Valberg L S, Ghent C N, Lloyd D A, Frei J V, Chamberlain M J
Can Med Assoc J. 1978 Aug 12;119(3):229-36.
The value of tests for the detection of body iron overload was investigated in 8 patients with clinically manifest primary hemochromatosis, 12 patients with cirrhosis and iron overload and 20 patients with liver disease and low or normal iron stores. Iron overload was defined as the presence of stainable iron in more than 50% of hepatocytes in a liver biopsy specimen. The percentages of patients with a true-positive (abnormal) or true-negative (normal) result were: serum iron concentration 65%, transferin saturation 85%, serum ferritin concentration 78%, serum ferritin:serum glutamic oxaloacetic transaminase (SGOT) index 78%, percent iron absorption 58%, percent iron absorption in relation to serum ferritin concentration 80% and percent iron absorption in relation to serum ferritin:SGOT index 93%. The calculated predictive value of a normal test result for the exclusion of iron overload in patients with liver disease, a group with an assumed prevalence of iron overload of 10%, was 98% to 99% for transferrin saturation and serum ferritin concentration used alone and 100% for these measures used together; the predictive value of an abnormal result for the diagnosis of iron overload was less than 50% for all of the above measures used alone or in combination. Hence, in patients with an increased serum ferritin concentration or transferrin saturation, or both, determination of the hepatocellular iron content of a specimen from a percutaneous liver biopsy is required for the diagnosis of iron overload.
对8例有临床表现的原发性血色素沉着症患者、12例肝硬化伴铁过载患者以及20例肝病且铁储存量低或正常的患者，研究了检测体内铁过载的各项检查的价值。铁过载定义为肝活检标本中超过50%的肝细胞存在可染色铁。检查结果为真阳性（异常）或真阴性（正常）的患者百分比分别为：血清铁浓度65%、转铁蛋白饱和度85%、血清铁蛋白浓度78%、血清铁蛋白：血清谷草转氨酶（SGOT）指数78%、铁吸收率58%、与血清铁蛋白浓度相关的铁吸收率80%以及与血清铁蛋白：SGOT指数相关的铁吸收率93%。对于肝病患者（假定铁过载患病率为10%），单独使用转铁蛋白饱和度和血清铁蛋白浓度时，正常检查结果排除铁过载的计算预测值为98%至99%，两者联合使用时为100%；单独或联合使用上述所有检查时，异常结果诊断铁过载的预测值均小于50%。因此，对于血清铁蛋白浓度或转铁蛋白饱和度升高或两者均升高的患者，诊断铁过载需要经皮肝活检标本测定肝细胞铁含量。
