初诊再生障碍性贫血及非再障全血细胞减少患者血清铁蛋白水平分析

程源山++况丽平++李回军

[摘要]目的 探讨血清铁蛋白（SF）在初诊再生障碍性贫血（AA）及其他表现为全血细胞减少疾病中的水平及临床意义。方法 收集2010年1月～2016年2月在我院接受治疗的340例初诊全血细胞减少患者，根据诊断分为AA组（176例）、骨髓增生异常综合征组（MDS组，56例）、白血病组（57例）、免疫性疾病组（36例）和巨幼细胞性贫血组（15例）。另选取30名健康体检者为对照组。应用化学发光法检测患者和对照组SF水平并进行全血细胞计数。结果 测得初诊AA患者SF水平为（536.32±345.29）μg/L，高于对照组、免疫性疾病组和巨幼细胞性贫血组，但低于MDS组和白血病组，差别均有统计学意义（P<0.05）。AA组中，60岁以上、男性以及重型AA患者的SF水平较高。白细胞计数，血小板计数与SF水平成负相关（r=-0.171，P<0.05；r=-0.156，P<0.05），初诊AA患者达到铁过载标准为13%，男性和高龄是铁过载的危险因素（P<0.05）。结论 初诊AA患者SF水平较正常人增高；在表现为全血细胞减少的疾病中，其SF水平低于血液肿瘤患者，对全血细胞减少患者的诊断有一定意义。

[关键词]全血细胞减少；再生障碍性贫血；血清铁蛋白

[中图分类号] R556.5 [文献标识码] A [文章编号] 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

再生障礙性贫血（aplastic anemia，AA）和临床许多血液系统疾病的血象表现为全血细胞减少，即贫血同时伴有白细胞（WBC）和血小板（PLT）减少。AA和其他表现为全血细胞减少的血液疾病时有混淆。血清铁蛋白（serum ferritin，SF）可反映机体储存铁的状态，通过检测SF水平来了解贫血的病因，是临床诊断贫血原因的常用手段。目前SF水平及铁过载的研究对象主要集中在输血依赖患者[1]，在初诊AA及其他表现为全血细胞减少的血液病却鲜见报道，本文通过分析全血细胞减少患者SF水平来探讨SF水平与疾病类型的关系，为临床全血细胞减少的诊治提供帮助，现报道如下。