Akkermans M D, Uijterschout L, Nuijsink M, Hendriks D M, van Goudoever J B, Brus F
a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands.
b Department of Paediatrics , VU University Medical Centre , Amsterdam , The Netherlands.
Pediatr Hematol Oncol. 2017 Feb;34(1):10-16. doi: 10.1080/08880018.2016.1268226. Epub 2017 Feb 10.
Low iron stores in children, absolute iron deficiency (AID), can lead to impaired neurodevelopment and requires iron therapy. In the presence of infection/inflammation, like in cystic fibrosis (CF), serum ferritin (SF) is not a reliable biomarker for AID. Red blood cell distribution width (RDW) is a promising alternative reported not to be influenced by infection in healthy children. Currently, there are no data on the diagnostic capacity of RDW to detect AID in pediatric CF patients. This was a prospective observational study that investigated iron status biomarkers in 53 Dutch pediatric CF patients. AID was defined using World Health Organization criteria for SF in stable patients (no recent pulmonary exacerbation) and C-reactive protein (CRP) ≤10 mg/l. Patients with AID had higher RDW levels than patients without AID (p = 0.019). An RDW ≥13.2% showed the following test statistics: sensitivity 100%; specificity 39.4%; positive predictive value 20%; and negative predictive value 100%. Furthermore, we found a correlation between RDW and CRP in the total group that originated from the stable patients (r = 0.308; p = 0.042). In conclusion, the diagnostic capacity of RDW for detecting AID in pediatric CF patients seems limited because RDW levels might also be influenced by chronic infection/inflammation in these patients.
儿童体内铁储备不足，即绝对缺铁（AID），可导致神经发育受损，需要进行铁治疗。在存在感染/炎症的情况下，如在囊性纤维化（CF）中，血清铁蛋白（SF）并非AID的可靠生物标志物。红细胞分布宽度（RDW）是一种有前景的替代指标，据报道在健康儿童中不受感染影响。目前，尚无关于RDW检测小儿CF患者AID诊断能力的数据。这是一项前瞻性观察性研究，调查了53名荷兰小儿CF患者的铁状态生物标志物。AID的定义采用世界卫生组织对稳定患者（近期无肺部加重）的SF标准以及C反应蛋白（CRP）≤10mg/l。患有AID的患者的RDW水平高于未患AID的患者（p = 0.019）。RDW≥13.2%显示出以下检验统计量：敏感性100%；特异性39.4%；阳性预测值20%；阴性预测值100%。此外，我们发现稳定患者的整个组中RDW与CRP之间存在相关性（r = 0.308；p = 0.042）。总之，RDW检测小儿CF患者AID的诊断能力似乎有限，因为这些患者的RDW水平也可能受慢性感染/炎症影响。
