血清可溶性转铁蛋白受体对成人缺铁性贫血的诊断价值

doi:10.3969/j.issn.1673-8640.2019.11.010

摘要/Abstract

摘要：

目的探讨血清可溶性转铁蛋白受体（sTfR）对成人缺铁性贫血（IDA）的诊断价值,观察sTfR与传统IDA评价指标血清铁（SI）和总铁结合力（TIBC）之间的相关性,分析sTfR以及sTfR/SI比值的诊断效能。方法选取IDA患者79例,其他类型贫血患者50例（肾性贫血患者35例、巨幼细胞性贫血患者7例、再生障碍性贫血患者8例）,以同期体检健康者60名作为正常对照组。留取研究对象血清标本,采用免疫比浊法测定sTfR,比色法测定SI和TIBC。采用受试者工作特征（ROC）曲线评价sTfR及sTfR/SI比值的诊断效能,采用回归分析评价sTfR与SI、TIBC的相关性。结果在成年健康人群中,男性和女性的sTfR水平差异无统计学意义（P=0.389）;IDA组sTfR水平明显高于其他类型贫血组和正常对照组（P<0.01）;sTfR的曲线下面积（AUC）为0.985（P<0.01）,最佳临界值为77.42 nmol/L,敏感性和特异性分别为93.67%、96.08%;sTfR与SI呈曲线负相关（r=-0.796,P<0.01）,与TIBC有较高相关性（r=0.668,P<0.01）,呈线性正相关;IDA组sTfR/SI比值明显高于其他类型贫血组和正常对照组（P<0.01）;sTfR/SI比值的AUC为0.998（P<0.01）,最佳临界值为11.84,敏感性为93.70%,特异性为100.00%。结论 sTfR在IDA的诊断及鉴别诊断中具有重要的临床价值;sTfR/SI比值可以作为IDA的诊断指标,且诊断效能优于sTfR单项检测。

关键词: 可溶性转铁蛋白受体, 血清铁, 总铁结合力, 缺铁性贫血

Abstract:

Objective To investigate the role of serum soluble transferrin receptor（sTfR） in the diagnosis of adult iron deficiency anemia（IDA）,to observe the correlations between serum iron（SI）,total iron binding capacity（TIBC） and sTfR,and to analyze the diagnostic efficiency of sTfR and sTfR/SI ratio. Methods A total of 79 patients with IDA and 50 patients with other types of anemia,including 35 cases of renal anemia,7 cases of megaloblastic anemia and 8 cases of aplastic anemia,were enrolled. Totally,60 healthy adults were enrolled as control group. Their serum samples were collected. Serum sTfR was determined by immunoturbidimetry assay. SI and TIBC were determined by colorimetry method. The diagnostic efficiency of sTfR and sTfR/SI ratio were analyzed by receiver operating characteristic（ROC） curve analysis. The correlations between SI,TIBC and sTfR were analyzed by regression analysis. Results In healthy adults,there was no statistical significance of sTfR between males and females（P=0.389）. The level of sTfR in IDA group was higher than those in other anemia group and control group（P<0.01）. In the diagnosis of IDA,the area under curve（AUC） of sTfR was 0.985（P<0.01）. The optimal cut-off value of sTfR was 77.42 nmol/L,and the sensitivity and specificity were 93.67% and 96.08%,respectively. There was a negative correlation between sTfR and SI（r=-0.796,P<0.01）,and sTfR was positively correlated with TIBC（r=0.668,P<0.01）. The sTfR/SI ratio in IDA group was higher than those in other anemia group and control group（P<0.01）. In the diagnosis of IDA,the AUC of sTfR/SI ratio was 0.998（P<0.01）. The optimal cut-off value was 11.84. The sensitivity and specificity were 93.70% was 100.00%,respectively. Conclusions The indicator, sTfR, is of significance in the diagnosis and differential diagnosis of IDA,sTfR/SI ratio can be used as a diagnostic indicator of IDA,and its diagnostic efficiency is better than that of sTfR.

Key words: Soluble transferrin receptor, Serum iron, Total iron binding capacity, Iron deficiency anemia

中图分类号:

R446.1

周春雷, 陈如萍, 王凯, 高强, 穆红. 血清可溶性转铁蛋白受体对成人缺铁性贫血的诊断价值[J]. 检验医学, 2019, 34(11): 1002-1006.

ZHOU Chunlei, CHEN Ruping, WANG Kai, GAO Qiang, MU Hong. Role of serum soluble transferrin receptor in the diagnosis of adult iron deficiency anemia[J]. Laboratory Medicine, 2019, 34(11): 1002-1006.

图/表 5

表1 IDA组、其他类型贫血组和正常对照组sTfR水平比较

组别	例数	sTfR（nmol/L）	sTfR/SI比值
IDA组	79	153.17±66.69	46.58±31.36
其他类型贫血组	50	43.74±21.84^*	3.17±2.21^*
正常对照组	60	35.37±7.41^*	2.17±1.10^*

图1 各组间sTfR和sTfR/SI比值注：（a）各组间sTfR/SI比值;（b）各组间sTfR水平

图2 sTfR与SI、TIBC的相关性分析注：（a）sTfR与SI的回归分析结果,Y=1.221+547.045×1/X（r=-0.796,P=0.000）;（b）sTfR与TIBC的回归分析结果,Y=49.291+0.139X（r=0.668,P=0.000）

表2 sTfR、sTfR/SI比值的ROC曲线参数

项目	AUC	95%可信区间		P值	最佳临界值（nmol/L）	敏感性（%）	特异性（%）
项目	AUC	下限	上限	P值	最佳临界值（nmol/L）	敏感性（%）	特异性（%）
sTfR	0.985	0.972	0.997	0.000	77.42	93.67	96.08
sTfR/SI	0.998	0.994	1.001	0.000	11.84	93.70	100.00

图3 sTfR、sTfR/SI比值诊断IDA的ROC曲线注：（a）sTfR的ROC曲线;（b）sTfR/SI的ROC曲线

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