可溶性转铁蛋白受体在儿童铁缺乏症诊断中的价值

Value of soluble transferrin receptor in the diagnosis of iron deficiency in children

目的调查6个月至7岁各年龄段儿童铁缺乏症的发生率;评价可溶性转铁蛋白受体(sTfR)在儿童铁缺乏症筛查中的应用价值。方法采用诊断性试验方法,检测浙江省杭州市502例来我院体检的6个月至7岁儿童血清sTfR、铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)以及C反应蛋白(CRP)水平,同时检测血常规和血锌原卟啉(ZPP)。结果铁缺乏症的检出率为19.5%(98/502),其中婴儿组(≤1岁)检出率为34.7%,幼儿组(大于1岁、小于或等于3岁)19.4%,学龄前组(大于3岁、小于或等于7岁)14.0%。婴儿组铁缺乏的检出率明显高于其他两个年龄组。婴儿组sTfR均值(2.02±0.73 mg/L)明显高于幼儿组(1.68±0.40 mg/L)和学龄前组(1.67±0.29 mg/L),差异有统计学意义(P<0.05)。sTfR诊断铁缺乏的界值在婴儿组为2.02 mg/L(灵敏度70.3%,特异度82.2%),幼儿组为1.85 mg/L(灵敏度71.7%,特异度86.4%),学龄前组为1.85 mg/L(灵敏度77.8%,特异度88.6%)。sTfR与SF、TIBC、TS、ZPP及MCV具有相关性(r分别为0.107、0.276、-0.139、0.175、-0.140,P均<0.05)。结论 7岁以下儿童中,婴儿组是铁缺乏发生率最高的;婴儿组sTfR均值及其诊断铁缺乏的界值均高于其他年龄组;sTfR是诊断儿童尤其是婴儿铁缺乏症的一个较敏感指标。

Objective To study the prevalence of iron deficiency in children between 6 months and 7 years and to study the diagnostic value of soluble transferrin receptor（sTfR） for iron deficiency in the children.Methods A total of 502 healthy children between 6 months and 7 years from Hangzhou City of Zhejiang Province were enrolled.Serum sTfR,serum ferritin（SF）,serum iron（SI）,total iron blinding capacity（TIBC）,zinc protoporphyrin（ZPP）,Hb,MCV and CRP levels were measured.Results The prevalence rate of iron deficiency was 19.5% in children at ages of 6 months to 7 years.The prevalence rate of iron deficiency was the highest in infants（≤1 year old;34.7%）,followed by in toddlers（1-3 years old;19.4%） and preschoolers（3-7 years old;14.0%）.The mean serum sTfR level in infants（2.02±0.73 mg/L） was significantly higher than that in toddlers（1.68±0.40 mg/L） and preschoolers（1.67±0.29 mg/L）（P〈0.05）.The best cut-off value of serum sTfR for the diagnosis of iron deficiency was 2.02 mg/L in infants（sensitivity： 70.3%,specificity： 82.2%）.The best cut-off value was 1.85 mg/L in toddlers（sensitivity： 71.7%;specificity： 86.4%）,and that was 1.85 mg/L in preschoolers（sensitivity： 77.8%;specificity： 88.6%）.Serum sTfR was correlated with SF（r=0.107,P〈0.05）,TIBC（r=0.276,P〈0.01）,TS（r=-0.139,P〈0.05）,ZPP（r=0.175,P〈0.01） and MCV（r=-0.140,P〈0.01）.Conclusions Iron deficiency is more prevalent in infants ≤1 year old.The mean serum level and the cut-off value of sTfR in infants are higher than in toddlers and preschoolers.Serum sTfR is an effective index for the diagnosis of iron deficiency in children,especially in infants≤1 year old.