【奥译言】有这样一款智能手机APP：通过“手指甲自拍”可以无创检测贫血

2018-12-11 09:27 阅读数：3773 标签：

美国研究人员开发出一款智能手机APP，用户可以通过这款APP拍摄手指甲照片来确定自己的血红蛋白水平。

据称，这款APP能够帮助慢性贫血患者进行自我管理，让患者监测自己的病情，确定患者需要调整治疗或接受输血的时间，从而最大程度降低输血过早或过晚的副作用或并发症。

研究人员对手指甲照片进行了研究，并对337名受试者的指甲床颜色与全血细胞计数（CBC）检测到的血红蛋白水平进行了关联分析。在这337人当中，有些人很健康，另一些人则诊断出有多种贫血症状。

这些研究人员通过其中 237 名受试者开发出一种将手指甲颜色转化为血液血红蛋白水平的算法，之后对另外100 名受试者进行了检测。

他们发现，利用单个智能手机图像，在无个体校准情况下，测量血红蛋白水平的准确度为2.4 g/dL，灵敏度高达97％。

根据对4名患者为期数周的个性化校准测试，检测的准确度进一步提高至0.92 g/dL，与基于血液的血红蛋白测试的准确度相当。

埃默里大学医学院儿科副教授和该研究的主要研究者Wilbur Lam说：“所有其他的贫血即时检测（POC）工具都需要用到外部设备，并需要在侵入性、成本和准确性之间进行权衡。这是一款独立应用程序，可以查看血红蛋白水平，而无需抽血。”

Lam同时也是亚特兰大儿童保健中心（Children’s Healthcare of Atlanta）的Aflac癌症和血液疾病中心（Aflac Cancer and Blood Disorders Center）的临床血液学家兼生物工程学家，而且还是佐治亚理工学院生物医学工程系（Wallace H. Coulter Department of Biomedical Engineering）的一名教员。

这款APP是前生物医学工程研究生Rob Mannino攻读博士学位时所研究的部分内容，他患有β地中海贫血，这是一种由β珠蛋白基因突变引起的遗传性血液疾病。

Mannino说：“我的病需要每月输血治疗。医生会对我的血红蛋白水平进行多次检测，但对我来说，每次输血都要去医院接受血液检测是个麻烦事。而现在医生只需根据我的血红蛋白水平趋势来预估输血时间。”

Lam补充道：“Mannino在输血前后、血红蛋白水平不断变化时拍下了自己的照片，这使得他能够以一种非常有效的方式不断改进和调整自己的技术。所以从本质上说，在APP的每次迭代中，他都是自己完美的初始测试对象。”

据研究人员称，这款APP只能用于筛查，而不能用于临床诊断。

由于这项技术可供任何人随时使用，因此适用于孕妇、月经出血异常的女性或跑步者/运动员。

这款APP非常简单，意味着可以在发展中国家应用。

临床诊断工具必须有严格的准确度要求。研究人员相信，通过进一步的研究，他们预期这款APP最终能够达到取代针对临床诊断所进行的血液贫血测试的准确性。

贫血症是一种血液病，影响着全球范围内的20亿人，如果不加以治疗，会导致疲劳、苍白和心脏不适。目前，诊断贫血的金标准为全血细胞计数（CBC）。

该研究得到了美国国家科学基金会（NSF）、2017年度马萨诸塞州综合医院初级护理技术奖和美国国立卫生研究院（NIH）的支持。

英文原文

Smartphone app can detect anaemia through photos of fingernails

US researchers have developed a smartphone app through which users can take photos of their fingernails to determine their haemoglobin levels.

The app is claimed to enable self-management for patients suffering from chronic anaemia. It has been designed to allow patients to monitor their disease and identify the times when they need to adjust their therapies or receive transfusions, thereby minimising side effects or complications of having transfusions too early or too late.

The researchers analysed photos of fingernails and then correlated the colour of the fingernail beds with haemoglobin levels measured by CBC in 337 people, of whom some were healthy, and others had a variety of anaemia diagnoses.

They developed an algorithm for converting fingernail colour to blood haemoglobin levels with 237 people and then tested it on 100.

Through a single smartphone image, with no personalised calibration, haemoglobin levels could be measured with an accuracy of 2.4 grams/deciliter with a sensitivity of up to 97%.

With personalised calibration, tested on four patients over several weeks, indicated improvement in the accuracy to 0.92 grams/deciliter, on par with point-of-care blood-based haemoglobin tests.

Emory University School of Medicine associate professor of paediatrics and the study’s principal investigator Wilbur Lam said: “All other ‘point-of-care’ anaemia detection tools require external equipment, and represent trade-offs between invasiveness, cost, and accuracy.

“This is a standalone app that can look at haemoglobin levels without the need to draw blood.”

Lam is also a clinical haematologist-bioengineer at the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, and a faculty member in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech.

The app is part of the PhD work of former biomedical engineering graduate student Rob Mannino, who suffers from beta-thalassemia, an inherited blood disorder caused due to a mutation in the beta-globin gene.

Mannino said: “Treatment for my disease requires monthly blood transfusions. My doctors would test my haemoglobin levels more if they could, but it’s a hassle for me to get to the hospital in between transfusions to receive this blood test. Instead, my doctors currently have to just estimate when I’m going to need a transfusion, based on my haemoglobin level trends.”

Lam added: “He took pictures of himself before and after transfusions as his haemoglobin levels were changing, which enabled him to constantly refine and tweak his technology on himself in a very efficient manner. So essentially, he was his own perfect initial test subject with each iteration of the app.”

According to the researchers, the app can be used only for screening, and not clinical diagnosis.

As this technology could be used by anyone at any time, it can be appropriate for pregnant women, women with abnormal menstrual bleeding, or runners/athletes.

Due to its simplicity, it could be useful in developing countries.

Strict accuracy requirements are mandatory for clinical diagnostic tools. The researchers believe that with additional research, they expect to eventually achieve accuracy to replace blood-based anaemia testing for clinical diagnosis.

Anaemia is a blood condition that affects two billion people worldwide and can lead to fatigue, paleness and cardiac distress if left untreated. The current gold standard for anaemia diagnosis is known as a complete blood count (CBC).

This research was supported by the National Science Foundation, the 2017 Massachusetts General Hospital Primary Care Technology Prize, and the National Institutes of Health.

内容来自：Verdict Medical Devices

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