Objective To explore the diagnosis and clinical value of reticulocyte hemoglobin content (Ret-He) in the diagnosis of iron deficiency in pregnant women with mild thalassemia.
Methods A total of 550 pregnant women with outpatient in The Third Hospital of Mianyang and Mianyang Central Hospital were selected as the study subjects from January 2017 to October 2019, including 200 pregnant women with iron deficiency (group ID), 105 pregnant women with iron deficiency anemia (group IDA), 81 pregnant women with mild thalassemia and iron deficiency (group TT1), 32 pregnant women with mild thalassemia without iron deficiency (group TT0), and 132 healthy pregnant women in the same period (control group). Ret-He, Hb, MCV, MCH, MCHC, Ret% and serum ferritin (SF) levels were detected, ROC curve was used to evaluate the value of iron deficiency in pregnant women with mild thalassaemia. Meanwhile, iron deficiency pregnant women who participated in iron treatment were selected from groups ID, IDA and TT1 to compare the changes of each observation index before and after iron agent treatment.
Results Hb, MCHC and Ret-He levels in TT1 group were significantly lower than those in the other 4 groups ( P<0.05). SF level in TT1 group was significantly lower than that in ID, TT0, control groups ( P<0.05), but no significant difference was observed from IDA group ( P>0.05). Hb, MCH, MCHC and Ret-He levels in ID group were higher than those in IDA, TT1, TT0 groups ( P<0.05). And SF level in TT0 group was not significantly different from that of control group ( P>0.05). ROC curve showed that the critical value is 22.9 pg of Ret-He to diagnose iron deficiency in thalassemia pregnant women with sensitivity and specificity as 99.0% and 79.0%. Ret-He, Hb and SF were statistically increased in pregnant women with thalassemia and iron-deficiency, pregnant women with iron-deficiency and pregnant women with iron-deficiency anemia after iron supplementation ( P<0.01).
Conclusions Ret-He content in pregnant women with thalassemia and iron-deficiency is lower than that in normal pregnant women, and it is a more accurate hematological indicator in diagnosing iron-deficiency in pregnant women with thalassemia when compared with the others. Ret-He can be used not only as a screening and diagnosis indicator for iron deficiency, but also as a monitor for iron treatment in pregnant women with thalassemia.
摘要： 目的 探讨网织红细胞血红蛋白含 量 (Ret-He) 对 轻型地中海贫血孕妇铁缺乏的诊断及疗效评价。 方法 选取 2017 年 1 月—2019 年 10 月绵阳市第三人民医院和绵阳市中心医院门诊产科建卡孕妇 550 例作为研究对 象, 其中铁缺乏孕妇 200 例(ID 组)、缺铁性贫血孕妇 105 例(IDA 组), 轻型地中海贫血合并缺铁孕妇 81 例(TT1 组), 轻型地 中海贫血未合并缺铁孕妇 32 例(TT0 组)及同期健康孕妇 132 例 (对照组) , 对各组进行 Ret-He、Hb、MCV、MCH、MCHC、Ret%等血液学指标及 SF 水平检测, 对所得数据应用 ROC 曲线进行诊断轻型地中海贫血孕妇铁缺乏的价值评价, 同时 从 ID 组、IDA 组、TT1 组选取参与铁剂治疗的缺铁孕妇, 比较铁剂治疗前后各观察指标的变化。 结果 TT1 组的 Hb、MCHC 及 Ret-He 均低于其他四组, 差异有统计学意义( P<0.05), SF 水平低于 ID、TT0、对照三组( P<0.05), 而与 IDA 组差 异无统计学意义 ( P>0.05) ; ID 组的 Hb、MCH、MCHC 及 Ret-He 均高于 IDA、TT1、TT0 三组( P<0.05) ; TT0 组的 SF 水平与 对照组差异无统计学意义 ( P>0.05); ROC 分析显示, 在临界值为 22.9 pg 时, Ret-He 对地中海贫血孕妇铁缺乏的诊断灵 敏度和特异度分别为 99.0％和 79.0％; 参与铁剂治疗的轻型地中海贫血合并缺铁孕妇、ID 孕妇及 IDA 孕妇在补铁治疗 后 Ret-He、Hb 及 SF 均增高, 差异有统计学意义( P<0.01)。 结论 轻型地中海贫血孕妇铁缺乏时 Ret-He 含量低于普通 孕妇, Ret-He 相较其他血液学指标, 对轻型地中海贫血孕妇铁缺乏的诊断准确性更高。Ret-He 不仅可作为轻型地中 海贫血孕妇铁缺乏的筛查诊断指标, 还可用于轻型地中海贫血孕妇铁剂治疗的监测。