地中海贫血筛查试验在小红细胞低色素性贫血病因鉴别诊断中的应用

摘要

目的：探讨红细胞体积散布宽度变异系数（RDW-CV）、红细胞脆性（EFT）、葡萄糖-6-磷酸脱氢酶（G-6-PD）活性和血红蛋白（Hb）电泳在小红细胞性贫血病因鉴别诊断中的作用。方法所有2362例参检人群进行以上地中海初筛试验检测；对参检人群中筛选出的287例小红细胞性贫血的参检者进行血清铁蛋白及地中海贫血基因检测，作为确诊地中海贫血和缺铁性贫血（IDA）的分组依据。对结果做统计学分析。结果IDA 组的 RDW-CV 显著高于其他组；EFT、G6PD、Hb 电泳检测对地中海贫血诊断的灵敏度分别为92．2％、80．4％、92．2％，特异度分别为86．0％、47.4％、45．6％。在排除了地中海贫血的小红细胞性贫血中，EFT、G6PD、Hb 电泳检测对 IDA 的诊断灵敏度分别为13．0％、65．2％、71．7％，特异度分别为72．7％、90．9％、100％。结论以血液学指标 MCV、MCH、RDW-CV 为基础，结合 Hb 电泳、EFT、G6PD 结果可对小红细胞性贫血进行地中海贫血及 IDA 及慢性病贫血的鉴别诊断。%Objective To study the value of the Red blood cell volume distribution width coefficient of variation (RDW-CV)、Erythrocyte osmotic fragility test(EFT)、Glucose-6-phosphate dehydrogenase(G-6-PD)and Hemoglobin (Hb)electrophoresis for the diagnosis of microcytic anemia.Methods 2362 people were included in this study.All peo-ple received thalassaemia screening test.287 people with microcytic anemia were detected by serum ferritin and thalas-semia gene analysis and thus were divided into IDA group or thalassemia group.Results The RDW-CV of IDA group was significantly higher than others.The sensitivity of EFT,G6PD,Hb electrophoresis to diagnosis thalassaemia were 92.2%,80.4%,92.2% respectively.The specificity of those test were 86.0%,47.4%,45.6%.In microcytic anemia which excludes thalassaemia,the sensitivity of EFT,G6PD and Hb electrophoresis to diagnosis IDA were 13.0%,65. 2%,71.7%.The specificity of those test were 72.7%,90.9%,100%.Conclusion Be based on MCV,MCH,RDW-CV and combined with Hb electrophoresis,EFT and G6PD,it can be helpful to differentiate miocrocytic anemia into thalas-saemia,IDA and anaemia of chronic disease.