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目的回顾性分析新生儿足跟血滤纸干血片血红蛋白电泳数据,计算Hb A的正常参考区间并探讨Hb A用于β-珠蛋白生成障碍性贫血诊断的临界值。方法随机选取2014年12月到2015年5月出生的新生儿足跟血滤纸干血片血红蛋白电泳时没有出现Hb Bart′s及其他异常血红蛋白的3768例结果计算新生儿Hb A的95%可信区间。并随机选取同时期新生儿足跟血标本2987例做地贫基因检测,以基因检测结果为诊断金标准,绘制辅助诊断β-珠蛋白生成障碍性贫血的ROC曲线,确定阳性切值并计算阳性预测值,探讨Hb A用于新生儿β-珠蛋白生成障碍性贫血的诊断价值。结果经统计Hb A呈偏态分布,新生儿性别、体重及孕周对Hb A结果无明显影响(P>0.05),中位数为17.9%,95%可信区间为(8.6%,37.4%)。统计结果显示,β-珠蛋白生成障碍性贫血组和健康组的Hb A、Hb F含量有显著性差异。ROC曲线结果表明,Hb A用于β-珠蛋白生成障碍性贫血诊断的最佳切值为12.55%(灵敏度0.667,特异性0.847)。结论为降低临床召回压力,综合考虑特异性和阳性预测值,建议采用Hb A的95%可信区间(<8.6%)作为新生儿滤纸干血片Hb A诊断β-珠蛋白生成障碍性贫血的临界值。
Objective To retrospectively analyze the hemoglobin electrophoresis data of dry hematophagoides in hematology hematology filter paper and to calculate the normal reference interval of Hb A and to explore the critical value of Hb A in the diagnosis of β-globinogenic anemia. Methods Randomly select 3768 cases of Hb Bart’s and other abnormal hemoglobin when hemoglobin electrophoresis of dry hematophagus was taken from December 2014 to May 2015. 95% confidence in neonatal Hb A Range. 2987 cases of neonatal heel hematoma were selected randomly to detect the thalassemia gene. The genetic test was used as the gold standard of diagnosis to draw the ROC curve to help diagnose β-globinogenic anemia. The positive cut-off value was calculated and the positive Predict the value of Hb A for the diagnosis of neonatal β-globin aplastic anemia. Results There was a skewed distribution of Hb A in statistics. Neonatal sex, body weight and gestational age had no significant effect on Hb A (P> 0.05), with a median of 17.9% and a 95% confidence interval of 8.6% and 37.4% ). The statistical results showed that there was a significant difference in the contents of Hb A and Hb F between the β-globin aplastic anemia group and the healthy group. The results of ROC curve showed that the optimal cut-off value of Hb A for the diagnosis of beta-thalassemia was 12.55% (sensitivity 0.667, specificity 0.847). Conclusions In order to reduce the pressure on clinical recall and to consider the specificity and positive predictive value comprehensively, it is recommended to use the 95% confidence interval (<8.6%) of Hb A as a diagnostic marker for β-globinogenic anemia Threshold.