静脉铁剂治疗对缺铁新标志物的影响。

Chinnappa Shanmugakumar, Bhandari Sunil

Department of Nephrology, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, Kingston upon Hull, UK.

Int J Artif Organs. 2010 May;33(5):297-301.

BACKGROUND

Detection of iron deficiency in patients with end-stage renal disease (ESRD) remains challenging due to the lack of reliable markers. The immature reticulocyte fractions (IRF) RET-Y and RBC-Y may serve as useful novel markers. We investigated the ability of IRF to detect functional iron deficiency in ESRD patients in comparison to Serum ferritin (SF) and Transferrin saturation (TSAT) and the influence of intravenous iron therapy on these markers.

METHODS

Cross sectional (n=40) and prospective (n=20) studies of hemodialysis patients were performed; 20 patients received intravenous iron (200 mg) monthly and were followed up for 5 months. Iron deficiency was defined as SF < or =200 microg/L and/or TSAT < or =20%. A RBC-Y < or =171 and/or RET-Y < or =168.7 were criteria for iron deficiency. Correlations between traditional and novel markers were examined. Results are given as mean+/-SEM. Paired t-test was used to test for significance.

RESULTS

27 male and 13 female patients, mean age of 56.7+/-3.02 years were enrolled in the cross-sectional study. TSAT correlated with RBC-Y and RET-Y, r=0.47 and 0.61, respectively. Correlations for SF with RBC-Y and RET-Y were r=0.23 and 0.22, respectively. In the prospective component (11 males and 9 females of mean age 60+/-3.4 years), RET-Y and RBC -Y remained stable during iron therapy. The coefficients of variation were RBC-Y 2.54%, RET-Y 4.23%, TSAT 28.74% and SF 35.34%.

CONCLUSIONS

RBC-Y and RET-Y correlated with TSAT and SF allowing detection of functional iron deficiency. These measures were less susceptible to fluctuations than traditional markers.

背景

由于缺乏可靠的标志物，终末期肾病（ESRD）患者缺铁的检测仍然具有挑战性。未成熟网织红细胞分数（IRF）RET - Y和RBC - Y可能是有用的新型标志物。我们研究了IRF与血清铁蛋白（SF）和转铁蛋白饱和度（TSAT）相比检测ESRD患者功能性缺铁的能力，以及静脉铁剂治疗对这些标志物的影响。

方法

对血液透析患者进行横断面研究（n = 40）和前瞻性研究（n = 20）；20例患者每月接受静脉铁剂（200 mg）治疗，并随访5个月。缺铁定义为SF≤200μg/L和/或TSAT≤20%。RBC - Y≤171和/或RET - Y≤168.7为缺铁标准。检查传统标志物与新型标志物之间的相关性。结果以平均值±标准误表示。采用配对t检验进行显著性检验。

结果

横断面研究纳入27例男性和13例女性患者，平均年龄56.7±3.02岁。TSAT与RBC - Y和RET - Y相关，r分别为0.47和0.61。SF与RBC - Y和RET - Y的相关性r分别为0.23和0.22。在前瞻性研究部分（11例男性和9例女性，平均年龄60±3.4岁），铁剂治疗期间RET - Y和RBC - Y保持稳定。变异系数分别为：RBC - Y 2.54%，RET - Y 4.23%，TSAT 28.74%，SF 35.34%。