摘要
目的评价几种铁参数在铁缺乏症诊断中的价值。方法连续性收集９０例贫血病人（缺铁性贫血３６例，慢性病贫血２３例，慢性病伴缺铁性贫血３１例），做骨髓铁染色、血清转铁蛋白受体（ｓＴｆＲ）、血清铁蛋白（Ｓｅｒｕｍｆｅｒｉｔｉｎ，ＳＦ）、血清铁（Ｓｅｒｕｍｉｒｏｎ，ＳＩ）、总铁结合力（Ｔｏｔａｌｉｒｏｎｂｉｎｄｉｎｇｃａｐａｃｉｔｙ，ＴＩＢＣ）、转铁蛋白饱和度（Ｔｒａｎｓｆｅｒｉｎｓａｔｕｒａｔｉｏｎ，ＴＳ）等检查，应用似然比（ＬＲ）和受试者工作特征（ＲＯＣ）曲线分析方法，以骨髓铁染色作为金标准对以上的铁参数诊断慢性病合并缺铁性贫血的价值进行分析。结果在判断慢性病是否合并缺铁性贫血时ＳＦ在２５～４４μｇ／Ｌ时的ＬＲ最大（５８），ｓＴｆＲ＞５０ｎｍｏｌ／Ｌ时的ＬＲ最大（６０）；ＲＯＣ曲线下面积以ｓＴｆＲ最大（０８４），其他依次是ｓＴｆＲ／ｌｏｇＳＦ（０．８３）、ＳＦ（０７７）、ｓＴｆＲ／ＳＦ（０．７４）、ＳＩ（０７２）、ＴＩＢＣ（０６８）。结论认为ＲＯＣ曲线与ＬＲ对科学评价铁参数诊断价值有重要的意义。
Objective To evaluate the value of iron parameters in diagnosing iron deficiency (ID).Methods Cross sectional study was performed for diagnostic tests. Ninety consecutive patients with anemia including iron deficiency anemia without chronic diseases (36 cases), chronic diseases (54) were divided into chronic diseases without ID(ACD) (23 cases) and chronic diseases with ID(CDID) (31) by bone marrow iron staining. The exclusion criteria included hemolytic anemia, deficiency of Vitamin B 12 or folic acid, blood transfusion, taking iron preparations within one month and hematological malignancies. By using absence of bone marrow iron as gold standard of ID, we compared the diagnostic powers in the diagnosis of iron deficiency for sTfR, serum iron, total iron binding capacity, serum ferritin (SF), transferrin saturation and the presence of hypochromic red cells by analyzing the likelihood ratio, the area under ROC(AUC ROC ).Results AUC ROC for sTfR in determining ID in groups IDA+CDID vs. ACD, IDA vs. ACD and CDID vs. ACD were 0.9 (95%CI:0.82～0.98), 0.96(0 9～0 99) and 0.84 (0.72～0.96) respectively, AUC ROC for SF in above groups 0.87 (95%CI:0.77～0.87), 0.94(0.86～0.99) and 0.77(0.63～0.91) respectively. AUC ROC for other iron parameters in determining iron deficiency in chronic diseases was lower than 70%.Conclusion ROC and LR are useful tools for evaluating iron parameters in diagnosing iron deficiency. TfR is a best parameter in determining iron deficiency in chronic diseases than SF and other iron parameters.
出处
《中华医学杂志》
CAS
CSCD
北大核心
1999年第2期99-103,共5页
National Medical Journal of China
关键词
缺铁性贫血
似然参数
ROC曲线
诊断
Anemia, iron deficiency Likelihood Ratio ROC curve Diagnosis
