Saeed Hayder, Woods Ryan R, Lester Joshua, Herzig Roger, Gul Zartash, Monohan Gregory
Department of Internal Medicine, University of Kentucky, Lexington, KY, USA,
Int J Hematol. 2015 Aug;102(2):195-9. doi: 10.1007/s12185-015-1813-1. Epub 2015 May 22.
Ferritin is known to be involved in numerous physiological roles, such as iron storage, as well as various pathological conditions and in generalized inflammatory states. Hyperferritinemia is also encountered in the setting of hemophagocytic lymphohistiocytosis (HLH). Current diagnostic criteria exist to define HLH based on several clinical and biochemical markers, including the serum ferritin level. In this study, we retrospectively evaluated the value of ferritin >500 ng/mL in diagnosing HLH in 344 consecutive patients admitted to the medical intensive care unit at our hospital. Nine cases of HLH were identified. Comparison of the HLH with the non-HLH group showed that their maximum median serum ferritin level was 25,652 (range 1977-100,727 ng/mL) versus 1180 (503-85,168 ng/mL) (P < 0.001), platelets were 30 (5-92 × 10(3)/μL) versus 113 (0-507 × 10(3)/μL) (P < 0.001), absolute neutrophil counts were 2.56 (0.02-23.7 × 10(3)/μL) versus 7.7 (0.01-82.7 × 10(3)/μL) (P = 0.002), and triglycerides were 255 (156-394 mg/dL) versus 127 (17-624 mg/dL) (P = 0.002), respectively. Using a receiver operating characteristic curve, the optimal maximum serum ferritin level for the diagnosis of HLH was 3951 ng/mL, exceeding the current diagnostic cutoff set forth in the HLH-2004 guidelines. These data suggest that a higher cutoff value of ferritin level may have improved utility in the diagnosis of secondary HLH in the critical care setting.
已知铁蛋白参与多种生理功能，如铁储存，以及各种病理状况和全身性炎症状态。噬血细胞性淋巴组织细胞增生症（HLH）患者也会出现高铁蛋白血症。目前存在基于多种临床和生化指标（包括血清铁蛋白水平）来定义HLH的诊断标准。在本研究中，我们回顾性评估了铁蛋白>500 ng/mL在我院医学重症监护病房收治的344例连续患者中诊断HLH的价值。共确诊9例HLH。HLH组与非HLH组比较显示，其血清铁蛋白最高中位数水平分别为25,652（范围1977 - 100,727 ng/mL）和1180（503 - 85,168 ng/mL）（P < 0.001），血小板计数分别为30（5 - 92×10³/μL）和113（0 - 507×10³/μL）（P < 0.001），绝对中性粒细胞计数分别为2.56（0.02 - 23.7×10³/μL）和7.7（0.01 - 82.7×10³/μL）（P = 0.002），甘油三酯分别为255（156 - 394 mg/dL）和127（17 - 624 mg/dL）（P = 0.002）。通过绘制受试者工作特征曲线，诊断HLH的最佳血清铁蛋白最高水平为3951 ng/mL，超过了HLH - 2004指南中设定的当前诊断临界值。这些数据表明，在重症监护环境下，更高的铁蛋白水平临界值可能在继发性HLH的诊断中具有更好的效用。
