与加纳儿童改良相对剂量反应试验相比，血清视黄醇和视黄醇结合蛋白的炎症调整在评估维生素A缺乏时提高了特异性，但降低了敏感性。

Inflammation Adjustments to Serum Retinol and Retinol-Binding Protein Improve Specificity but Reduce Sensitivity when Estimating Vitamin A Deficiency Compared with the Modified Relative Dose-Response Test in Ghanaian Children.

作者信息

Suri Devika J, Wirth James P, Adu-Afarwuah Seth, Petry Nicolai, Rohner Fabian, Sheftel Jesse, Tanumihardjo Sherry A

机构信息

Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA.

GroundWork, Fläsch, Switzerland.

出版信息

Curr Dev Nutr. 2021 Jul 15;5(8):nzab098. doi: 10.1093/cdn/nzab098. eCollection 2021 Aug.

DOI:10.1093/cdn/nzab098

PMID:34386690

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8352745/

Abstract

BACKGROUND

Serum retinol and retinol-binding protein (RBP) concentrations are commonly used biomarkers of vitamin A deficiency (VAD); however, evidence indicates that they are not always accurate, especially in populations with high exposure to inflammation.

OBJECTIVE

The aim was to assess sensitivity and specificity of serum retinol and RBP concentrations to predict VAD, with and without adjustment for inflammation (using categorical and regression-adjusted approaches), using the modified relative dose-response (MRDR) as the reference standard for liver reserves.

METHODS

This secondary analysis of diagnostic accuracy used inflammation and RBP data and analyzed serum retinol and MRDR from a subsample of women of reproductive age ( = 178) and preschool children ( = 166) in the cross-sectional 2017 Ghana Micronutrient Survey.

RESULTS

Inflammation (elevated C-reactive protein and/or α-acid glycoprotein) was present in 41% of children and 16% of women. Among children, estimates of VAD prevalence were as follows: 7% (MRDR), 40% (serum retinol), 29% (categorical-adjusted serum retinol), 24% (RBP), 13% (categorical-adjusted RBP), and 7% (regression-adjusted RBP). Sensitivity (95% CI) ranged from 22.2% (2.81%, 60.0%; both adjusted RBPs) to 80.0% (44.4%, 97.5%; serum retinol), whereas specificity ranged from 63.3% (54.7%, 71.3%; serum retinol) to 93.5% (88.0%, 97.0%; regression-adjusted RBP). Among women, VAD prevalence ranged from 1% (RBP) to 4% (all others); sensitivity was 0% and specificity was >96% for all indicators.

CONCLUSIONS

Serum retinol and RBP had varying accuracy in estimating VAD, especially in children; adjustment for inflammation increased accuracy by increasing specificity at the expense of sensitivity. Effects of inflammation adjustment in the context of high inflammation and VAD prevalence need to be further explored. Especially in populations with high inflammation, the MRDR test should accompany serum retinol or RBP measurements in a subsample of subjects in population-based surveys. This trial was registered with the Open Science Framework registry (doi: 10.17605/OSF.IO/J7BP9).

摘要

背景

血清视黄醇和视黄醇结合蛋白（RBP）浓度是常用的维生素A缺乏（VAD）生物标志物；然而，有证据表明它们并不总是准确的，尤其是在炎症暴露水平高的人群中。

目的

目的是评估血清视黄醇和RBP浓度预测VAD的敏感性和特异性，采用改良相对剂量反应法（MRDR）作为肝脏储备的参考标准，在调整和未调整炎症的情况下（使用分类法和回归调整法）进行评估。

方法

这项诊断准确性的二次分析使用了炎症和RBP数据，并分析了2017年加纳横断面微量营养素调查中育龄妇女（n = 178）和学龄前儿童（n = 166）子样本的血清视黄醇和MRDR。

结果

41%的儿童和16%的妇女存在炎症（C反应蛋白和/或α-酸性糖蛋白升高）。在儿童中，VAD患病率估计如下：7%（MRDR）、40%（血清视黄醇）、29%（分类调整血清视黄醇）、24%（RBP）、13%（分类调整RBP）和7%（回归调整RBP）。敏感性（95%CI）范围为22.2%（2.81%，60.0%；两种调整后的RBP）至80.0%（44.4%，97.5%；血清视黄醇），而特异性范围为63.3%（54.7%，71.3%；血清视黄醇）至93.5%（88.0%，97.0%；回归调整RBP）。在妇女中，VAD患病率范围为1%（RBP）至4%（所有其他指标）；所有指标的敏感性为0%，特异性>96%。

结论

血清视黄醇和RBP在估计VAD方面具有不同的准确性，尤其是在儿童中；炎症调整通过以敏感性为代价提高特异性来提高准确性。炎症调整在高炎症和VAD患病率背景下的影响需要进一步探索。特别是在高炎症人群中，在基于人群的调查中，应在一部分受试者中同时进行MRDR检测和血清视黄醇或RBP测量。该试验已在开放科学框架注册中心注册（doi: 10.17605/OSF.IO/J7BP9）。