25-羟基维生素D、红细胞参数与铁代谢指标联合检测对0～18岁缺铁性贫血人群的预测价值OA
Predictive value of combined detection of 25-hydroxyvitamin D,erythrocyte parameters and iron metabolism indicators for iron deficiency anemia in people aged 0-18 years
目的 探讨25-羟基维生素D[25-(OH)D]、红细胞参数与铁代谢指标联合检测诊断0～18岁缺铁性贫血(IDA)人群的价值.方法 选取0～18岁确诊为IDA的人群与健康的人群各75例,均按照年龄分为学龄前组(0～6岁)和学龄期组(7～18岁).分别检测各组血清25-(OH)D、血红蛋白(Hb)、平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、转铁蛋白饱和度(TS)、血清铁蛋白(SF)和转铁蛋白(TRF)水平;进行独立样本非参数检验并绘制受试者工作特征(ROC)曲线,分层判断不同指标对不同年龄段IDA的诊断价值,制定不同的筛查流程.结果 IDA组25-(OH)D、Hb、MCV、MCH、SF、TS水平低于对照组,TRF高于对照组,差异有统计学意义(P＜0.05).0～18岁整体样本中,25-(OH)D为IDA独立预测因子(OR=0.960,P=0.017);年龄分层分析显示,学龄前儿童25-(OH)D在单因素分析中无显著差异,未纳入多因素独立预测模型;学龄期儿童中,25-(OH)D在多因素分析中无独立诊断价值(P=0.170).学龄前组、学龄期组和0～18岁人群最优联合诊断模型的ROC曲线下面积分别为0.881、0.873、0.885,显著高于单一指标.结论 不同年龄段IDA患者最优诊断模型存在明显的异质性,25-(OH)D仅在0～18岁全年龄段人群中具有独立预测价值,分层后在学龄前组和学龄期组均无独立预测价值.分年龄段进行联合检测可有效弥补单一指标的诊断缺陷,为临床早期精准诊断提供可靠的实验室依据.
Objective To investigate the value of combined detection of 25-hydroxyvitamin D[25-(OH)D],erythrocyte parameters,and iron metabolism indicators in the diagnosis of iron defi-ciency anemia(IDA)in people aged 0-18 years.Methods A total of 75 people aged 0 to 18 years with confirmed IDA and 75 healthy controls were enrolled.All subjects were further divided into pre-school group(0 to 6 years)and school-age group(7 to 18 years)according to age.Serum levels of 25-(OH)D,hemoglobin(Hb),mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),transferrin saturation(TS),serumferritin(SF),and transferrin(TRF)were measured in each group.Independent-sample non-parametric tests were performed,and receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic value of different indicators for IDA across dif-ferent age groups,with the aim of establishing distinct screening algorithms.Results In IDA group,the levels of 25-(OH)D,Hb,MCV,MCH,SF,and TS were significantly lower than those in the control subgroup,while TRF levels were significantly higher(P＜0.05).In the overall sam-ple aged 0 to 18 years,25-(OH)D was identified as an independent predictor of IDA(OR=0.960,P=0.017).Age-stratified analysis revealed that 25-(OH)D was not significant in univari-ate analysis in the preschool group and thus was not included in the multivariate independent predic-tion model;in the school-age group,25-(OH)D showed no independent diagnostic value in multi-variate analysis(P=0.170).The area under the ROC curve of the optimal combined diagnostic model was 0.881,0.873,and 0.885 for the preschool group,school-age group,and the overall 0 to 18 years group,respectively,which were significantly higher than those of any single indicator.Conclusion The optimal diagnostic models for IDA patients exhibit marked heterogeneity across different age groups.25-(OH)D demonstrates independent predictive value only in the overall 0 to 18 years population,but has no independent predictive value after stratification in both the preschool and school-age subgroups.Age-stratified combined detection can effectively compensate for the diag-nostic limitations of single indicators and provide a reliable laboratory basis for early and precise clinical diagnosis.
赵熙;樊文辉;靳伟舰;刘杰;马贤纵;常帅
中国人民解放军总医院第七医学中心,检验科,北京,100700中国人民解放军总医院第七医学中心,检验科,北京,100700中国人民解放军总医院第七医学中心,检验科,北京,100700中国人民解放军总医院第七医学中心,检验科,北京,100700中国人民解放军总医院第一医学中心消化学部,北京,100853||中国人民解放军总医院第七医学中心,消化内科,北京,100700中国人民解放军总医院第七医学中心,检验科,北京,100700
医药卫生
缺铁性贫血25羟基维生素D血红蛋白平均红细胞体积转铁蛋白饱和度血清铁蛋白转铁蛋白联合诊断
iron deficiency anemia25-hydroxyvitamin Dhemoglobinmean corpuscular vol-umetransferrin saturationserum ferritintransferrincombined diagnosis
《实用临床医药杂志》 2026 (17)
46-53,62,9
国家自然科学基金资助项目(82500685)
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