Petkova Nina Y, Raynov Julian I, Petrova Daniela Y, Ramsheva Zorka N, Petrov Borislav A
Clinic of Hematology, Military Medical Academy, Sofia.
Clinic of Nephrology, Military Medical Academy, Sofia.
Folia Med (Plovdiv). 2019 Jun 1;61(2):223-230. doi: 10.2478/folmed-2018-0065.
Iron deficiency anemia (IDA) is a common medical condition, yet there is still some diagnostic uncertainty in this respect. The aim of this study was to compare the clinical significance of biomarkers of iron deficiency (ID) in diagnosing IDA and iron-deficient erythropoiesis in anemic patients.
A total of 103 untreated patients with non-hemolytic anemia were included. Blood count, reticulocyte hemoglobin content (CHr), iron, transferrin saturation (TSAT), ferritin (Ferr), soluble transferrin receptor (sTfR) and sTfR/logFerr index (sTfR-F index) were determined in the patients.
TSAT<16% diagnosed 79 patients with IDA (76.6%), Ferr<30 µg/l - 50 patients with IDA (48.5%). Thomas-plot analysis found 76 patients with ID (73.8%) and 56 of them were with iron-restricted erythropoiesis and IDA (54.4%). Biomarkers of ID were significantly different in anemic patients with iron-deficient erythropoiesis (CHr<28 pg) compared with patients with normal hemoglobinisation (p<0.001). With regard to the predictive value of the parameters of ID for iron-deficient erythropoiesis in anemia, their mutually controlled influence proved sTfR-F index only as independent statistically significant (p=0.011). The optimal cut-off value of sTfR-F index from the ROC curve analysis for detecting iron-deficient erythropoiesis in anemia (CHr<28 pg) was 1.35, with sensitivity of 82.1% and specificity of 80.9% (AUC 0.866; p<0.001).
Diagnosis of IDA depends on the applied biomarkers of ID, and TSAT or ferritin when used alone may lead to diagnostic difficulties. Combining sTfR-F index and CHr to evaluate iron-deficient erythropoiesis in patients with anemia in addition to ferritin and TSAT could contribute to improving the diagnosis of IDA in clinical practice.
缺铁性贫血（IDA）是一种常见的医学病症，但在这方面仍存在一些诊断上的不确定性。本研究的目的是比较缺铁（ID）生物标志物在诊断贫血患者的IDA和缺铁性红细胞生成中的临床意义。
共纳入103例未经治疗的非溶血性贫血患者。测定患者的血细胞计数、网织红细胞血红蛋白含量（CHr）、铁、转铁蛋白饱和度（TSAT）、铁蛋白（Ferr）、可溶性转铁蛋白受体（sTfR）和sTfR/对数铁蛋白指数（sTfR-F指数）。
TSAT<16%诊断出79例IDA患者（76.6%），Ferr<30μg/l诊断出50例IDA患者（48.5%）。Thomas图分析发现76例ID患者（73.8%），其中56例为铁限制红细胞生成和IDA患者（54.4%）。与血红蛋白正常的患者相比，缺铁性红细胞生成的贫血患者（CHr<28 pg）的ID生物标志物有显著差异（p<0.001）。关于ID参数对贫血中铁缺乏性红细胞生成的预测价值，它们相互控制的影响仅证明sTfR-F指数具有独立的统计学意义（p=0.011）。ROC曲线分析得出的用于检测贫血中铁缺乏性红细胞生成（CHr<28 pg）的sTfR-F指数的最佳截断值为1.35，敏感性为82.1%，特异性为80.9%（AUC 0.866；p<0.001）。
IDA的诊断取决于所应用的ID生物标志物，单独使用TSAT或铁蛋白可能会导致诊断困难。除了铁蛋白和TSAT外，结合sTfR-F指数和CHr来评估贫血患者的缺铁性红细胞生成，可能有助于改善临床实践中IDA的诊断。
