Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia
Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia
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DOI：
10.1002/ajh.23354
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发表时间：
2013-02-01
影响因子：
12.8
通讯作者：
Goodnough, Lawrence T.
中科院分区：
文献类型：
--
作者：
Bregman, David B.;Morris, David;Goodnough, Lawrence T.
铁调素是铁稳态的主要调节剂，其水平可鉴别对口服铁剂治疗无反应的缺铁性贫血（IDA）患者。在这项研究中，IDA患者接受了为期14天的硫酸亚铁治疗试验（导入）。无应答者（血红蛋白升高20 ng/mL）预测口服铁剂无应答的敏感性为41.3%，特异性为84.4%，阳性预测值为81.6%。铁蛋白> 30 ng/mL或转铁蛋白饱和度（TSAT）>15%的PPV分别为59.2和55%。铁调素、铁蛋白和TSAT的阴性预测值分别为46.3、22.7和19.7。FCM与口服铁剂相比，分别显示65.3%与20.8%（P < 0.0001）的Hgb增加≥ 1 gm/dL，Hgb增加1.7 +/- 1.3与0.6 +/- 0.9 g/dL（P = 0.0025）。我们的结论是铁调素预测缺铁性贫血患者口服铁剂无反应性，并且在此方面其作用上级于TSAT或铁蛋白。口服铁剂治疗无效并不能排除缺铁性贫血，因为三分之二的患者随后对静脉铁剂有反应。Am.血液学杂志88：97-101，2013. (C)2012 Wiley Periodicals，Inc.
Levels of hepcidin, a major regulator of iron homeostasis, may identify patients with iron deficiency anemia (IDA) who will not respond to oral iron therapy. In this study, IDA patients underwent a 14-day trial (run-in) course of ferrous sulfate therapy. Nonresponders (Hgb increase 20 ng/mL, showed sensitivity of 41.3%, specificity of 84.4%, and positive predictive value of 81.6% for predicting nonresponsiveness to oral iron. PPVs for ferritin> 30 ng/mL or transferrin saturation (TSAT)>15% were 59.2 and 55%, respectively. Negative predictive values for hepcidin, ferritin, and TSAT were 46.3, 22.7, and 19.7, respectively. FCM versus oral iron showed Hgb increases of =1 gm/dL in 65.3% versus 20.8% (P < 0.0001) and Hgb increases of 1.7 +/- 1.3 versus 0.6 +/- 0.9 g/dL (P = 0.0025), respectively. We conclude that hepcidin predicts nonresponsiveness to oral iron in patients with IDA and is superior to TSAT or ferritin for this purpose. Nonresponse to oral iron therapy does not rule out IDA, since two-thirds of patients subsequently responded to intravenous iron. Am. J. Hematol. 88:97-101, 2013. (C) 2012 Wiley Periodicals, Inc.