外周血无创总血红蛋白测定与静脉血血红蛋白检测在肾病患儿中的对比

发布时间：2018-05-03 11:20

本文选题：肾病 + 儿童　；参考：《北京大学学报(医学版)》2017年05期

【摘要】：目的:对比外周血无创总血红蛋白测定与静脉血血红蛋白检测在肾病患儿血红蛋白测量中的相关性及一致性,并分析其可能的影响因素,为外周血无创总血红蛋白检测技术应用于肾病儿童血红蛋白的监测提供参考依据。方法:选择北京大学第一医院儿科2014年10月至2015年2月85名肾病住院患儿作为研究对象,其中男50例(58.8%),女35例(41.2%),年龄(9.35±4.29)岁(3~18岁),非惯用手的无名指作为检测部位,用无创血红蛋白检测仪(PRONTO-7)检测无创血红蛋白浓度(noninvasive hemoglobin monitoring by spectrophotometry,Sp Hb),然后在5 min内抽取静脉血2 m L,通过血液分析仪(Beckman coulter DXH-800)测定静脉血红蛋白浓度(true hemoglobin,t Hb)。对所测得的Sp Hb和t Hb两组数据进行比较分析。结果:对85对数据进行统计学分析,相关性分析显示,Sp Hb与t Hb的相关系数为0.85(P0.05),有显著相关性。Bland-Altman一致性分析显示,Sp Hb与t Hb的差值的平均值为-1.3 g/d L,标准差为1.47 g/d L,两者差值的95%CI为-4.2~1.5 g/d L,提示Sp Hb的平均测量结果低于t Hb测量结果。根据Sp Hb与t Hb的差值百分比绘制Bland-Altman一致性描点图,显示差值/均值百分比的均值为-9.8%,一致性界限为(-35.9%,16.2%),超过了《全国临床检验操作规程》中允许的±6%的可接受范围。外周血无创血红蛋白检测与静脉血血红蛋白检测的一致率为31.8%,一致率的95%CI为21.7%~41.9%。四格表卡方检验显示采用Sp Hb值诊断贫血灵敏度较高,但特异性低,假阳性率高,且差异具有统计学意义(P=0.000)。结论:肾病患儿的无创血红蛋白检测值与静脉血红蛋白值之间具有显著相关性,可以用于动态监测血红蛋白浓度的变化趋势,但一致性不足,无创血红蛋白测定尚不能取代静脉血红蛋白测定,尚不能用于贫血的诊断,其在肾病患儿血红蛋白浓度测量中的准确度有待于进一步探讨。
[Abstract]:Objective: to compare the correlation and consistency between peripheral blood noninvasive total hemoglobin measurement and venous hemoglobin measurement in children with nephropathy, and to analyze the possible influencing factors. To provide reference for the application of noninvasive total hemoglobin in peripheral blood to monitor hemoglobin in children with nephropathy. Methods: from October 2014 to February 2015, 85 hospitalized children with nephropathy were selected from the first Hospital of Peking University, including 50 males and 35 females, aged 9.35 卤4.29 years. Noninvasive hemoglobin monitoring by spectrophotometry was used to detect noninvasive hemoglobin concentration. Venous blood was extracted within 5 min. Venous hemoglobin concentration was measured by Beckman coulter DXH-800). The measured data of SB and t HB were compared and analyzed. Results: 85 pairs of data were analyzed statistically. Correlation analysis showed that the correlation coefficient between SpHb and t HB was 0.85 / P0.05.The Bland-Altman consistency analysis showed that the average value of difference between SpHb and t-Hb was -1.3 g / d / L, the standard deviation was 1.47 g / d / L, and the 95%CI of the difference was -4.21.5 g / d / L, suggesting that the difference between Sp HB and t HB was -4.21.5 g / d / L. The average measured result is lower than that of t HB. According to the percentage of difference between SB and t HB, the Bland-Altman consistency plot was drawn, which showed that the average value of difference / mean percentage was -9.8, and the consistency limit was -35.9and 16.2cm, which exceeded the acceptable range of 卤6% allowed in the National procedure for Clinical examination. The consistent rate of noninvasive hemoglobin detection in peripheral blood and that of venous hemoglobin was 31.8.The 95%CI of consistency rate was 21.7% and 41.9% respectively. The four grid chart chi-square test showed that the diagnosis of anemia by SpHb value was sensitive, but the specificity was low, the false positive rate was high, and the difference was statistically significant. Conclusion: there is a significant correlation between the noninvasive hemoglobin detection value and the venous hemoglobin value in children with nephropathy, which can be used to dynamically monitor the change trend of hemoglobin concentration, but the consistency is insufficient. Non-invasive hemoglobin measurement can not replace intravenous hemoglobin measurement and can not be used in the diagnosis of anemia. Its accuracy in measuring hemoglobin concentration in children with nephropathy needs to be further explored.
【作者单位】：北京大学第一医院儿科;厦门市妇幼保健院儿科;
【分类号】：R726.9

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