【罂粟摘要】无创血红蛋白检查作为检测择期手术患者术前贫血的指标——一项前瞻性研究
无创血红蛋白检查作为检测择期手术患者术前贫血的指标——一项前瞻性研究
使用绝对值进行无创血红蛋白测定缺乏精密性，不能作为术前贫血治疗的唯一依据。然而，它可能会作为一种筛查测试，当数值保持在预先设定的分界值以下时，以高灵敏度来提示患者“贫血”。根据以往数据，无创血红蛋白临界值(女性146g·L−1，男性152g·L−1)能以99%的灵敏度检测出真正的贫血。通过对择期手术患者术前进行无创和有创血红蛋白的前瞻性测量，验证这些具有预先设定临界值的指标测试。在809名患者中，女性的检测敏感度(95%CI)估计为98.9%(94.1-99.9%)，男性为96.4%(91.0-99.0%)。这能够免去9%的女性和28%的男性患者的有创血液检查。在女性患者中，较低的无创血红蛋白临界值(138g.L−1)将免去28%的有创血液检查，灵敏度为95%。以女性152g·L−1和男性162g·L−1为无创血红蛋白的临界值，可达到99%的敏感性，可分别免去3%和9%的有创检查。无创血红蛋白检查和实验室血红蛋白检查结果之间的偏差和一致性限值分别为2和−25~28g·L−1。患者和测量方法不影响无创血红蛋白检查和血红蛋白实验室检查结果之间的一致性。虽然灵敏度很高，但使用预先设定的临界值进行指标测试时，并未能够十分灵敏地达到检测真正贫血的目的。然而，关于血液保护效果，在男性中使用指标测试可能在临床上有用，而在女性中使用较低临界值(132g·L−1)的指标测试可能在临床上更加合适。
Non-invasive haemoglobin measurement as an index test to detect pre-operative anaemia in elective surgery patients–a prospective study
Non-invasive haemoglobin measurement using absolute values lacks the precision to be the sole basis for the treatment of pre-operative anaemia. However, it can possibly serve as a screening test, indexing 'anaemia’ with high sensitivity when values remain under prespecified cut-off values. Based on previous data, non-invasive haemoglobin cut-off values (146g·L−1for women and 152g·L−1for men) detect true anaemia with 99% sensitivity. An index test with these prespecified cut-off values was verified by prospective measurement of noninvasive and invasive haemoglobin pre-operatively in elective surgical patients. In 809 patients, this showed an estimated sensitivity (95%CI) of 98.9% (94.1–99.9%) in women and 96.4% (91.0–99.0%) in men. This saved invasive blood tests in 9% of female and 28% of male patients. In female patients, a lower non-invasive haemoglobin cut-off value (138g·L−1) would save 28% of invasive blood tests with a sensitivity of 95%. The target 99% sensitivity would be reached by non-invasive haemoglobin cut-off values of 152g·L−1 in female and 162 g·L−1 in male patients, saving 3% and 9% of invasive blood tests, respectively. Bias and limits of agreement between non-invasive and laboratory haemoglobin levels were 2 and −25 to 28g·L−1, respectively. Patient and measurement characteristics did not influence the agreement between non-invasive and laboratory haemoglobin levels. Although sensitivity was very high, the index test using prespecified cut-off values just failed to reach the target sensitivity to detect true anaemia. Nevertheless, with respect to blood-sparing effects, the use of the index test in men may be clinically useful, while an index test with a lower cut-off (132g·L−1) could be more clinically appropriate in women.
翻译：佟睿 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组