Hoffmann Johannes J M L, Urrechaga Eloísa, Aguirre Urko
Clin Chem Lab Med. 2015 Nov;53(12):1883-94. doi: 10.1515/cclm-2015-0179.
More than 40 mathematical indices have been proposed in the hematological literature for discriminating between iron deficiency anemia and thalassemia trait in subjects with microcytic red blood cells (RBCs). None of these discriminant indices is 100% sensitive and specific and also the ranking of the discriminant indices is not consistent. Therefore, we decided to conduct the first meta-analysis of the most frequently used discriminant indices.
An extensive literature search yielded 99 articles dealing with 12 indices that were investigated five or more times. For each discriminant index we calculated the diagnostic odds ratio (DOR) and summary ROC analysis was done for comparing the performance of the indices.
The ratio of microcytic to hypochromic RBCs (M/H ratio) showed the best performance, DOR=100.8. This was significantly higher than that of all other indices investigated. The RBC index scored second (DOR=47.0), closely followed by the Sirdah index (DOR=46.7) and the Ehsani index (DOR=44.7). Subsequently, there was a group of four indices with intermediate and three with lower DOR. The lowest performance (DOR=6.8) was found for the RDW (Bessman index). Overall, the indices performed better for adults than for children.
The M/H ratio outperformed all other discriminant indices for discriminating between iron deficiency anemia and thalassemia trait. Although its sensitivity and specificity are not high enough for making a definitive diagnosis, it is certainly of value for identifying those subjects with microcytic RBC in whom diagnostic tests for confirming thalassemia are indicated.
血液学文献中已提出40多种数学指标，用于鉴别小细胞性红细胞（RBC）患者的缺铁性贫血和地中海贫血特征。这些鉴别指标没有一个是100%敏感和特异的，而且鉴别指标的排名也不一致。因此，我们决定对最常用的鉴别指标进行首次荟萃分析。
广泛的文献检索产生了99篇涉及12个指标的文章，这些指标被研究了5次或更多次。对于每个鉴别指标，我们计算了诊断比值比（DOR），并进行了汇总ROC分析以比较各指标的性能。
小细胞性红细胞与低色素性红细胞的比值（M/H比值）表现最佳，DOR = 100.8。这显著高于所研究的所有其他指标。红细胞指数排名第二（DOR = 47.0），紧随其后的是Sirdah指数（DOR = 46.7）和Ehsani指数（DOR = 44.7）。随后，有一组四个指标的DOR处于中等水平，三个指标的DOR较低。RDW（Bessman指数）的性能最低（DOR = 6.8）。总体而言，这些指标在成人中的表现优于儿童。
在鉴别缺铁性贫血和地中海贫血特征方面，M/H比值优于所有其他鉴别指标。虽然其敏感性和特异性不足以做出明确诊断，但对于识别那些小细胞性RBC患者，即需要进行地中海贫血确诊诊断测试的患者，它肯定具有价值。
