골수저장철 평가에 있어서 혈청 가용성트란스페린 수용체와 로그혈청페리틴 비율의 유용성

Abstract

Background : In diagnosis of iron deficiency anemia (IDA) and anemia of chronic disease (ACD), bone marrow examination is the gold standard, which is too invasive. Serum ferritin is most commonly used parameter of iron status in chronic disease patients but may be influenced by the presence of infection, inflammation and malignancy. Recently soluble transferrin receptor (sTfR) has been advocated as a useful parameter of iron deficiency. In this study, we have evaluated the clinical efficiency of sTfR/log ferritin ratio in the identification of BM iron depletion for the ACD patients. Method : The 258 patients were classified as four groups on the basis of stainable iron in the bone marrow, including group I (Increased storage iron in BM, 61 patients), group II (Adequate storage iron in BM, 71 patients), group III (Decreased storage iron in BM, 81 patients), group IV (Absent storage iron in BM, 45 patients). The blood levels of sTfR, hemoglobin (Hb), RBC indices, serum ferritin, serum iron, and TIBC were measured and sTfR/log ferritin ratio was calculated. The sTfR/log ferritin ratios were compared with each other group. The correlations between sTfR/log ferritin ratio and other parameters were investigated for overall group ( n=258). Results : The sTfR/log ferritin ratio was significantly higer in group IV than in other groups. Inverse correlation was observed between serum ferritin and sTfR level for the overall group (n=258, r=-0.269 and p-value=0.000). The receiver operating characteristic (ROC) curve analysis was performed. Based on the data, sTfR/log ferritin ratio of 1,500 was selected as the cutoff value for the diagnosis of group IV. This cutoff value of 1,500 showed a sensitivity of 49% and a specificity of 97%. Conculsion : The sTfR/log ferritin ratio is the useful marker in the evalutation of iron status, especially in patient with infection and malignancy.