低色素标志物在检测非贫血绝经前女性潜在缺铁中的临床价值
Clinical Value of Hypochromia Markers in the Detection of Latent Iron Deficiency in Nonanemic Premenopausal Women.
作者信息
Urrechaga Eloísa, Borque Luís, Escanero Jesús F
机构信息
Laboratory, Hospital Galdakao - Usansolo, Galdakao, Spain.
Department of Pharmacology and Physiology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain.
出版信息
J Clin Lab Anal. 2016 Sep;30(5):623-7. doi: 10.1002/jcla.21912. Epub 2016 Feb 22.
BACKGROUND
Iron deficiency (ID) is the most common cause of anemia in fertile women and hemoglobin (Hb) within the reference interval does not exclude ID. The consequence of an imbalance between the iron requirements and supply is a reduction of red-cell Hb content, which causes hypochromic cells. The aim of this study was to assess the reliability of new parameters low Hb density (LHD%), reticulocyte Hb equivalent (RetHe), and percentage of hypochromic erythrocytes (%HypoHe) in the detection of latent ID (LID), defined as depletion of iron stores without anemia.
METHODS
Two hundred fifty consecutive nonanemic women in fertile age (18-40 years, mean 33.5 years), whose analyses had been requested by general practitioners, were included. Independent samples t-test, receiver operating characteristic (ROC) curve analysis (gold standard for detecting LID ferritin <30 μg/l), and Cohen's kappa index were applied.
RESULTS
One hundred fifty-three women had ferritin within the reference range and Hb >120 g/L; 97 (38.8%) had LID. The results were as follows: %HypoHe-AUC 0.934, cutoff 1.6%, sensitivity 85.7%, specificity 92.1%; RetHe-AUC 0.914, cutoff 29.9 pg, sensitivity 86.8%, specificity 85.7%; LHD%-AUC 0.898, cutoff 5.0%, sensitivity 85.9%, specificity 84.1%. Applying those cutoffs, agreement between ferritin and %HypoHe was κ 0.61 and 0.56 for RetHe and LHD%.
CONCLUSIONS
LHD%, %HypoHe, and RetHe emerge as reliable tests for the investigation of LID and could improve the ability to detect ID before anemia is present.
背景
缺铁（ID）是育龄女性贫血最常见的原因，参考区间内的血红蛋白（Hb）并不能排除缺铁。铁需求与供应失衡的结果是红细胞Hb含量降低，导致细胞低色素。本研究的目的是评估新参数低Hb密度（LHD%）、网织红细胞Hb当量（RetHe）和低色素红细胞百分比（%HypoHe）在检测潜在缺铁（LID，定义为无贫血的铁储存耗竭）中的可靠性。
方法
纳入了250名连续的育龄非贫血女性（18 - 40岁，平均33.5岁），她们的分析由全科医生提出要求。应用独立样本t检验、受试者工作特征（ROC）曲线分析（检测LID的金标准为铁蛋白<30μg/l）和科恩kappa指数。
结果
153名女性铁蛋白在参考范围内且Hb>120g/L；97名（38.8%）有LID。结果如下：%HypoHe - AUC 0.934，临界值1.6%，灵敏度85.7%，特异性92.1%；RetHe - AUC 0.914，临界值29.9pg，灵敏度86.8%，特异性85.7%；LHD% - AUC 0.898，临界值5.0%，灵敏度85.9%，特异性84.1%。应用这些临界值，铁蛋白与%HypoHe之间的一致性κ为0.61，RetHe和LHD%为0.56。
结论
LHD%、%HypoHe和RetHe是用于LID调查的可靠检测方法，可提高在贫血出现之前检测缺铁的能力。
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