The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District, Beijing 100050, China.
Health and Family Planning Supervision Institution of Chaoyang, Panjiayuan Huawei 25, Chaoyang District, Beijing 100021, China.
Nutrients. 2017 May 2;9(5):450. doi: 10.3390/nu9050450.
Our aim was to evaluate the cut-off value and efficiency of using reticulocyte hemoglobin content as a marker to diagnose iron deficiency anemia in Chinese adults. 140 adults who needed bone marrow aspiration for diagnosis at the hematology department of the Peking Union Medical College Hospital were enrolled according to the inclusive and exclusive criteria. Venous blood samples were collected to detect complete blood count, including hemoglobin, reticulocyte hemoglobin content, hematocrit, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, free erythrocyte protoporphyrin; iron indexes of serum ferritin, serum transferrin receptor, and unsaturated iron-binding capacity; and inflammation markers of C-reactive protein and α-acid glycoprotein. Bone marrow samples were obtained for the bone marrow iron staining, which was used as the standard for the evaluation of iron status in this study. Subjects were divided into three groups according to hemoglobin levels and bone marrow iron staining results: the IDA (iron deficiency anemia) group, the NIDA (non-iron deficiency anemia) group, and the control group. The differences of the above-mentioned indexes were compared among the three groups and the effect of inflammation was also considered. The cut-off value of reticulocyte hemoglobin content was determined by receiver operation curves. The IDA group ( = 56) had significantly lower reticulocyte hemoglobin content, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, and serum ferritin; and higher free erythrocyte protoporphyrin, unsaturated iron-binding capacity, and serum transferrin receptor ( < 0.05) compared with the NIDA group ( = 38) and control group ( = 46). Hematocrit, serum ferritin, and unsaturated iron-binding capacity were significantly affected by inflammation while reticulocyte hemoglobin content and other parameters were not. The cut-off value of reticulocyte hemoglobin content for diagnosing iron deficiency anemia was 27.2 pg, with a sensitivity of 87.5% and a specificity of 92.9%. The cut-off values for mean cellular volume, serum ferritin, and serum transferrin receptor were 76.6, 12.9, and 4.89 mg/L, respectively. Reticulocyte hemoglobin content had the largest area under the curve of 0.929, while those for mean cellular volume, serum ferritin, serum transferrin receptor were 0.922, 0.887, and 0.900, respectively. Reticulocyte hemoglobin content has a high sensitivity and specificity in the diagnosis of iron deficiency anemia, and its comprehensive diagnostic efficacy is better than other traditional indicators-such as serum ferritin and serum transferrin receptor.
我们的目的是评估网织红细胞血红蛋白含量作为中国人铁缺乏性贫血诊断标志物的截断值和效率。根据纳入和排除标准，共纳入了 140 名因诊断需要在我院血液科行骨髓穿刺的成年人。采集静脉血样检测全血细胞计数，包括血红蛋白、网织红细胞血红蛋白含量、红细胞压积、平均红细胞体积、红细胞血红蛋白浓度、血红蛋白含量、游离原卟啉；血清铁蛋白、血清转铁蛋白受体和未饱和铁结合力的铁指标；以及 C 反应蛋白和α-酸性糖蛋白的炎症标志物。获取骨髓样本进行骨髓铁染色，作为本研究中评估铁状态的标准。根据血红蛋白水平和骨髓铁染色结果将受试者分为三组：IDA（缺铁性贫血）组、NIDA（非缺铁性贫血）组和对照组。比较三组间上述指标的差异，并考虑炎症的影响。通过接收者操作曲线确定网织红细胞血红蛋白含量的截断值。IDA 组（n=56）的网织红细胞血红蛋白含量、平均红细胞体积、红细胞血红蛋白浓度、血红蛋白含量和血清铁蛋白明显低于 NIDA 组（n=38）和对照组（n=46）；而游离原卟啉、未饱和铁结合力和血清转铁蛋白受体较高（<0.05）。红细胞压积、血清铁蛋白和未饱和铁结合力受炎症显著影响，而网织红细胞血红蛋白含量和其他参数不受影响。网织红细胞血红蛋白含量诊断铁缺乏性贫血的截断值为 27.2pg，灵敏度为 87.5%，特异性为 92.9%。平均红细胞体积、血清铁蛋白和血清转铁蛋白受体的截断值分别为 76.6、12.9 和 4.89mg/L。网织红细胞血红蛋白含量的曲线下面积最大为 0.929，而平均红细胞体积、血清铁蛋白和血清转铁蛋白受体的曲线下面积分别为 0.922、0.887 和 0.900。网织红细胞血红蛋白含量在铁缺乏性贫血的诊断中具有较高的灵敏度和特异性，其综合诊断效能优于其他传统指标，如血清铁蛋白和血清转铁蛋白受体。
