its relevance to anemia and thalassemia diagnosis[J].Analyst,2016,141(7):2145-2149.
[2]SRIVASTAVA A,SHAJI R V.Cure for thalassemia major-from allogeneic hematopoietic stem cell transplantation to gene therapy[J].Haematologica,2017,102(2):214-223.
[3]CHEN P Q,LIANG Q N,HUANG T S,et al.A simple,rapid,and highly sensitive electrochemical DNA sensor for the detection ofα-andβ-thalassemia in China[J].JClin Lab Anal,2016,30(5):719-726.
[4]张艳芳,谢丰华,万志丹,等.血红蛋白电泳联合地中海贫血基因检测对地中海贫血患者的诊断价值[J].中国优生与遗传杂志,2017,25(5):29-31.
[5]黄昭前,姚红霞,林丽娥,等.血常规检测对地中海贫血与缺铁性贫血患者感染的临床诊断分析[J].中华医院感染学杂志,2016,26(15):3447-3449.
[6]裴元元,冉健,李高驰,等.单个或联合血液学指标检测在地中海贫血筛查中的应用价值研究[J].中国优生与遗传杂志,2015,23(7):24-25.
[7]MATHEWS V,SRIVASTAVA A,CHANDY M.Allogeneic stem cell transplantation for thalassemia major[J].Hematol Oncol Clin North Am,2014,28(6):1187-1190.
[8]黄利华,刘冬霞,李伟明,等.广东省清远地区人群α-地中海贫血基因型及临床表型特点[J].第三军医大学学报,2017,39(6):584-588.
[9]张卫云,杨雄攀,李林海,等.MCH、MCV、RDW-CV、HbA2和红细胞脆性试验在地中海贫血和缺铁性贫血鉴别诊断中的应用[J].生物技术通讯,2016,27(2):244-248.
[10]成明,李健,郭奇伟,等.厦门地区3 715例地中海贫血基因检测结果分析[J].中国妇幼保健,2015,30(12):1870-1872.
[11]吕荣钰,飞球,陈小文,等.常规基因检测阴性的地中海贫血疑似病例再行进一步基因检测仍有7%的阳性发现[J].中国循证儿科杂志,2014,9(4):274-277.
[12]黄燕婷.平均红细胞体积和红细胞脆性及血红蛋白电泳联合检测在珠蛋白生成障碍性贫血中的应用[J].检验医学与临床,2014(z1):93-94.
[13]唐仁强,李彬,李辉.平均红细胞含量、平均红细胞体积及红细胞体积分布宽度在缺铁性贫血与地中海贫血鉴别诊断中的意义[J].中国临床医生杂志,2016,44(8):60-62.
[14]朱晓洁,刘宇鹏,刘瑞玉,等.惠州市同型地中海贫血夫妇的胎儿产前地中海贫血基因诊断分析[J].中国妇幼保健,2015,30(19):3270-3273.
[15]AMREEN K,KUMAR A S.Electrochemical redox signaling of hemoglobin in human whole blood and its relevance to anemia and thalassemia diagnosis[J].Analyst,2016,141(7):2145-2149.
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