Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland.
Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
Arch Med Res. 2018 Aug;49(6):405-417. doi: 10.1016/j.arcmed.2018.12.005. Epub 2018 Dec 17.
Serum or plasma ferritin concentration is recommended by WHO as a biomarker to assess iron status in individuals and populations.
A systematic review was undertaken to summarise the evidence for ferritin reflecting iron status and to assess the cut-off points in different populations. Electronic databases were searched for studies evaluating ferritin concentrations compared against bone marrow aspirates for iron deficiency and to liver biopsies for risk of iron overload.
From 18822 records, 298 studies were assessed in full-text, including 72 studies on iron deficiency and 36 on iron overload in the quantitative analysis. All studies were observational. For iron deficiency, the mean ferritin concentration in healthy individuals was 15.1 μg/L (9 studies, 390 participants) when bone marrow iron content was 0, and 70.4 μg/L (3 studies, 151 participants) when bone marrow iron was 1+ or higher. In non-healthy populations, mean ferritin concentrations were 82.43 μg/L for iron depletion (38 studies, 1023 participants) and 381.61 μg/L for iron sufficiency (38 studies, 1549 participants) with wide variations depending on the pathology. For iron overload the results point out to a cut-off close to 500 μg/L although the data was very limited.
Ferritin concentration is low in iron deficient individuals and high in iron-loaded individuals, regardless of confounding clinical conditions. Current WHO thresholds for healthy populations appear valid but the data is limited for different age groups or physiological conditions. For iron overload, ferritin concentration would only help in the presumptive diagnosis and guide the need for further assessment.
世界卫生组织（WHO）建议使用血清或血浆铁蛋白浓度作为评估个体和人群铁状态的生物标志物。
系统综述总结了铁蛋白反映铁状态的证据，并评估了不同人群的铁蛋白截断值。电子数据库中检索了评估铁蛋白浓度与骨髓抽吸液评估铁缺乏症和肝活检评估铁过载的研究。
从 18822 条记录中，全文评估了 298 项研究，其中包括 72 项关于铁缺乏症的研究和 36 项关于铁过载的研究。所有研究均为观察性研究。对于铁缺乏症，当骨髓铁含量为 0 时，健康个体的平均铁蛋白浓度为 15.1μg/L（9 项研究，390 名参与者），当骨髓铁为 1+或更高时，平均铁蛋白浓度为 70.4μg/L（3 项研究，151 名参与者）。在非健康人群中，铁耗竭的平均铁蛋白浓度为 82.43μg/L（38 项研究，1023 名参与者），铁充足的平均铁蛋白浓度为 381.61μg/L（38 项研究，1549 名参与者），但由于病理不同，差异很大。对于铁过载，结果表明截断值接近 500μg/L，但数据非常有限。
无论是否存在混杂的临床状况，铁缺乏症患者的铁蛋白浓度较低，铁负荷过重的患者的铁蛋白浓度较高。目前世界卫生组织（WHO）对健康人群的阈值似乎是有效的，但针对不同年龄组或生理状况的数据有限。对于铁过载，铁蛋白浓度仅有助于初步诊断，并指导进一步评估的需要。
