Intragumtornchai T, Rojnukkarin P, Swasdikul D, Israsena S
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Intern Med. 1998 Mar;243(3):233-41. doi: 10.1046/j.1365-2796.1998.00290.x.
To determine the diagnostic values of serum ferritin and other conventional laboratory tests in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis.
Cross-sectional study for diagnostic tests.
University hospital.
Seventy-two consecutive patients with liver cirrhosis in whom the haemoglobin level was less than 13.0 g dL(-1) for men and 12.0 g dL(-1) for women. The diagnosis of liver cirrhosis was based on characteristic clinical and hepatic ultrasonographic findings.
By using absence of bone marrow iron as the standard criterion, the diagnostic powers of mean corpuscular volume, transferrin saturation, serum ferritin and the presence of hypochromic red cells in the diagnosis of iron deficiency were compared by analysing the likelihood ratios, the area under the receiver operating curves (ROC) and the stepwise logistic regression associated with each test.
Twenty-nine patients (40.3%) demonstrated no stainable iron in the bone marrow. The likelihood ratios, the area under the ROC and the stepwise logistic regression indicated that serum ferritin was the most powerful test predictive of iron deficiency. Other tests added little further diagnostic values. The likelihood ratios associated with the serum ferritin levels were as follows: <50 microg L(-1), 22.3; 51-200 microg L(-1), 1.5-1.8; 201-400 microg L(-1), 1.0; >400 microg L(-1), <1. These results indicate that serum ferritin level <50 microg L(-1) depict a very high probability of iron deficiency anaemia (0.83-0.99) irrespective of the patient's pre-test probability.
Serum ferritin is the most powerful noninvasive test for the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. It should be the primary test of choice in patients suspected of having the disease. When the level was less than 50 microg L(-1), iron supplement may be prescribed without necessitating bone marrow aspiration.
确定血清铁蛋白及其他传统实验室检查对肝硬化患者缺铁性贫血的诊断价值。
诊断试验的横断面研究。
大学医院。
72例连续入选的肝硬化患者，男性血红蛋白水平低于13.0 g/dL，女性低于12.0 g/dL。肝硬化的诊断基于特征性临床及肝脏超声检查结果。
以骨髓铁缺乏作为标准，通过分析似然比、受试者工作特征曲线（ROC）下面积及与每项检查相关的逐步逻辑回归，比较平均红细胞体积、转铁蛋白饱和度、血清铁蛋白及低色素红细胞在缺铁诊断中的诊断效能。
29例患者（40.3%）骨髓中无可染色铁。似然比、ROC下面积及逐步逻辑回归表明，血清铁蛋白是预测缺铁最有效的检查。其他检查几乎没有额外的诊断价值。与血清铁蛋白水平相关的似然比分别为：<50 μg/L，22.3；51 - 200 μg/L，1.5 - 1.8；201 - 400 μg/L，1.0；>400 μg/L，<1。这些结果表明，无论患者的检验前概率如何，血清铁蛋白水平<50 μg/L时缺铁性贫血的可能性非常高（0.83 - 0.99）。
血清铁蛋白是诊断肝硬化患者缺铁性贫血最有效的非侵入性检查。对疑似该病的患者应作为首选的初步检查。当血清铁蛋白水平低于50 μg/L时，可不进行骨髓穿刺而直接给予铁剂补充。
