Lin Huijun, Zhan Bicui, Shi Xiaoyan, Feng Dujin, Tao Shuting, Wo Mingyi, Fei Xianming, Wang Weizhong, Yu Yan
Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
Department of Clinical Laboratory, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.
PeerJ. 2024 Feb 29;12:e17063. doi: 10.7717/peerj.17063. eCollection 2024.
Cancer-related anemia (CRA) is a functional iron deficient anemia, and the early diagnosis will improve the prognosis of the patients. This prospective study aimed to investigate the utility of mean reticulocyte volume (MRV) in the early diagnosis of CRA.
A total of 284 first-diagnosed cancer patients were enrolled, and the subjects were assigned anemia and non-anemia groups by hemoglobin (Hb) concentrations. The mature RBC and reticulocyte indices were detected with BC-7500 blood analyzer, and the MRV, reticulocyte hemoglobin (RHE) content, and reticulocyte production index (RPI) were obtained. ROC curves were constructed in identifying anemia diagnosed by the combination of RHE and RPI. An adjusted multivariate analyse and quartiles were used to assess the associations of MRV with early CRA diagnosed by combining RBC indices (MCV, MCH and MCHC), respectively.
No statistical differences were observed in MCV, RHE and MRV levels between anemia and non-anemia subjects ( > 0.05). MRV exhibited a complete or high correlation with the RHE levels ( = 1.000, < 0.001), or MCV, MCH, and MCHC in anemia patients (: 0.575-0.820, < 0.001). ROC curves analyse indicated a highest area under curve of 0.829 (95% CI [0.762-0.895]) and 0.884 (95% CI [0.831-0.936]) for MRV in identifying anemia in male and female patients, respectively ( < 0.001). When the optimal cutoff values of MRV were set at 100.95 fl in males and 98.35 fl in females, the sensitivity and specificity were 1.00 and 0.68, and 1.00 and 0.73, respectively. The regression analyse showed that, when being as a categorical variable, MRV showed an odds ratio of 19.111 (95% CI [6.985-52.288]; < 0.001) for the incidence of CRA. The incidence of overall anemia demonstrated a more significant decrease trend along with the increase of MRV quartiles (p-trend < 0.001).
This study revealed that the MRV can be used as a convenient and sensitive index in early diagnosis of cancer-related anemia, and decreased MRV level may be the powerful predictor of overt anemia in cancer patients.
癌症相关性贫血（CRA）是一种功能性缺铁性贫血，早期诊断可改善患者预后。本前瞻性研究旨在探讨平均网织红细胞体积（MRV）在CRA早期诊断中的应用价值。
共纳入284例初诊癌症患者，根据血红蛋白（Hb）浓度将受试者分为贫血组和非贫血组。采用BC-7500血液分析仪检测成熟红细胞和网织红细胞指标，计算MRV、网织红细胞血红蛋白（RHE）含量和网织红细胞生成指数（RPI）。构建RHE和RPI联合诊断贫血的ROC曲线。分别采用校正多因素分析和四分位数法评估MRV与红细胞指标（MCV、MCH和MCHC）联合诊断的早期CRA的相关性。
贫血组与非贫血组患者MCV、RHE和MRV水平比较，差异均无统计学意义（P>0.05）。MRV与RHE水平呈完全或高度相关（r=1.000, P <0.001），与贫血患者的MCV、MCH和MCHC也呈显著相关（r: 0.575 - 0.820, P <0.001）。ROC曲线分析显示，MRV诊断男性贫血患者的曲线下面积最高为0.829（95%CI [0.762 - 0.895]），诊断女性贫血患者的曲线下面积最高为0.884（95%CI [0.831 - 0.936]）（P <0.001）。当男性MRV最佳截断值设定为100.95 fl，女性设定为98.35 fl时，则其敏感度和特异度分别为1.00及0.68以及1.00及0.73。回归分析显示，作为分类变量时，MRV对CRA发生率显示比值比为19.111（95%CI [6.985 - 52.288]; P <0.001）。随着MRV四分位数的增加，总体贫血发生率呈更显著的下降趋势（P趋势<0.001）。
本研究表明，MRV可作为CRA早期诊断的便捷、敏感指标，MRV水平降低可能是癌症患者明显贫血的有力预测指标。
