可溶性转铁蛋白受体在儿童铁缺乏症诊断中的价值

Value of soluble transferrin receptor in the diagnosis of iron deficiency in children

摘要:

目的：调查6个月至7岁各年龄段儿童铁缺乏症的发生率；评价可溶性转铁蛋白受体（sTfR）在儿童铁缺乏症筛查中的应用价值。方法：采用诊断性试验方法，检测浙江省杭州市502例来我院体检的6个月至7岁儿童血清sTfR、铁蛋白(SF)、血清铁(SI)、总铁结合力（TIBC）以及C反应蛋白（CRP）水平，同时检测血常规和血锌原卟啉（ZPP）。结果：铁缺乏症的检出率为19.5%（98/502），其中婴儿组（≤1岁）检出率为34.7%，幼儿组（大于1岁、小于或等于3岁）19.4%，学龄前组（大于3岁、小于或等于7岁）14.0%。婴儿组铁缺乏的检出率明显高于其他两个年龄组。婴儿组sTfR均值（2.02±0.73 mg/L）明显高于幼儿组（1.68±0.40 mg/L）和学龄前组（1.67±0.29 mg/L），差异有统计学意义（P<0.05）。sTfR诊断铁缺乏的界值在婴儿组为2.02 mg/L（灵敏度70.3%，特异度 82.2%），幼儿组为1.85 mg/L(灵敏度71.7%，特异度86.4%)，学龄前组为1.85 mg/L（灵敏度77.8%， 特异度88.6%)。sTfR与SF、TIBC、TS、ZPP及MCV具有相关性（r分别为0.107、0.276、-0.139、0.175、-0.140，P均<0.05）。结论：7岁以下儿童中，婴儿组是铁缺乏发生率最高的；婴儿组sTfR均值及其诊断铁缺乏的界值均高于其他年龄组；sTfR是诊断儿童尤其是婴儿铁缺乏症的一个较敏感指标。

Abstract:

OBJECTIVE: To study the prevalence of iron deficiency in children between 6 months and 7 years and to study the diagnostic value of soluble transferrin receptor (sTfR) for iron deficiency in the children. METHODS: A total of 502 healthy children between 6 months and 7 years from Hangzhou City of Zhejiang Province were enrolled. Serum sTfR, serum ferritin (SF), serum iron (SI), total iron blinding capacity (TIBC), zinc protoporphyrin (ZPP), Hb, MCV and CRP levels were measured. RESULTS: The prevalence rate of iron deficiency was 19.5% in children at ages of 6 months to 7 years. The prevalence rate of iron deficiency was the highest in infants (≤1 year old; 34.7%), followed by in toddlers (1-3 years old; 19.4%) and preschoolers (3-7 years old; 14.0%). The mean serum sTfR level in infants (2.02±0.73 mg/L) was significantly higher than that in toddlers (1.68±0.40 mg/L) and preschoolers (1.67±0.29 mg/L) (P<0.05).The best cut-off value of serum sTfR for the diagnosis of iron deficiency was 2.02 mg/L in infants (sensitivity: 70.3%, specificity: 82.2%). The best cut-off value was 1.85 mg/L in toddlers (sensitivity: 71.7%; specificity: 86.4%), and that was 1.85 mg/L in preschoolers (sensitivity: 77.8%; specificity: 88.6%). Serum sTfR was correlated with SF (r=0.107, P<0.05), TIBC (r=0.276, P<0.01), TS (r=-0.139, P<0.05), ZPP (r=0.175, P<0.01) and MCV (r=-0.140, P<0.01). CONCLUSIONS: Iron deficiency is more prevalent in infants ≤1 year old. The mean serum level and the cut-off value of sTfR in infants are higher than in toddlers and preschoolers. Serum sTfR is an effective index for the diagnosis of iron deficiency in children, especially in infants≤ 1 year old.