Klinik und Poliklinik für Urologie, Johannes-Guttenberg University, Mainz, Germany.
Clin Chem Lab Med. 2011 Feb;49(2):207-13. doi: 10.1515/CCLM.2011.056. Epub 2010 Dec 14.
Biochemical markers have problems in distinguishing iron deficiency anemia (IDA) from anemia of chronic disease (ACD), and the combined state of iron-restricted erythropoiesis (IRE) with ACD (ACD/IRE). We investigated the extent to which hepcidin-25, a potential marker for the evaluation of iron metabolism, enables the differentiation of the states above, and to assess its correlation with convential markers of iron deficiency.
One hundred and fifty-five patients with anemia were classified as having IDA, ACD or ACD/IRE using clinical findings, biochemical markers and hematological indices. The diagnostic performance of hepcidin-25 alone or in combination with the reticulocyte hemoglobin content (CHr) was evaluated using receiver-operating characteristic curve analysis and multivariate analysis. Hepcidin-25 was determined using an isotope-dilution micro-HPLC-tandem mass spectrometry method.
Hepcidin-25 correlated with biochemical markers of iron deficiency but not with hematological indices. Use of a hepcidin-25 cut-off of ≤ 4 nmol/L allowed the differentiation of IDA from ACD and ACD/IRE, but not the discrimination of ACD from ACD/IRE in patients with severe inflammation. Furthermore, the discrimination of ACD/IRE from ACD required the combination with CHr.
Hepcidin-25 is primarily an indicator for decreased body iron levels, but not for IRE. The combination of hepcidin-25 with CHr in a diagnostic plot (hepcidin-25 plot) might be useful for the differentiation of ACD from ACD/IRE and IDA.
生化标志物在鉴别缺铁性贫血（IDA）与慢性病贫血（ACD）以及伴有慢性病的铁限制红细胞生成（ACD/IRE）方面存在问题。我们研究了铁调素-25（一种评估铁代谢的潜在标志物）在多大程度上能够区分上述状态，并评估其与常规缺铁标志物的相关性。
通过临床发现、生化标志物和血液学指标，将 155 例贫血患者分为 IDA、ACD 或 ACD/IRE。使用受试者工作特征曲线分析和多变量分析评估铁调素-25 单独或与网织红细胞血红蛋白含量（CHr）联合的诊断性能。使用同位素稀释微 HPLC-串联质谱法测定铁调素-25。
铁调素-25与缺铁的生化标志物相关，但与血液学指标无关。使用铁调素-25截断值≤4nmol/L 可区分 IDA 与 ACD 和 ACD/IRE，但不能区分严重炎症患者的 ACD 与 ACD/IRE。此外，区分 ACD/IRE 需要与 CHr 联合。
铁调素-25主要是体内铁水平降低的指标，而不是 IRE 的指标。在诊断图（铁调素-25 图）中联合使用铁调素-25 和 CHr 可能有助于区分 ACD 与 ACD/IRE 和 IDA。
