2019 年第 5 期 第 14 卷

网织红细胞血红蛋白含量等指标在妊娠期缺铁性贫血筛检中的意义

Significance of reticulocyte hemoglobin in screening of iron-deficiency anemia in pregnant women

作者：张瀚月张璐璐许瑞段文冰李晓莹唐闻刘芸

英文作者：

单位：250021济南，山东大学附属省立医院临床医学检验部

英文单位：

关键词：缺铁性贫血；网织红细胞血红蛋白含量；低色素红细胞百分比

英文关键词：

• 摘要：

• 【摘要】目的    探讨外周血网织红细胞血红蛋白含量（Ret-He）、低色素红细胞百分比（Hypo%）等指标在孕妇缺铁性贫血（IDA）诊断中的临床价值。方法    选取2016年1—3月于山东大学附属省立医院产科门诊就诊的孕妇179例，根据血红蛋白和血清铁蛋白（SF）水平将患者分为IDA组（66例）、缺铁非贫血组（64例）、正常对照组（49例）。比较3组全血红细胞参数，包括血红蛋白、红细胞体积分布宽度（RDW）、平均红细胞体积（MCV）、平均红细胞血红蛋白（MCH）、平均红细胞血红蛋白浓度（MCHC）；比较3组网织红细胞（RET）计数及分群结果，包括RET百分数（RET%）、RET绝对值（RET#）、低荧光RET比率（LFR）、中荧光RET比率（MFR）、高荧光RET比率（HFR）、未成熟RET比率（IRF）、Ret-He；比较各组SF、Hypo%。分析MCV、MCH、MCHC、RDW、Ret-He、Hypo%对IDA的诊断价值。结果    正常对照组、缺铁非贫血组、IDA组的MCV、MCH、MCHC逐渐降低，组间两两比较差异均有统计学意义（均P＜0.05），IDA组血红蛋白明显低于正常对照组与缺铁非贫血组［（83±28）g/L比（125±7）、（123±7）g/L］，RDW明显高于正常对照组与缺铁非贫血组［（16.7±4.7）%比（13.3±0.7）%、（13.1±1.1）%］，差异均有统计学意义（均P＜0.05）。缺铁非贫血组和IDA组的RET%、RET#、MFR、HFR、IRF均明显高于正常对照组，LFR、Ret-He均明显低于正常对照组，差异均有统计学意义（均P＜0.05）；IDA组RET%明显高于缺铁非贫血组［（2.5±0.7）%比（2.2±0.5）%］，LFR、Ret-He明显低于缺铁非贫血组［（79±9）%比（80±6）%、（20.5±2.2）pg比（27.7±4.6）pg］，差异均有统计学意义（均P＜0.05）。IDA组Hypo%水平高于正常对照组及缺铁非贫血组，SF水平明显低于正常对照组及缺铁非贫血组，差异均有统计学意义（均P＜0.05）。MCV、MCH、MCHC、RDW、Ret-He、Hypo%诊断IDA的曲线下面积分别为0.847、0.876、0.901、0.747、0.934、0.968。Ret-He临界值为29.0 pg时，诊断IDA的敏感度为96.8%，特异度为87.8%；Hypo%临界值为6%时，诊断IDA的敏感度为90.1%，特异性为91.6%。结论    Ret-He、Hypo%可准确反映孕妇铁缺乏状态，尤其对于已经发生铁缺乏但尚未发生贫血的患者，是IDA早期诊断的较敏感指标。

• 【Abstract】Objective    To investigate the clinical values of peripheral blood reticulocyte hemoglobin(Ret-He) and hypochromic erythrocyte percentage(Hypo%) in the diagnosis of iron-deficiency anemia(IDA) in pregnant women. Methods    A total of 179 pregnant women who visited Shandong Provincial Hospital Affiliated to Shandong University from January 2016 to March 2016 were enrolled. According to the levels of hemoglobin and serum  ferroprotein(SF), the patients were divided into IDA group(66 cases), iron deficiency non-anemia group(64 cases) and normal group(49 cases). Hemoglobin, red blood cell volume distribution width(RDW), mean red blood cell volume(MCV), mean red blood cell hemoglobin(MCH) and mean red blood cell hemoglobin concentration(MCHC) were detected. Reticulocyte ratio(RET%), reticulocyte absolute value(RET#), low fluorescent reticulocyte ratio(LFR), medium fluorescent reticulocyte ratio(MFR), high fluorescent reticulocyte ratio(HFR), immature reticulocyte ratio(IRF) and Ret-He were detected. Diagnostic values of MCV, MCH, MCHC, RDW, Ret-He and Hypo% for IDA were analyzed. Results    Levels of MCV, MCH and MCHC showed a downtrend differences among the normal control group, iron deficiency non-anemia group and IDA group(all P＜0.05). Hemoglobin level in IDA group was significantly lower than that in normal control group and iron deficiency non-anemia group［（83±28）g/L vs （125±7）, （123±7）g/L］; RDW in IDA group was significantly higher than that in normal control group and iron deficiency non-anemia group［（16.7±4.7）% vs （13.3±0.7）%, （13.1±1.1）%］（all P＜0.05）. RET%, RET#, MFR, HFR, IRF in iron deficiency non-anemia group and IDA group were significantly higher and LFR, Ret-He were significantly lower than those in normal control group(all P＜0.05). In IDA group, RET% was significantly higher than that in iron deficiency non-anemia group［（2.5±0.7）% vs （2.2±0.5）%］; LFR and Ret-He were significantly lower than those in iron deficiency non-anemia group［（79±9）% vs （80±6）%, （20.5±2.2）pg vs （27.7±4.6）pg］（all P＜0.05）. Hypo% in IDA group was significantly higher and SF level was significantly lower than those in normal control group and iron deficiency non-anemia group(all P＜0.05). Areas under the receiver operating characteristic curve  of MCV, MCH, MCHC, RDW, Ret-He and Hypo% in diagnosing IDA were 0.847, 0.876, 0.901, 0.747, 0.934 and 0.968, respectively. When the threshold value of Ret-He was 29.0 pg, the diagnostic sensitivity was 96.8% and the specificity was 87.8%. When the threshold value of Hypo% was 6%, the sensitivity in diagnosing IDA was 90.1% and the specificity was 91.6%. Conclusion    Ret-He and Hypo% can be used as sensitive diagnostic indicators of IDA in pregnant women, especially for patients who have iron deficiency but have not developed anemia.