Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions.
Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions.
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DOI：
10.1155/2018/9394060
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发表时间：
2018
影响因子：
--
通讯作者：
Stein J
中科院分区：
文献类型：
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作者：
Dignass A;Farrag K;Stein J
患有炎症性肠病（IBD）、慢性心力衰竭（CHF）和慢性肾病（CKD）等炎症性疾病的患者缺铁率很高，会产生不良的临床后果。在正常情况下，血清铁蛋白水平是铁状态的敏感标志物，但铁蛋白是一种急性期反应物，会因炎症反应而升高，从而使诊断复杂化。促炎细胞因子还会引发铁调素的增加，铁调素会限制膳食铁的吸收，并促进铁蛋白在储存部位对铁的螯合。因此，尽管血清铁蛋白水平正常或较高，但患有炎症的患者由于铁调素表达增加，红细胞生成和其他细胞功能的铁利用率可能受到限制。因此，缺铁的标准阈值（<30μg/L）不适用，还应评估铁可用性标志物转铁蛋白饱和度（TSAT）。血清铁蛋白阈值<100μg/L或TSAT<20%可被认为诊断CHF、CKD和IBD缺铁。如果血清铁蛋白为100-300μg/L，则需要TSAT<20%才能确认缺铁。建议对这些高危人群进行血清铁蛋白和 TSAT 的常规监测，以便发现和管理铁缺乏症。
Patients with inflammatory conditions such as inflammatory bowel disease (IBD), chronic heart failure (CHF), and chronic kidney disease (CKD) have high rates of iron deficiency with adverse clinical consequences. Under normal circumstances, serum ferritin levels are a sensitive marker for iron status but ferritin is an acute-phase reactant that becomes elevated in response to inflammation, complicating the diagnosis. Proinflammatory cytokines also trigger an increase in hepcidin, which restricts uptake of dietary iron and promotes sequestration of iron by ferritin within storage sites. Patients with inflammatory conditions may thus have restricted availability of iron for erythropoiesis and other cell functions due to increased hepcidin expression, despite normal or high levels of serum ferritin. The standard threshold for iron deficiency (<30 μg/L) therefore does not apply and transferrin saturation (TSAT), a marker of iron availability, should also be assessed. A serum ferritin threshold of <100 μg/L or TSAT < 20% can be considered diagnostic for iron deficiency in CHF, CKD, and IBD. If serum ferritin is 100–300 μg/L, TSAT < 20% is required to confirm iron deficiency. Routine surveillance of serum ferritin and TSAT in these at-risk groups is advisable so that iron deficiency can be detected and managed.