网织红细胞血红蛋白含量评估在小儿紫绀型心脏病缺铁和缺铁性贫血中的作用：印度尼西亚的一项诊断研究。
The role of reticulocyte hemoglobin equivalent on the evaluation of iron deficiency and iron deficiency anemia in pediatric cyanotic heart disease: a diagnostic study in Indonesia.
机构信息
Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Harapan Kita Women's and Children's Hospital, Jakarta, Indonesia.
出版信息
BMC Pediatr. 2024 Aug 23;24(1):541. doi: 10.1186/s12887-024-05000-w.
BACKGROUND
In light of prolonged hypoxia, children with cyanotic heart disase (CHD) are at a high risk of developing iron deficiency iron deficiency (ID) and iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is a novel and dependable indicator for assessing iron status. However, there has been no previous study regarding cut-off value in pediatric CHD group. The purpose of this study is to assess the role of Ret-He and to establish cut-off points in the diagnosis of iron deficiency and IDA in pediatric cyanotic heart disease.
METHOD
This study was conducted in two tertiary hospitals in Jakarta, Indonesia. 59 children with CHD, aged 3 months to 18 years, were enrolled consecutively. To determine iron status, hematological parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin) and biochemical parameters for iron status (serum ferritin, transferrin saturation) were analysed and compared to Ret-He levels. The receiver operating characteristic (ROC) analysis was performed for the Ret-He cut-off points for ID and IDA. Sensitivity, specificity, positive and negative predictive value were calculated for each cut-off point.
RESULT
Normal iron status was identified in 27 (45.8%) subjects, ID in 8 (13.5%) subjects, and IDA 24 (40.7%) subjects. The ID cut-off value for Ret-He is 28.8 pg (sensitivity 75%, specificity 85.2%, PPV 60%, NPV 92%, and AUC 0.828) and the Ret-He cut-off point for IDA is 28.15 pg (sensitivity 75%, specificity 88.9%, PPV 85.7%, NPV 80%, and AUC 0.824). Hemoglobin should be used in conjunction with Ret-He. ID might be detected in this cohort with Ret-He 28.8 pg and hemoglobin > 16,5 g/dL. While Ret-He 28.15 pg or Ret-He 28.15-28.8 pg with hemoglobin 16.5 g/dL could be used to diagnose IDA.
CONCLUSION
The reticulocyte hemolgobin equivalent could be utilised as an iron status parameter in pediatric CHD, with a cut-off value of 28.8 pg for ID and 28.15 pg for IDA.
背景
由于长时间缺氧，患有紫绀型先天性心脏病（CHD）的儿童患缺铁性贫血（ID）和缺铁性贫血（IDA）的风险很高。网织红细胞血红蛋白当量（Ret-He）是评估铁状态的一种新型和可靠的指标。然而，以前没有关于儿科 CHD 组的截断值的研究。本研究旨在评估 Ret-He 的作用，并确定诊断儿科紫绀型先天性心脏病缺铁和 IDA 的截断值。
方法
这项研究在印度尼西亚雅加达的两家三级医院进行。连续纳入 59 名年龄在 3 个月至 18 岁的 CHD 儿童。为了确定铁状态，分析了血液学参数（血红蛋白、血细胞比容、平均红细胞体积、平均红细胞血红蛋白）和铁状态的生化参数（血清铁蛋白、转铁蛋白饱和度），并与 Ret-He 水平进行了比较。对 Ret-He 的 ID 和 IDA 的截断值进行了接收者操作特征（ROC）分析。计算了每个截断值的敏感性、特异性、阳性和阴性预测值。
结果
27 名（45.8%）受试者铁状态正常，8 名（13.5%）受试者 ID，24 名（40.7%）受试者 IDA。Ret-He 的 ID 截断值为 28.8 pg（敏感性 75%，特异性 85.2%，PPV 60%，NPV 92%，AUC 0.828），IDA 的 Ret-He 截断值为 28.15 pg（敏感性 75%，特异性 88.9%，PPV 85.7%，NPV 80%，AUC 0.824）。血红蛋白应与 Ret-He 一起使用。在这个队列中，Ret-He 为 28.8 pg，血红蛋白>16.5 g/dL，可能会检测到 ID。而 Ret-He 为 28.15 pg 或 Ret-He 为 28.15-28.8 pg，血红蛋白为 16.5 g/dL，可用于诊断 IDA。
结论
网织红细胞血红蛋白当量可作为儿科 CHD 的铁状态参数，其 ID 的截断值为 28.8 pg，IDA 的截断值为 28.15 pg。
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