背景:鉴于长期缺氧,紫红色性心脏病(CHD)患儿发生缺铁性缺铁性缺铁性(ID)和缺铁性贫血(IDA)的风险很高.网织红细胞血红蛋白当量(Ret-He)是评估铁状态的一种新颖可靠的指标。然而,以前没有关于小儿CHD组的临界值的研究.这项研究的目的是评估Ret-He的作用,并建立诊断小儿紫癜性心脏病中铁缺乏和IDA的临界点。
方法:本研究在雅加达的两家三级医院进行,印度尼西亚。59名冠心病儿童,3个月至18岁,连续登记。为了确定铁的状态,血液学参数(血红蛋白,血细胞比容,平均红细胞体积,平均红细胞血红蛋白)和铁状态的生化参数(血清铁蛋白,转铁蛋白饱和度)进行分析并与Ret-He水平进行比较。对ID和IDA的Ret-He截止点进行接收器工作特性(ROC)分析。灵敏度,特异性,计算每个截止点的阳性和阴性预测值.
结果:在27名(45.8%)受试者中确定了正常的铁状态,8名(13.5%)受试者的ID,和国际开发协会24名(40.7%)受试者。Ret-He的ID截止值为28.8pg(灵敏度75%,特异性85.2%,PPV60%,净现值92%,和AUC0.828),IDA的Ret-He截止点为28.15pg(灵敏度75%,特异性88.9%,PPV85.7%,净现值80%,和AUC0.824)。血红蛋白应与Ret-He结合使用。在该队列中可以检测到ID,其具有Ret-He28.8pg和血红蛋白>16.5g/dL。而具有血红蛋白16.5g/dL的Ret-He28.15pg或Ret-He28.15-28.8pg可用于诊断IDA。
结论:网织红细胞血红蛋白当量可用作小儿冠心病的铁状态参数,ID的截止值为28.8pg,IDA的截止值为28.15pg。
BACKGROUND: In light of prolonged hypoxia, children with cyanotic heart disase (CHD) are at a high risk of developing iron deficiency iron deficiency (ID) and iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is a novel and dependable indicator for assessing iron status. However, there has been no previous study regarding cut-off value in pediatric CHD group. The purpose of this study is to assess the role of Ret-He and to establish cut-off points in the diagnosis of iron deficiency and IDA in pediatric cyanotic heart disease.
METHODS: This study was conducted in two tertiary hospitals in Jakarta, Indonesia. 59 children with CHD, aged 3 months to 18 years, were enrolled consecutively. To determine iron status, hematological parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin) and biochemical parameters for iron status (serum ferritin, transferrin saturation) were analysed and compared to Ret-He levels. The receiver operating characteristic (ROC) analysis was performed for the Ret-He cut-off points for ID and IDA. Sensitivity, specificity, positive and negative predictive value were calculated for each cut-off point.
RESULTS: Normal iron status was identified in 27 (45.8%) subjects, ID in 8 (13.5%) subjects, and IDA 24 (40.7%) subjects. The ID cut-off value for Ret-He is 28.8 pg (sensitivity 75%, specificity 85.2%, PPV 60%, NPV 92%, and AUC 0.828) and the Ret-He cut-off point for IDA is 28.15 pg (sensitivity 75%, specificity 88.9%, PPV 85.7%, NPV 80%, and AUC 0.824). Hemoglobin should be used in conjunction with Ret-He. ID might be detected in this cohort with Ret-He 28.8 pg and hemoglobin > 16,5 g/dL. While Ret-He 28.15 pg or Ret-He 28.15-28.8 pg with hemoglobin 16.5 g/dL could be used to diagnose IDA.
CONCLUSIONS: The reticulocyte hemolgobin equivalent could be utilised as an iron status parameter in pediatric CHD, with a cut-off value of 28.8 pg for ID and 28.15 pg for IDA.