网织红细胞血红蛋白当量与传统血清铁指标在婴儿缺铁性贫血的非人灵长类动物模型中预测缺铁和贫血具有相当的预测准确性。
Reticulocyte Hemoglobin Equivalent has Comparable Predictive Accuracy as Conventional Serum Iron Indices for Predicting Iron Deficiency and Anemia in a Nonhuman Primate model of Infantile Iron Deficiency.
机构信息
Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, USA.
出版信息
J Nutr. 2023 Jan;153(1):148-157. doi: 10.1016/j.tjnut.2022.11.002. Epub 2022 Dec 20.
BACKGROUND
Infantile iron deficiency (ID) causes anemia and compromises neurodevelopment. Current screening relies on hemoglobin (Hgb) determination at 1 year of age, which lacks sensitivity and specificity for timely detection of infantile ID. Low reticulocyte Hgb equivalent (RET-He) indicates ID, but its predictive accuracy relative to conventional serum iron indices is unknown.
OBJECTIVES
The objective was to compare diagnostic accuracies of iron indices, red blood cell (RBC) indices, and RET-He for predicting the risk of ID and IDA in a nonhuman primate model of infantile ID.
METHODS
Serum iron, total iron binding capacity, unsaturated iron binding capacity, transferrin saturation (TSAT), Hgb, RET-He, and other RBC indices were determined at 2 wk and 2, 4, and 6 mo in breastfed male and female rhesus infants (N = 54). The diagnostic accuracies of RET-He, iron, and RBC indices for predicting the development of ID (TSAT < 20%) and IDA (Hgb < 10 g/dL + TSAT < 20%) were determined using t tests, area under the receiver operating characteristic curve (AUC) analysis, and multiple regression models.
RESULTS
Twenty-three (42.6%) infants developed ID and 16 (29.6%) progressed to IDA. All 4 iron indices and RET-He, but not Hgb or RBC indices, predicted future risk of ID and IDA (P < 0.001). The predictive accuracy of RET-He (AUC = 0.78, SE = 0.07; P = 0.003) for IDA was comparable to that of the iron indices (AUC = 0.77-0.83, SE = 0.07; P ≤ 0.002). A RET-He threshold of 25.5 pg strongly correlated with TSAT < 20% and correctly predicted IDA in 10 of 16 infants (sensitivity: 62.5%) and falsely predicted possibility of IDA in only 4 of 38 unaffected infants (specificity: 89.5%).
CONCLUSIONS
RET-He is a biomarker of impending ID/IDA in rhesus infants and can be used as a hematological parameter to screen for infantile ID.
背景
婴儿缺铁（ID）会导致贫血并损害神经发育。目前的筛查依赖于在 1 岁时测定血红蛋白（Hgb），但这种方法缺乏敏感性和特异性，无法及时发现婴儿 ID。低网织红细胞血红蛋白当量（RET-He）提示 ID，但它相对于传统血清铁指标的预测准确性尚不清楚。
目的
本研究旨在比较铁指标、红细胞（RBC）指标和 RET-He 在预测非人类灵长类婴儿 ID 模型中 ID 和 IDA 风险方面的诊断准确性。
方法
测定 54 例母乳喂养的雄性和雌性恒河猴婴儿在 2 周龄和 2、4、6 月龄时的血清铁、总铁结合能力、未饱和铁结合能力、转铁蛋白饱和度（TSAT）、Hgb、RET-He 和其他 RBC 指标。使用 t 检验、受试者工作特征曲线（ROC）下面积（AUC）分析和多元回归模型，确定 RET-He、铁和 RBC 指标预测 ID（TSAT<20%）和 IDA（Hgb<10g/dL+TSAT<20%）发展的诊断准确性。
结果
23 例（42.6%）婴儿发生 ID，16 例（29.6%）进展为 IDA。所有 4 项铁指标和 RET-He，但不是 Hgb 或 RBC 指标，都预测了未来 ID 和 IDA 的风险（P<0.001）。RET-He（AUC=0.78，SE=0.07；P=0.003）对 IDA 的预测准确性与铁指标相当（AUC=0.77-0.83，SE=0.07；P≤0.002）。RET-He 阈值为 25.5pg 与 TSAT<20%强烈相关，并正确预测了 16 例 IDA 婴儿中的 10 例（敏感性：62.5%），而仅错误预测了 38 例未受影响婴儿中的 4 例（特异性：89.5%）发生 IDA 的可能性。
结论
RET-He 是恒河猴婴儿 ID/IDA 即将发生的生物标志物，可用作筛查婴儿 ID 的血液学参数。
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