Suega Ketut, Kandarini Yenny, Tubung Jemi
Hematology and Medical Oncology Division, Internal Medicine Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Bali, Indonesia.
Nephrology Division, Internal Medicine Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Bali, Indonesia.
Open Access Maced J Med Sci. 2019 Jan 14;7(1):97-102. doi: 10.3889/oamjms.2019.012. eCollection 2019 Jan 15.
Several iron indicators can be used to detect iron deficiency anaemia (IDA) where confounding comorbidities occurred such as patients with regular hemodialysis.
This study was aimed to determine the diagnostic value of serum transferrin receptor (sTfR) and transferrin receptor-transferrin index (TfR-F index) and to combine these two markers in detecting IDA in regular hemodialysis anaemic patients.
There were 70 patients recruited consecutively. IDA was diagnosed based on TS < 20% and ferritin level < 200 ng/L and functional iron deficiency when TS < 20% and ferritin > 200 ng/L. TfR-F index calculated as sTfR/log ferritin.
Correlation of ferritin to iron level was changed when its correlation adjusted by confounding inflammation (CRP level > 10). The correlation strength of ferritin to iron serum before adjusted was r = 0.37 with p = 0.02 but became r = 0.65 with p = 0.023 after adjusted to CRP > 10. In inflammation (CRP > 10), ferritin mild-moderately correlated with iron but became moderately strong when there was no inflammation (CRP < 10). AUC for sTfR was 0.77 with p = 0.028 (95% CI 0.55-0.99), and for TfR-F index has larger AUC 0.85% with p = 0.004 (95%CI 0.69-1.00), hence TfR-F index more superior than sTfR. sTfR and sTfR-F index were not correlated with CRP with p > 0.05, and sTfR and TfR-F index mean level was different between IDA and ACD patients although not statistically significant.
When sTfR and the TfR-F index used in combination to detect IDA, we found the largest AUC on ROC 0.98 (95% CI 0.94-1.00).
在诸如定期血液透析患者等存在混杂合并症的情况下，有几种铁指标可用于检测缺铁性贫血（IDA）。
本研究旨在确定血清转铁蛋白受体（sTfR）和转铁蛋白受体 - 转铁蛋白指数（TfR - F指数）的诊断价值，并将这两种标志物联合用于检测定期血液透析贫血患者的IDA。
连续招募70例患者。根据转铁蛋白饱和度（TS）<20%且铁蛋白水平<200 ng/L诊断IDA，当TS<20%且铁蛋白>200 ng/L时诊断为功能性缺铁。TfR - F指数计算为sTfR/铁蛋白对数。
当通过混杂炎症（CRP水平>10）调整铁蛋白与铁水平的相关性时，其相关性发生了变化。调整前铁蛋白与血清铁的相关强度为r = 0.37，p = 0.02，但调整至CRP>10后变为r = 0.65，p = 0.023。在炎症状态（CRP>10）下，铁蛋白与铁轻度 - 中度相关，但在无炎症（CRP<10）时变为中度强相关。sTfR的曲线下面积（AUC）为0.77（p = 0.028，95%可信区间0.55 - 0.99），TfR - F指数的AUC更大，为0.85%（p = 0.004，95%可信区间0.69 - 1.00），因此TfR - F指数比sTfR更具优势。sTfR和sTfR - F指数与CRP无相关性（p>0.05），尽管无统计学意义，但IDA和慢性病贫血（ACD）患者的sTfR和TfR - F指数平均水平不同。
当联合使用sTfR和TfR - F指数检测IDA时，我们发现ROC曲线下面积最大为0.98（95%可信区间0.94 - 1.00）。
