本文關(guān)鍵詞： 低血紅蛋白密度 鐵代謝 缺鐵性貧血 診斷 療效觀察　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過檢測紅細(xì)胞新參數(shù)低血紅蛋白密度(low hemoglobin density,LHD)及鐵代謝指標(biāo)的實(shí)驗(yàn)診斷研究,評價(jià)低血紅蛋白密度在缺鐵性貧血(iron deficiency anemia,IDA)診斷及鑒別診斷的應(yīng)用價(jià)值,并通過口服鐵劑后LHD的變化情況,動(dòng)態(tài)監(jiān)測缺鐵性貧血患者對鐵劑治療的的療效反應(yīng),為臨床缺鐵性貧血的診治提供新的參考依據(jù)。方法:選取2016年6月至2016年11月在吉林大學(xué)第一醫(yī)院就診的門診及住院患者共170例,分為缺鐵性貧血組50例,腫瘤性貧血組50例、腎性貧血組50例;對照組為同期我院的健康體檢者20例。分別采用全自動(dòng)血細(xì)胞分析儀測定各組紅細(xì)胞參數(shù)中的LHD、RBC、HGB、HCT、MCV、MCH、MCHC,全自動(dòng)生化分析儀測定血清鐵(serum iron,SI)、血清鐵蛋白(serum ferritin,SF)及總鐵結(jié)合力(total iron binding capacity,TIBC),特種蛋白儀測定轉(zhuǎn)鐵蛋白(transferrin,Tf),轉(zhuǎn)鐵蛋白飽和度(transferrin saturation,TS),分別對以上各項(xiàng)參數(shù)進(jìn)行組內(nèi)比較和組間比較,并分析LHD與鐵代謝參數(shù)的相關(guān)性;通過ROC曲線分析LHD和鐵代謝指標(biāo)在IDA和ACD中的敏感度、特異度及臨界值;動(dòng)態(tài)觀察IDA患者治療1w、4w、8w、12w的LHD變化情況,同時(shí)比對慢性病貧血治療前后LHD和鐵代謝指標(biāo)的變化情況。全部檢驗(yàn)數(shù)據(jù)采用SPSS 23.0進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果:1.LHD在各組的檢測結(jié)果:LHD在IDA組為77.4%±23.4%,顯著高于腫瘤性貧血組3.9%±3.7%、腎性貧血組5.4%±4.9%和對照組2.3%±1.6%(P值均0.05)。腫瘤性貧血組、腎性貧血組與對照組之間差異無統(tǒng)計(jì)學(xué)意義。2.LHD及鐵代謝指標(biāo)對IDA診斷的臨界值、敏感度及特異度:當(dāng)ROC曲線下面積(area under ROC curve,AUC)為0.993時(shí),LHD對IDA診斷的臨界值是6.8%,敏感度100%、特異度98.4%。轉(zhuǎn)鐵蛋白飽和度(TS)、血清鐵(SI)、轉(zhuǎn)鐵蛋白(Tf)、鐵蛋白(SF)、總鐵結(jié)合力(TIBC)的AUC、敏感度和特異度分別為(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%)。比對.LHD對腫瘤性貧血和腎性貧血診斷的ROC曲線:LHD對腫瘤性貧血和腎性貧血診斷能力較低,敏感度分別為39.5%、57.5%,特異度分別為81.4%和78.7%。3.LHD與鐵代謝指標(biāo)對IDA診斷的相關(guān)性:缺鐵性貧血患者中LHD與TIBC呈正相關(guān)(r=0.32,P0.05),與SI、TS呈負(fù)相關(guān)(r值分別為-0.419、-0.599,P值均0.05),與SF、TF無顯著相關(guān)性。.4.IDA組治療前LHD與HGB的相關(guān)性:LHD水平檢測結(jié)果是重度貧血組(HGB:30~60g/L)高于中度貧血組(HGB:60~90g/L)高于輕度貧血組(HGB:90~110/120g/L),分別為94.6%±9.5%84.8%±17.4%56.0%±19.2%;LHD隨著HGB的減低而增高,二者呈負(fù)相關(guān)(r=-0.515,P=0.001)。5.貧血患者治療前、后LHD變化情況:28例缺鐵性貧血患者口服鐵劑治療前LHD為87.8%±12.8%,口服鐵劑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%。同時(shí),血清鐵增高、鐵蛋白增高、紅細(xì)胞及血紅蛋白逐漸恢復(fù)正常;LHD水平于治療后第4w較治療前明顯降低,差異有統(tǒng)計(jì)學(xué)意義,12w接近正常水平。腎性貧血和腫瘤性貧血患者在對癥治療前后,LHD變化差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:1.LHD對缺鐵性貧血診斷有較高敏感度、特異度,且LHD只在缺鐵性貧血時(shí)明顯升高,在其他不伴缺鐵的貧血類型中不升高,可作為缺鐵性貧血診斷和鑒別診斷的參考指標(biāo)。2.缺鐵性貧血中LHD隨HGB的降低而升高,二者呈負(fù)相關(guān),LHD隨著貧血的加重而增高。LHD與鐵代謝指標(biāo)有一定相關(guān)性,可反映機(jī)體鐵缺乏的嚴(yán)重程度。3.缺鐵性貧血患者口服鐵劑后12周LHD基本恢復(fù)正常水平,連續(xù)動(dòng)態(tài)監(jiān)測LHD可有效評估病情變化和鐵劑治療效果。
[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%鹵1.6%(P鍊煎潎0.05).鑲跨槫鎬ц傳琛，

本文編號：1489229