目的　成人中应用血液学指标筛查地中海贫血的报道较多,但成人的血液学诊断值不能应用于新 生儿。本研究旨在评价红细胞平均体积(MCV)、红细胞脆性、红细胞体积分布宽度(RDW)对新生儿地中海贫血的 诊断价值。方法　以386例在本院新生儿科接受治疗的高未结合胆红素血症患儿为研究对象,根据地贫基因诊断 结果分为地贫组(n=35)和非地贫组(n=351)。检测患儿MCV、红细胞脆性、RDW等血液学指标,作出ROC曲 线,分别计算曲线下面积和各指标的最佳临界值以及相应的敏感度、特异度。结果　地贫组的MCV、RDW和脆性 分别是80±8fL、16.2%±1.0%、31%±13%,而非地贫组为94±9fL、15.8%±1.0%、46%±14%,其中两组 MCV和红细胞脆性的差别具有显著意义(均P<0.01)。在诊断地贫时,MCV的ROC曲线下面积(AUCROC)为 0.877,最佳临界值为88fL,该临界值的敏感度和特异度分别是92%和73.5%;红细胞脆性的AUCROC为0.796,最 佳临界值为37.5%,该临界值的敏感度和特异度分别是85%和75%;RDW的AUCROC为0.630,最佳临界值为 15.9%,该临界值的敏感度和特异度分别是73%和58%。结论　MCV和红细胞脆性均可作为新生儿地贫诊断的 有效指标,且MCV的诊断价值优于红细胞脆性。

Objective Although many studies have shown the significance of hematologic parameters in the diagnosis of thalassemia in adults, no related reports were found in neonates. This study aimed to evaluate the value of mean corpuscular volume (MCV), red cell distribution width (RDW) and erythrocyte fragility in the diagnosis of neonatal thalassemia.Methods A total of 386 hospitalized newborns with hyperbilirubinemia were enrolled in this study. They were divided into two groups: Thalassemia group (n= 35)and Non-thalassemia group(n=351) according to the results of thalassemia gene diagnosis. MCV, erythrocyte fragility and RDV were detected. Their ROC curves were made to calculate the areas under ROC (AUC ROC), the cut-offs,sensitivity and specificity of each marker in the diagnosis of thalassemia.Results Both MCV and erythrocyte fragility were significantly lower in the Thalassemia group than in the Non-thalassemia group (80±8 fL vs 94±9 fL, 31%±13% vs 46%±14%,P< 0.01). No differences were observed between the two groups for RDW. AUC ROCs of MCV, RDW and erythrocyte fragility in the diagnosis of thalassemia were 0.877, 0.630 and 0.796, respectively. The cut-offs of MCV, RDW and erythrocyte fragility was 88 fL, 15.9%, and 37.5%, respectively. The sensitivity and specificity of MCV were 92% and 73.5%, respectively, 73% and 58% for RDW and 85% and 75% for erythrocyte fragility. Conclusions Both MCV and erythrocyte fragility can serve as markers for the diagnosis of neonatal thalassemia, and MCV appears to be a better one.