铁代谢指标测定对慢性病贫血并发缺铁的诊断意义

The significance of peripheral iron parameters used in diagnosing anemia of chronic disease complicated with iron deficiency

目的 :了解血清铁蛋白 (SF)、转铁蛋白饱和度 (TS)、血清转铁蛋白受体 (sTFR)及sTFR/log(SF)等外周血铁代谢指标对缺铁性贫血 (IDA)、慢性病贫血 (ACD)和慢性病贫血并发缺铁 (ACD/ID)的鉴别诊断意义。方法 :病例为IDA患者 18例 ,ACD患者 2 0例 ,其中 10例为ACD/ID患者。SF测定采用微粒酶免疫法 ,TS测定采用化学发光法 ,sTFR测定采用双夹心抗体酶联免疫吸附法。结果 :IDA患者的SF值、TS值显著低于ACD患者 ,其sTFR、sTFR/log(SF)值显著高于ACD患者。ACD患者中 ,ACD/ID患者与无缺铁的ACD(ACD/IR)患者间SF值无显著差别 ;但ACD/ID患者的TS值明显低于ACD/IR患者 ,而sTFR和sTFR/log(SF)值则显著高于ACD/IR患者。TS<4 0 %对ACD/ID检出的敏感性为 10 0 % ,特异性为 6 7% ;sTFR >30nmol/L对ACD/ID检出的敏感性为 90 % ,特异性为 82 % ;sTFR/log(SF) >2 0对ACD/ID检出的敏感性和特异性均为 90 %。结论 :新的铁代谢指标sTFR ,尤其是sTFR/log(SF)是传统铁代谢指标的必要补充 ,联合应用上述铁代谢指标可对ACD、IDA和ACD/ID患者进行准确的鉴别诊断。

Objective:To analyze the significance of iron parameters such as serum ferritin(SF), transferritin saturation(TS), serum transferritin receptor(sTFR) and the ratio(sTFR/log(SF)) in differentiate diagnosing iron deficiency anemia(IDA), anemia of chronic disease(ACD) and ACD complicated with iron deficiency(ACD/ID).Methods:SF was determined using microparticle enzyme immunoassay, TS was determined by colormetric method and sTFR was determined by enzyme linked immunosorbent assay in 18 patients with IDA and 20 patients with ACD. Among the ACD patients, 10 were found to be deficient in iron using bone marrow particle iron stain.Results:IDA patients had significantly lower SF, TS and higher sTFR, Stfr/log(SF) than ACD patients. Among ACD patients, ACD/ID patients had significantly lower TS and higher sTFR, sTFR/log(SF) than iron repleted ACD(ACD/IR) patients.But SF was not significantly different between the two groups. A TS percentile lower than 40% is 100% sensitive and 67% specific in detecting ACD/ID cases among ACD patients. The sensitivity and specificity of sTFR(>30 nmol/L) were 90% and 82%, respectively while those of sTFR/log(SF)(>20) were both 90%.Conclusion:The new iron parameters of sTFR and sTFR/log(SF) are supplementary to traditional iron parameters and the combination of them may enable us to make precise differentiation among IDA, ACD and ACD/ID cases.