Ruivard M, Boursiac M, Mareynat G, Sapin A F, Gerbaud L, Derumeaux H, Fouilhoux A C, Travade P, Philippe P
Fédération de médecine interne, maladies infectieuses et hématologie, Hôtel-Dieu, Clermont-Ferrand, France.
Rev Med Interne. 2000 Oct;21(10):837-43. doi: 10.1016/s0248-8663(00)00234-4.
This study was aimed at determining the diagnostic value of conventional laboratory tests regarding the iron status and serum transferrin receptor in hospitalized patients.
Patients who had to undergo bone marrow aspirate examination were included in this 8-month prospective study. Iron deficiency was defined as the absence of stainable iron on bone marrow examination. Patients with stainable iron were included in the control group. The higher value of diagnostic efficacy determined the cut-off value for each parameter of the iron status.
Twenty-one patients (17 females, four males) (mean age: 52 years) with iron deficiency and 33 control subjects (20 females, 13 males) (mean age: 60 years) were included in the study. The ratio serum transferrin receptor/serum ferritin had the best diagnostic efficiency (78%) with a sensitivity of 81% and a specificity of 97%. Serum ferritin alone with a cut-off value of 60 micrograms/L had the same specificity (97%) but a lower sensitivity (76%). The diagnostic value of all other analyzed tests was below 66% (transferrin alone, mean corpuscular volume, transferrin saturation, iron, serum transferrin receptor alone, red cell distribution width).
Among in-patients, ferritin remains the first intention test to diagnose iron deficiency, but the cut-off value should be increased (60 micrograms/L in this study). The ratio "serum transferrin receptor to serum ferritin" provides the highest specificity with a higher cost and should be used only in doubtful cases.
本研究旨在确定常规实验室检查对住院患者铁状态和血清转铁蛋白受体的诊断价值。
本项为期8个月的前瞻性研究纳入了必须接受骨髓穿刺检查的患者。缺铁定义为骨髓检查未见可染铁。有可染铁的患者纳入对照组。根据诊断效能的较高值确定铁状态各参数的临界值。
本研究纳入了21例缺铁患者（17例女性，4例男性）（平均年龄：52岁）和33例对照者（20例女性，13例男性）（平均年龄：60岁）。血清转铁蛋白受体/血清铁蛋白比值的诊断效能最佳（78%），敏感性为81%，特异性为97%。血清铁蛋白单独检测，临界值为60微克/升时，特异性相同（97%），但敏感性较低（76%）。所有其他分析检测的诊断价值均低于66%（单独转铁蛋白、平均红细胞体积、转铁蛋白饱和度、铁、单独血清转铁蛋白受体、红细胞分布宽度）。
在住院患者中，铁蛋白仍是诊断缺铁的首选检测指标，但临界值应提高（本研究中为60微克/升）。“血清转铁蛋白受体与血清铁蛋白”比值具有最高的特异性，但成本较高，仅应在可疑病例中使用。
