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目的:探讨异常红细胞形态学和红细胞参数检查结合骨髓铁染色及血清铁蛋白在儿童缺铁性贫血诊断中的应用价值。方法:对388例缺铁性贫血(iron deficiency anemia,IDA)患儿进行了异常红细胞形态检验并进行血清铁蛋白(serum ferritin,SF)含量检测,还对其骨髓涂片进行铁染色检查。选取388例IDA及255例慢性病性贫血(chronic diseases anemia,ACD)患者进行平均红细胞体积(mean corpuscular volume,MCV)、平均红细胞血红蛋白量(mean corpuscular hemoglobin,MCH)、红细胞平均血红蛋白浓度(mean corpuscular hemoglobin concentration,MCHC)、红细胞分布宽度(red blood cell distribution width,RDW)和SF的检测,并与203例健康对照比较,对结果进行统计学分析。结果 :388例IDA患儿异常形态红细胞占56.25%~92.34%,骨髓细胞铁染色随血清铁蛋白检测指标的增高而增高。与ACD组比较,IDA组MCV、MCH、SF均明显降低,RDW增高,差异有统计学意义(P<0.05);与对照组比较,IDA组MCV、SF明显降低,ACD组MCV无明显变化,SF明显增高,差异有统计学意义(P<0.05);MCV、RDW和SF三项联合诊断IDA的敏感性最高,达99.9%。MCV、RDW和SF联合应用可在IDA诊断与鉴别诊断中发挥更大作用。结论:异常红细胞形态学和红细胞参数检查结合骨髓铁染色及血清铁蛋白在儿童IDA鉴别诊断中有临床参考价值。
Objective: To investigate the diagnostic value of abnormal erythrocyte morphology and erythrocyte parameters in the diagnosis of iron deficiency anemia in children with bone marrow iron staining and serum ferritin. Methods: 388 children with iron deficiency anemia (IDA) were examined for abnormal erythrocyte morphology and serum ferritin (SF) levels. Iron marrow smears were also examined by iron staining. The mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin (mean corpuscular hemoglobin) in 388 patients with IDA and 255 patients with chronic diseases anemia (ACD) concentration, MCHC, RDW and SF, and compared with 203 healthy controls, the results were statistically analyzed. Results: 388 cases of IDA children with abnormal morphology of red blood cells accounted for 56.25% ~ 92.34%, bone marrow cell iron staining increased with the detection of serum ferritin increased. Compared with the ACD group, the MCV, MCH and SF in IDA group were significantly decreased and RDW increased, the difference was statistically significant (P <0.05); compared with the control group, MCV, SF significantly decreased in IDA group, MCV had no significant change in ACD group, SF was significantly higher, the difference was statistically significant (P <0.05); MCV, RDW and SF three joint diagnosis of IDA highest sensitivity, 99.9%. The combined use of MCV, RDW and SF can play a greater role in the diagnosis and differential diagnosis of IDA. Conclusion: The abnormal erythrocyte morphology and erythrocyte parameter examination combined with bone marrow iron staining and serum ferritin have clinical value in the differential diagnosis of IDA in children.