慢性病贫血患者血清铁指标及骨髓内外铁检测的临床意义

The clinical significance of detection of Serum Iron index in patients with Anemia of Chronic Disease and bone marrow iron staining

目的了解血清铁(SI)、血清铁蛋白(SF)、总铁结合力(TIBC)、血清转铁蛋白受体(sTFR)等外周血铁指标和骨髓内外铁染色对缺铁性贫血(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32例、ACD患者67例,其中41例ACD/ID患者。SI、TIBC测定采用日立7600全自动生化分析仪法,SF测定采用化学发光法,sTFR采用双夹心抗体酶联免疫吸附法。结果67例慢性病贫血中骨髓可染铁缺乏有41例,占(61.5%)。缺铁性贫血组与慢性病贫血组或慢性病贫血并发缺铁SI,TIBC,SF值相比差异有显著性(P<0.01,P<0.05),与慢性病贫血不伴缺铁组相比差异无显著性(P>0.05);慢性病贫血伴缺铁组与慢性病贫血不伴缺铁组相比差异无显著性(P>0.05)。sTFR值在缺铁性贫血组、慢性病贫血组及慢性病贫血伴缺铁组。与健康对照组相比差异有显著性(P<0.01),而慢性病贫血不伴缺铁组与健康对照组相比差异有显著性(P<0.05);缺铁性贫血组与慢性病贫血组或慢性病贫血不伴缺铁组相比差异有显著性(P<0.01),而与慢性病贫血伴缺铁组相比差异无显著性(P>0.05),慢性病贫血伴缺铁组与不伴缺铁二组相比差异有显著性(P<0.01)。结论慢性病贫血病人半数以上存在缺铁。骨髓铁染色是鉴别铁缺乏最可靠的方法。新的铁代谢指标sTFR是传统铁代谢指标的必要补充,联合应用上述指标可对ACD、IDA和ACD/ID患者进行准确的鉴别诊断。

Objective To analyze the significance of iron paraments such as serum iron（SI）, serum ferritin（SF）, total iron-bind- ing capacity（TIBC）, serum transferring receptor（sTFR） in differential diagnosing iron deficiency anemia （IDA）, anemia of ctu-onic disease（ACD） and ACD complicated with iron deficiency （ACD/ID） .Methods SI and TIBC were determined using Hitachi-7600, SF was determined by colormetric method and sTFR was determined by enzyme linked immunosorbent assay in 32 patients with IDA and 67 patients with ACD. Among the ACD patients, 41 patients were found to be deficient in iron using bone marrow particle iron stain.Results 41 cases of the 67 cases （61.5%） were abely-dyed iron deficiency in bone marrow.The value of SI,TIBC,SF in anemia group of iron deficiency was significant difference from the group of chronic diseases and the group of chronic diseases with iron deficiency （ P 〈 0.01, P 〈 0.05） ,They are not significandy different from the anemia group of cttronic diseases without iron deficiency （P 〉 0.05）;There is no significant difference between the anemia group of chronic diseases with iron deficiency and the group of chronic diseases without iron deficiency （ P 〉 0.05） .The value of sTFR increased in all groups and there was a significant difference between the nomkal group and odaer groups （ P 〈 0.01 ）. But there was no significant difference between the normal group and the anemia group of chronic diseases without iron deficiency （ P 〉 0.05） ;There was a significant difference between the anemia group of chronic diseases mad the anemia group of chronic diseases without iron deficiency （ P 〈 0.01 ）. There was no significant difference between the anemia group of chronic diseases and the group of chronic diseases with iron deficiency （P 〉 0.05）. There was significant difference between the anemia group of chronic diseases and the group of iron deficiency （ P 〈 0.01 ）. Conclusion Half of the patients with anemia of chronic diseases had iron deficiency. The new iron parmneters of sTFR are supplementary to traditional iron paranleters and the combination of them may enable us to make precise differentiation among IDA,ACD/ID and ACD/NID cases.