本文選題：腎病 + 兒童��； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年05期

【摘要】：目的:對(duì)比外周血無(wú)創(chuàng)總血紅蛋白測(cè)定與靜脈血血紅蛋白檢測(cè)在腎病患兒血紅蛋白測(cè)量中的相關(guān)性及一致性,并分析其可能的影響因素,為外周血無(wú)創(chuàng)總血紅蛋白檢測(cè)技術(shù)應(yīng)用于腎病兒童血紅蛋白的監(jiān)測(cè)提供參考依據(jù)。方法:選擇北京大學(xué)第一醫(yī)院兒科2014年10月至2015年2月85名腎病住院患兒作為研究對(duì)象,其中男50例(58.8%),女35例(41.2%),年齡(9.35±4.29)歲(3~18歲),非慣用手的無(wú)名指作為檢測(cè)部位,用無(wú)創(chuàng)血紅蛋白檢測(cè)儀(PRONTO-7)檢測(cè)無(wú)創(chuàng)血紅蛋白濃度(noninvasive hemoglobin monitoring by spectrophotometry,Sp Hb),然后在5 min內(nèi)抽取靜脈血2 m L,通過(guò)血液分析儀(Beckman coulter DXH-800)測(cè)定靜脈血紅蛋白濃度(true hemoglobin,t Hb)。對(duì)所測(cè)得的Sp Hb和t Hb兩組數(shù)據(jù)進(jìn)行比較分析。結(jié)果:對(duì)85對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,相關(guān)性分析顯示,Sp Hb與t Hb的相關(guān)系數(shù)為0.85(P0.05),有顯著相關(guān)性。Bland-Altman一致性分析顯示,Sp Hb與t Hb的差值的平均值為-1.3 g/d L,標(biāo)準(zhǔn)差為1.47 g/d L,兩者差值的95%CI為-4.2~1.5 g/d L,提示Sp Hb的平均測(cè)量結(jié)果低于t Hb測(cè)量結(jié)果。根據(jù)Sp Hb與t Hb的差值百分比繪制Bland-Altman一致性描點(diǎn)圖,顯示差值/均值百分比的均值為-9.8%,一致性界限為(-35.9%,16.2%),超過(guò)了《全國(guó)臨床檢驗(yàn)操作規(guī)程》中允許的±6%的可接受范圍。外周血無(wú)創(chuàng)血紅蛋白檢測(cè)與靜脈血血紅蛋白檢測(cè)的一致率為31.8%,一致率的95%CI為21.7%~41.9%。四格表卡方檢驗(yàn)顯示采用Sp Hb值診斷貧血靈敏度較高,但特異性低,假陽(yáng)性率高,且差異具有統(tǒng)計(jì)學(xué)意義(P=0.000)。結(jié)論:腎病患兒的無(wú)創(chuàng)血紅蛋白檢測(cè)值與靜脈血紅蛋白值之間具有顯著相關(guān)性,可以用于動(dòng)態(tài)監(jiān)測(cè)血紅蛋白濃度的變化趨勢(shì),但一致性不足,無(wú)創(chuàng)血紅蛋白測(cè)定尚不能取代靜脈血紅蛋白測(cè)定,尚不能用于貧血的診斷,其在腎病患兒血紅蛋白濃度測(cè)量中的準(zhǔn)確度有待于進(jìn)一步探討。
[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 鹵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 鹵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.
【作者單位】： 北京大學(xué)第一醫(yī)院兒科;廈門市婦幼保健院兒科;
【分類號(hào)】：R726.9

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