低血红蛋白密度和铁代谢指标对缺铁性贫血的实验诊断研究

发布时间：2018-02-04 03:46

  本文关键词： 低血红蛋白密度 铁代谢 缺铁性贫血 诊断 疗效观察　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过检测红细胞新参数低血红蛋白密度(low hemoglobin density,LHD)及铁代谢指标的实验诊断研究,评价低血红蛋白密度在缺铁性贫血(iron deficiency anemia,IDA)诊断及鉴别诊断的应用价值,并通过口服铁剂后LHD的变化情况,动态监测缺铁性贫血患者对铁剂治疗的的疗效反应,为临床缺铁性贫血的诊治提供新的参考依据。方法:选取2016年6月至2016年11月在吉林大学第一医院就诊的门诊及住院患者共170例,分为缺铁性贫血组50例,肿瘤性贫血组50例、肾性贫血组50例;对照组为同期我院的健康体检者20例。分别采用全自动血细胞分析仪测定各组红细胞参数中的LHD、RBC、HGB、HCT、MCV、MCH、MCHC,全自动生化分析仪测定血清铁(serum iron,SI)、血清铁蛋白(serum ferritin,SF)及总铁结合力(total iron binding capacity,TIBC),特种蛋白仪测定转铁蛋白(transferrin,Tf),转铁蛋白饱和度(transferrin saturation,TS),分别对以上各项参数进行组内比较和组间比较,并分析LHD与铁代谢参数的相关性;通过ROC曲线分析LHD和铁代谢指标在IDA和ACD中的敏感度、特异度及临界值;动态观察IDA患者治疗1w、4w、8w、12w的LHD变化情况,同时比对慢性病贫血治疗前后LHD和铁代谢指标的变化情况。全部检验数据采用SPSS 23.0进行统计学处理。结果:1.LHD在各组的检测结果:LHD在IDA组为77.4%±23.4%,显著高于肿瘤性贫血组3.9%±3.7%、肾性贫血组5.4%±4.9%和对照组2.3%±1.6%(P值均0.05)。肿瘤性贫血组、肾性贫血组与对照组之间差异无统计学意义。2.LHD及铁代谢指标对IDA诊断的临界值、敏感度及特异度:当ROC曲线下面积(area under ROC curve,AUC)为0.993时,LHD对IDA诊断的临界值是6.8%,敏感度100%、特异度98.4%。转铁蛋白饱和度(TS)、血清铁(SI)、转铁蛋白(Tf)、铁蛋白(SF)、总铁结合力(TIBC)的AUC、敏感度和特异度分别为(0.992、100%、96.7%)、(0.984、98%、91.8%)、(0.953、95.9%、90.2%)、(0.947、98%、91.8%)、(0.863、78.6%、77.6%)。比对.LHD对肿瘤性贫血和肾性贫血诊断的ROC曲线:LHD对肿瘤性贫血和肾性贫血诊断能力较低,敏感度分别为39.5%、57.5%,特异度分别为81.4%和78.7%。3.LHD与铁代谢指标对IDA诊断的相关性:缺铁性贫血患者中LHD与TIBC呈正相关(r=0.32,P0.05),与SI、TS呈负相关(r值分别为-0.419、-0.599,P值均0.05),与SF、TF无显著相关性。.4.IDA组治疗前LHD与HGB的相关性:LHD水平检测结果是重度贫血组(HGB:30~60g/L)高于中度贫血组(HGB:60~90g/L)高于轻度贫血组(HGB:90~110/120g/L),分别为94.6%±9.5%84.8%±17.4%56.0%±19.2%;LHD随着HGB的减低而增高,二者呈负相关(r=-0.515,P=0.001)。5.贫血患者治疗前、后LHD变化情况:28例缺铁性贫血患者口服铁剂治疗前LHD为87.8%±12.8%,口服铁剂1w后降低至81.8%±21.5%,4w后降低至67.1%±20.4%,8w月后降低至37.8%±20.1%,12w后降低至14.2%±7.2%。同时,血清铁增高、铁蛋白增高、红细胞及血红蛋白逐渐恢复正常;LHD水平于治疗后第4w较治疗前明显降低,差异有统计学意义,12w接近正常水平。肾性贫血和肿瘤性贫血患者在对症治疗前后,LHD变化差异无统计学意义。结论:1.LHD对缺铁性贫血诊断有较高敏感度、特异度,且LHD只在缺铁性贫血时明显升高,在其他不伴缺铁的贫血类型中不升高,可作为缺铁性贫血诊断和鉴别诊断的参考指标。2.缺铁性贫血中LHD随HGB的降低而升高,二者呈负相关,LHD随着贫血的加重而增高。LHD与铁代谢指标有一定相关性,可反映机体铁缺乏的严重程度。3.缺铁性贫血患者口服铁剂后12周LHD基本恢复正常水平,连续动态监测LHD可有效评估病情变化和铁剂治疗效果。
[Abstract]:Objective: through the detection of red blood cell parameters of new low density (low hemoglobin density, hemoglobin LHD) on laboratory diagnosis and iron metabolism index, evaluation of low hemoglobin density in iron deficiency anemia (iron deficiency, anemia, IDA) in diagnosis and differential diagnosis, and the changes of LHD by oral iron, the effect of iron the treatment of dynamic monitoring in patients with iron deficiency anemia, to provide new reference for clinical diagnosis and treatment of iron deficiency anemia. Methods: from June 2016 to November 2016 in No.1 Hospital of Jilin University outpatient and hospitalized patients in 170 cases, divided into 50 cases of iron deficiency anemia group, group 50 cases of cancer anemia group of 50 cases of renal anemia; 20 cases of the control group for the same period in our hospital physical examination. Using automatic blood cell analyzer measured red cell parameters in LHD, RBC, HGB, HCT, MCV, MCH, MCHC, automatic biochemical Determination of serum iron analyzer (serum iron, SI), serum ferritin (serum ferritin, SF) and total iron binding capacity (total iron binding capacity, TIBC), the determination of transferrin specific protein (transferrin, Tf) instrument, transferrin saturation (transferrin saturation, TS), respectively for the above parameters within the group and comparison between groups, and the correlation analysis of LHD parameters and iron metabolism; through the analysis of ROC curve sensitivity index of LHD and IDA in iron metabolism and ACD, specificity and critical value; dynamic observation of treatment in patients with IDA 1W, 4W, 8W, LHD, 12W changes, at the same time ratio changes before and after treatment of anemia of chronic disease LHD and iron metabolism indices. All test data were statistically analyzed by SPSS 23. Results: 1.LHD in the test results of each group: 77.4% + 23.4% LHD in group IDA was significantly higher than that of tumor anemia was 3.9% + 3.7%, 5.4% + 4.9% renal anemia group and the 鐓х粍2.3%卤1.6%(P鍊煎潎0.05).鑲跨槫鎬ц传琛，

本文编号：1489229