Australian Red Cross Blood Service, Melbourne, VIC, Australia.
Haematologica. 2011 Aug;96(8):1099-105. doi: 10.3324/haematol.2010.037960. Epub 2011 Apr 20.
Currently used indicators of iron status have limitations. Hepcidin, a key regulator of iron metabolism, is reduced in iron deficiency. We sought to determine the properties of hepcidin as a diagnostic test of iron deficiency.
Sera from female, non-anemic, whole blood donors were analyzed for hepcidin (enzyme-linked immunosorbent assay), ferritin, soluble transferrin receptor and C-reactive protein. Iron deficiency was defined as (i) serum ferritin less than 15 ng/mL or (ii) soluble transferrin receptor /log(ferritin) index greater than 3.2 if the C-reactive protein concentration was less than 10 mg/L, or greater than 2.2 if the C-reactive protein concentration was greater than 10 mg/L). Receiver operating characteristic curves were plotted to determine the overall utility and identify optimal cut-points of hepcidin as a test of iron deficiency.
In 261 blood donors the prevalence of iron deficiency defined by ferritin concentration was 59/261 [22.6% (17.5, 27.7)], whereas defined by soluble transferrin receptor/log(ferritin) index it was 53/261 [20.4% (15.4, 25.2)]. The 95% reference range of hepcidin concentration in the iron-replete population was 8.2-199.7 ng/mL. The area under the receiver operating characteristic curve for hepcidin compared with ferritin concentration less than 15 ng/mL was 0.87 (0.82, 0.92), while that compared with the soluble transferrin receptor /log(ferritin) index was 0.89 (95% CI 0.84, 0.93). For a diagnosis of iron deficiency defined by the soluble transferrin receptor/log(ferritin) index, hepcidin less than 8 ng/mL had a sensitivity of 41.5% and a specificity of 97.6%, while hepcidin less than 18 ng/mL had a sensitivity of 79.2% and a specificity of 85.6%.
Serum hepcidin concentration may be a useful indicator of deficient iron stores. Further studies are required to evaluate the role of hepcidin in the diagnosis of iron deficiency in other groups of patients.
目前使用的铁状态指标存在局限性。铁调素是铁代谢的关键调节剂，在缺铁时会减少。我们试图确定铁调素作为缺铁诊断试验的特性。
分析女性非贫血全血供体的血清铁调素（酶联免疫吸附试验）、铁蛋白、可溶性转铁蛋白受体和 C 反应蛋白。缺铁定义为：（i）血清铁蛋白<15ng/ml；或（ii）如果 C 反应蛋白浓度<10mg/L，则可溶性转铁蛋白受体/铁蛋白指数大于 3.2；如果 C 反应蛋白浓度>10mg/L，则可溶性转铁蛋白受体/铁蛋白指数大于 2.2。绘制受试者工作特征曲线以确定铁调素作为缺铁试验的总体效用，并确定最佳切点。
在 261 名献血者中，根据铁蛋白浓度定义的缺铁患病率为 59/261[22.6%（17.5，27.7）]，而根据可溶性转铁蛋白受体/铁蛋白指数定义的缺铁患病率为 53/261[20.4%（15.4，25.2）]。铁充足人群铁调素浓度的 95%参考范围为 8.2-199.7ng/ml。铁调素与铁蛋白浓度<15ng/ml 的受试者工作特征曲线下面积与可溶性转铁蛋白受体/铁蛋白指数相比为 0.87（0.82，0.92），而与可溶性转铁蛋白受体/铁蛋白指数相比为 0.89（95%CI 0.84，0.93）。对于可溶性转铁蛋白受体/铁蛋白指数定义的缺铁诊断，铁调素<8ng/ml 的敏感性为 41.5%，特异性为 97.6%，而铁调素<18ng/ml 的敏感性为 79.2%，特异性为 85.6%。
血清铁调素浓度可能是铁储存不足的有用指标。需要进一步研究来评估铁调素在其他患者群体中铁缺乏症诊断中的作用。
