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目的探讨平均红细胞体积(Mean corpuscular volume,MCV)、平均红细胞血红蛋白量(Mean corpuscular hemoglobin,MCH)、红细胞分布宽度(RDW)及血清铁蛋白(Serum ferritin,SF)在鉴别缺铁性贫血和地中海贫血中的价值。方法收集广东省妇幼保健院2013年1月~2015年12月确诊为地中海贫血的患者120例(地贫组),缺铁性贫血的患者100例(IDA组),另收集60例健康志愿者(对照组),检测所有患者的血常规五分类和血清铁蛋白。结果地贫组和IDA组患者MCV和MCH均低于对照组,差异有统计学意义(P<0.05);地贫组MCV低于IDA组,差异有统计学意义(P<0.05);IDA组SF低于地贫组和对照组,差异有统计学意义(P<0.05),地贫组SF值高于对照组(P<0.05);地贫组和IDA组患者MCH值都低于对照组,差异有统计学意义(P<0.05);IDA组患者RDW值高于地贫组和对照组,差异有统计学意义(P<0.05)。同时多个项目联合检测更能提高鉴别诊断的效率,跟基因诊断金标准相比MCV、MCH、RDW及SF联合检测筛查地中海贫血的灵敏度为90.8%,特异度为90.0%。结论 MCV、MCH、RDW及SF在鉴别缺铁性贫血和地中海贫血中有重要的参考价值,对预防和降低重型地贫患儿的出生有着重要的意义。
Objective To investigate the relationship between mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), distribution width of red blood cells (RDW) and serum ferritin (SF) in the differential diagnosis of iron deficiency anemia and thalassemia In the value. Methods One hundred and twenty patients (thalassemia group) diagnosed as thalassemia from January 2013 to December 2015 in Guangdong Maternal and Child Health Hospital were collected, and 100 patients with IDA (IDA group) were enrolled. Another 60 healthy volunteers (Control group), all patients were tested for blood classification and serum ferritin. Results The MCV and MCH in thalassemia group and IDA group were significantly lower than those in control group (P <0.05). The MCV in thalassemia group was lower than that in IDA group (P <0.05) SF was lower than thalassemia group and control group, the difference was statistically significant (P <0.05), thalassemia group SF value was higher than the control group (P <0.05); Thalassemia group and IDA group MCH values were lower than the control group , The difference was statistically significant (P <0.05). The RDW in IDA group was higher than that in thalassemia group and control group (P <0.05). At the same time, the combined detection of multiple items can improve the efficiency of differential diagnosis. Compared with the gold standard of genetic diagnosis, the sensitivity, specificity and accuracy of the combined detection of MCV, MCH, RDW and SF in screening thalassemia were 90.8% and 90.0% respectively. Conclusion MCV, MCH, RDW and SF have important reference values in the differential diagnosis of iron deficiency anemia and thalassemia, and are of great significance in preventing and reducing the birth of children with severe thalassemia.