Zhan J Y, Zheng S S, Dong W W, Shao J
Department of Pediatric Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China.
Zhonghua Er Ke Za Zhi. 2020 Mar 2;58(3):201-205. doi: 10.3760/cma.j.issn.0578-1310.2020.03.008.
To explore the predictive values of routine blood test results for iron deficiency (ID) screening in children. Routine blood test results and serum ferritin (SF) levels from 1 443 healthy children (862 boys, 581 girls) aged 6 months to 18 years, who were seen for well-child visits between June 2017 and May 2019 in Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. ID was defined as SF<20 μg/L, iron deficiency anemia (IDA) as ID with anemia (hemoglobin(Hb)<110 g/L at 6 months-5 years of age, Hb<120 g/L at 6-18 years of age), non-anemia ID as ID without anemia, non-ID anemia as SF≥20 μg/L with anemia, and healthy control subjects as those with SF≥20 μg/L but without anemia. The blood test results including Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), and the percentage of low hemoglobin density (LHD) of healthy control, non-anemia ID, non-ID anemia, and IDA groups were compared by analysis of variance (ANOVA) or non-parametric test, quantitative data were described as ± or (interquartile range), and receiver operating characteristic curve (ROC) analysis was applied to assess predictive values of routine blood test results and LHD for detecting IDA and ID. Among 1 443 children with median age of 2.1(3.3) years, 1 061 children were in healthy control group, 292 in non-anemia ID group, 43 in non-ID anemia group and 47 in IDA group. The prevalence of ID was much higher than that of anemia (23.5% (339/1 443) 6.2% (90/1 443) , χ(2)=169.76, 0.01). Compared with control group, non-anemia ID group showed higher LHD (0.088 (0.093) 0.073 (0.068), 0.01) and RDW (0.131±0.013 0.126±0.008, 0.01), lower MCV ((80±4) (83±4) fl, 0.01) and MCHC values ((326±9) (329±8) g/L, 0.01). IDA group showed higher LHD (0.322(0.544)) and RDW (0.151±0.018), lower MCV ((73±6) fl) and MCHC values((309±14) g/L) than non-anemia ID group (all <0.01). The area under curve (AUC) values of MCHC, LHD, RDW and MCV for detecting ID were 0.63 (95: 0.60-0.67), 0.63 (95%:0.60-0.67), 0.67 (95: 0.63-0.70) and 0.73 (95: 0.69-0.76) respectively. With cutoff limits (MCV<80.2 fl, RDW>0.131 or MCHC<322 g/L), MCV, RDW and MCHC showed higher sensitivity for screening ID than hemoglobin (0.540, 0.469 and 0.336 0.139, χ(2)=121.70, 87.47, 35.56, all <0.01). MCV, RDW and MCHC can be used to screen ID in primary health care settings.
探讨血常规检查结果对儿童缺铁（ID）筛查的预测价值。回顾性分析了2017年6月至2019年5月在浙江大学医学院附属儿童医院进行健康体检的1443名6个月至18岁健康儿童（862名男孩，581名女孩）的血常规检查结果和血清铁蛋白（SF）水平。ID定义为SF<20μg/L，缺铁性贫血（IDA）定义为伴有贫血的ID（6个月至5岁儿童血红蛋白（Hb）<110g/L，6至18岁儿童Hb<120g/L），非贫血ID定义为不伴有贫血的ID，非ID贫血定义为SF≥20μg/L且伴有贫血，健康对照组定义为SF≥20μg/L且无贫血的儿童。采用方差分析（ANOVA）或非参数检验比较健康对照组、非贫血ID组、非ID贫血组和IDA组的血常规检查结果，包括Hb、平均红细胞体积（MCV）、平均红细胞血红蛋白浓度（MCHC）、红细胞分布宽度（RDW）和低血红蛋白密度（LHD）百分比，定量数据以±或（四分位数间距）表示，并应用受试者工作特征曲线（ROC）分析评估血常规检查结果和LHD对IDA和ID的检测预测价值。在1443名中位年龄为2.1（3.3）岁的儿童中，1061名儿童为健康对照组，292名儿童为非贫血ID组，43名儿童为非ID贫血组，47名儿童为IDA组。ID的患病率远高于贫血（23.5%（339/1443）对6.2%（90/1443），χ²=169.76，P<0.01）。与对照组相比，非贫血ID组的LHD（0.088（0.093）对0.073（0.068），P<0.01）和RDW（0.131±0.013对0.126±0.008，P<0.01）较高，MCV（（80±4）对（83±4）fl，P<0.01）和MCHC值（（326±9）对（329±8）g/L，P<0.01）较低。IDA组的LHD（0.322（0.544））和RDW（0.151±0.018）高于非贫血ID组，MCV（（73±6）fl）和MCHC值（（309±14）g/L）低于非贫血ID组（均P<0.01）。MCHC、LHD、RDW和MCV检测ID的曲线下面积（AUC）值分别为0.63（95%：0.60 - 0.67）、0.63（95%：0.60 - 0.67）、0.67（95%：0.63 - 0.70）和0.73（95%：0.69 - 0.76）。以截断值（MCV<80.2fl，RDW>0.131或MCHC<322g/L）判断，MCV、RDW和MCHC筛查ID的灵敏度高于血红蛋白（0.540、0.469和0.336对0.139，χ²=121.
