初診再生障礙性貧血及非再障全血細(xì)胞減少患者血清鐵蛋白水平分析

程源山++況麗平++李回軍

[摘要]目的 探討血清鐵蛋白（SF）在初診再生障礙性貧血（AA）及其他表現(xiàn)為全血細(xì)胞減少疾病中的水平及臨床意義。方法 收集2010年1月～2016年2月在我院接受治療的340例初診全血細(xì)胞減少患者，根據(jù)診斷分為AA組（176例）、骨髓增生異常綜合征組（MDS組，56例）、白血病組（57例）、免疫性疾病組（36例）和巨幼細(xì)胞性貧血組（15例）。另選取30名健康體檢者為對(duì)照組。應(yīng)用化學(xué)發(fā)光法檢測(cè)患者和對(duì)照組SF水平并進(jìn)行全血細(xì)胞計(jì)數(shù)。結(jié)果 測(cè)得初診AA患者SF水平為（536.32±345.29）μg/L，高于對(duì)照組、免疫性疾病組和巨幼細(xì)胞性貧血組，但低于MDS組和白血病組，差別均有統(tǒng)計(jì)學(xué)意義（P<0.05）。AA組中，60歲以上、男性以及重型AA患者的SF水平較高。白細(xì)胞計(jì)數(shù)，血小板計(jì)數(shù)與SF水平成負(fù)相關(guān)（r=-0.171，P<0.05；r=-0.156，P<0.05），初診AA患者達(dá)到鐵過(guò)載標(biāo)準(zhǔn)為13%，男性和高齡是鐵過(guò)載的危險(xiǎn)因素（P<0.05）。結(jié)論 初診AA患者SF水平較正常人增高；在表現(xiàn)為全血細(xì)胞減少的疾病中，其SF水平低于血液腫瘤患者，對(duì)全血細(xì)胞減少患者的診斷有一定意義。

[關(guān)鍵詞]全血細(xì)胞減少；再生障礙性貧血；血清鐵蛋白

[中圖分類(lèi)號(hào)] R556.5 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2017）04（c）-0020-03

[Abstract]Objective To investigate the level of serum ferritin （SF） and its clinical significance in newly diagnosed aplastic anemia （AA） and other disorders with pancytopenia.Methods From January 2010 to February 2016，340 patients with pancytopenia treated in our hospital were divided into AA group （176 cases），MDS group （56 cases），leukemia group（57 cases），immune disorders group（36 cases） and megaloblastic anemia group （15 cases） based on their diagnoses.Control group including 30 healthy people received health examination in our hospital.Serum ferritin level determined by chemiluminescence as well as complete blood count were tested among the patients and control group.Results SF level of newly diagnosed AA patients was （536.32±345.29） μg/L，and it was higher than that of control group and immune disorders group and megaloblastic anemia group，but it was lower than that of leukemia group and MDS group.All the differences are statistically significant （P<0.05）.In AA group，the patients that older than 60，male patients and sever aplastic anemia （SAA） patients had a higher level of SF.White blood cell count and platelet count were negatively correlated with SF level （r=-0.171，P<0.05；r=-0.156，P<0.05）.Iron overload was diagnosed in 13% newly diagnosed AA patients，male and age>60 years old were the risk factors of iron overload（P<0.05）.Conclusion SF level of newly diagnosed AA patients is higher than healthy people，and it is lower than patients with leukemia and MDS.SF level has a certain clinical significance to the differential diagnosis of the disorders with pancytopenia.

[Key words]Pancytopenia；Aplastic anemia；Serum ferritin

再生障礙性貧血（aplastic anemia，AA）和臨床許多血液系統(tǒng)疾病的血象表現(xiàn)為全血細(xì)胞減少，即貧血同時(shí)伴有白細(xì)胞（WBC）和血小板（PLT）減少。AA和其他表現(xiàn)為全血細(xì)胞減少的血液疾病時(shí)有混淆。血清鐵蛋白（serum ferritin，SF）可反映機(jī)體儲(chǔ)存鐵的狀態(tài)，通過(guò)檢測(cè)SF水平來(lái)了解貧血的病因，是臨床診斷貧血原因的常用手段。目前SF水平及鐵過(guò)載的研究對(duì)象主要集中在輸血依賴(lài)患者[1]，在初診AA及其他表現(xiàn)為全血細(xì)胞減少的血液病卻鮮見(jiàn)報(bào)道，本文通過(guò)分析全血細(xì)胞減少患者SF水平來(lái)探討SF水平與疾病類(lèi)型的關(guān)系，為臨床全血細(xì)胞減少的診治提供幫助，現(xiàn)報(bào)道如下。