Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children With Inflammatory Bowel Disease.
Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children With Inflammatory Bowel Disease.
复制标题
DOI：
10.1097/mpg.0000000000001335
复制
发表时间：
2017-05
影响因子：
2.9
通讯作者：
Suchdev PS
中科院分区：
文献类型：
--
作者：
Syed S;Kugathasan S;Kumar A;Prince J;Schoen BT;McCracken C;Ziegler TR;Suchdev PS
铁缺乏和贫血影响高达50-75%的炎症性肠病（IBD）患者。由于炎症对铁状态生物标志物的影响，IBD缺铁可能难以诊断。因此，需要更好的方法来准确地确定IBD中的铁状态。研究炎症与网织红细胞（CHr）血红蛋白含量的关系，并将其与标准铁生物标志物进行比较。我们对患有IBD的儿童进行了一项横断面研究。测定铁生物标志物[CHr、铁蛋白、可溶性转铁蛋白受体（sTfR）、hepcidin、血红蛋白]与炎症系统生物标志物[c反应蛋白（CRP）、α1-酸性糖蛋白（AGP）]。Spearman相关性用于评估炎症与铁生物标志物的关系。铁缺乏的金标准定义为炎症校正铁蛋白< 15 μg/L或sTfR bb0 8.3mg/L。受试者工作特征（ROC）曲线用于估计所有铁生物标志物的预后价值，以识别缺铁患者。我们分析了62名5至< 19岁儿童的数据。69%的受试者患有克罗恩病，31%患有溃疡性结肠炎，其中42%为女性，53%为非洲裔美国人。贫血发生率为32%，铁蛋白< 15 μg/L或sTfR > 8.3mg/L缺铁率为52%，RDW>14.5%缺铁率为39%，BIS<0mg/kg体重组为26%，CHr <28 pg组为25%，MCV <75fL/cell组为11%。在纠正了铁蛋白和sTfR的炎症水平后，缺铁的患病率为68%。CHr与CRP （rs - 0.44, p < 0.001）、AGP （rs - 0.37, p < 0.05）相关。炎症调整的CHr预测缺铁的最佳预后值为34 pg (ROC下面积为0.70)，敏感性88%，特异性30%。缺铁和贫血在这个儿童IBD队列中很常见。所有探索的铁生物标志物，包括CHr，都受到炎症的影响，应进行调整。单一的铁生物标志物不太可能最好地预测儿童IBD缺铁。需要铁干预研究来检查铁生物标志物对炎症背景下铁补充的反应。
Iron deficiency and anemia affect up to 50–75% of inflammatory bowel disease (IBD) patients. Iron deficiency in IBD may be difficult to diagnose because of the effect of inflammation on iron status biomarkers. Thus, there is a need for better methods to accurately determine iron status in IBD. To investigate the association of inflammation with hemoglobin content of reticulocytes (CHr) and the utility of CHr in comparison to standard iron biomarkers. We conducted a cross-sectional study of children with IBD. Iron biomarkers [CHr, ferritin, soluble transferrin receptor (sTfR), hepcidin, hemoglobin] were measured along with systemic biomarkers of inflammation [C-reactive protein (CRP), α1-acid glycoprotein (AGP)]. Spearman correlations were used to evaluate the relationship of inflammation and iron biomarkers. The gold standard for iron deficiency was defined as inflammation-corrected ferritin < 15 μg/L or sTfR > 8.3mg/L. Receiver operating characteristic (ROC) curves were used to estimate the prognostic values of all iron biomarkers to identify patients with iron deficiency. We analyzed data in 62 children aged 5 to < 19 years. Sixty-nine % of our subjects had Crohn’s disease and 31% had ulcerative colitis, of which 42% were females and 53% African American. The prevalence of anemia was 32%, of iron deficiency was 52% using ferritin < 15 μg/L or sTfR > 8.3mg/L, 39% using RDW>14.5%, 26% using BIS<0mg/kg body weight, 25% using CHr <28 pg and 11% using MCV <75fL/cell. After correcting ferritin and sTfR levels for inflammation, the prevalence of iron deficiency was 68%. CHr was correlated with CRP (rs −0.44, p < 0.001) and AGP (rs −0.37, p < 0.05). The optimal prognostic value for inflammation-adjusted CHr to predict iron deficiency was 34 pg (area under the ROC of 0.70), with 88% sensitivity and 30% specificity. Iron deficiency and anemia are very common in this pediatric IBD cohort. All explored iron biomarkers, including CHr, were affected by inflammation and should be adjusted. A single iron biomarker is unlikely to best predict iron deficiency in pediatric IBD. Iron intervention studies are needed to examine the response of iron biomarkers to iron supplementation in the setting of inflammation.