Efficacy of daily and weekly iron supplementation on iron status in exclusively breast-fed infants

Iron deficiency anemia (IDA) remains the most prevalent nutritional deficiency in infants worldwide. The purpose of this study was to determine the efficacy of daily and weekly iron supplementation for 3 months to improve the iron status in 4-month-old, exclusively breast-fed healthy infants. Infants 4 months of age were eligible for the open, randomized controlled trial if their mothers intended to continue exclusive breast-feeding until the infants were 6 months of age. Infants or mothers with iron deficiency (ID) or IDA on admission were excluded. The infants (n = 79) were randomly assigned to three groups, the first group receiving daily (1 mg/kg daily), the second group weekly (7 mg/kg weekly), and the third group no iron supplementation. Anthropometric measurements were taken on admission and at 6 and 7 months of age. Iron status was analyzed on admission and monthly for 3 months. Both hematologic parameters and anthropometric measurements were found to be similar among the three groups during the study period. Seven infants (31.8%) in the control group, six (26.0%) in the daily group, and three (13.6%) in the weekly group developed ID or IDA (P > 0.05). Infants whose mothers had ID or IDA during the study period were more likely to develop ID or IDA independently from iron supplementation. Serum ferritin levels decreased between 4 and 6 months of age in the control and daily groups; the weekly group showed no such decrease. In all groups, the mean levels of serum ferritin were significantly increased from 6 months to 7 months of age during the weaning period. In this study, which had a limited number of cases, weekly or daily iron supplementation was not found to decrease the likelihood of IDA. In conclusion, exclusively breast-fed infants with maternal IDA appeared to be at increased risk of developing IDA.     

Treatment of iron deficiency anemia and associated protein-losing enteropathy in children

PURPOSE: The aims of this study were to evaluate the response of oral iron treatment in children with iron deficiency anemia (IDA) fed whole cow's milk (WCM) or soy formula; to compare the incidence of fecal blood loss in infants fed WCM and soy formula; and to evaluate the incidence and relation of protein-losing enteropathy (PLE) and IDA by testing serum albumin, fecal blood loss, and fecal alpha1-antitrypsin (alpha1AT). METHODS: Twenty-four children with nutritional IDA were randomly assigned to receive either 16 oz WCM or soy formula daily. Both groups were treated with daily therapeutic oral iron during 12 weeks. Stool specimens for hemoglobin losses were collected at weeks 0, 3, 6, and 12. Levels of serum albumin and fecal alpha1AT were tested at diagnosis and when IDA was corrected. RESULTS: Anemia was corrected in 21 of the 24 children by week 6 or 12. Median fecal hemoglobin losses were not increased in either group at diagnosis or during treatment. Seven of 24 children had PLE at diagnosis with elevated fecal alpha1AT levels of 72 to 381 mg/dL that returned to normal after correction of IDA. Their initial fecal alpha1AT levels averaged 170 mg/ dL at diagnosis and 21 mg/dL after the IDA was corrected. Excessive WCM intake of 30 oz/day or more was present in 63% of the infants. CONCLUSIONS: Treatment of nutritional IDA with oral iron was just as effective with a limited quantity of either WCM or soy formula. Fecal hemoglobin losses were uncommon and did not differ in children at diagnosis or during treatment of IDA. PLE associated with IDA resolves when the IDA is corrected, but differences between children fed WCM or soy formula could not be detected.     

缺铁性贫血患儿血清胃泌素水平测定及间断补铁疗效观察

研究缺铁性贫血 (IDA)儿童胃泌素水平的变化 ;观察间断补铁治疗儿童IDA的疗效。方法 :49例 IDA患儿每周口服一次铁制剂 (元素铁 2 mg/kg) ,共 1 2周。在治疗前后测查 Hb、ZPP、SF及血清胃泌素。结果 :经补铁治疗 ,Hb、SF均极显著性升高 (P<0 .0 1 ) ,ZPP则明显下降 (P<0 .0 1 ) ;IDA患儿血清胃泌素水平明显升高 ,与对照组比较差异显著 ,治疗后恢复正常。结论 :1每周一次间断补铁治疗儿童 IDA效果显著。 2 IDA患儿胃泌素的异常分泌可能与缺铁所致的胃粘膜萎缩有关     

Leukocyte DNA damage in children with iron deficiency anemia: effect of iron supplementation

Iron deficiency is frequently associated with anemia. Iron is a transition-metal ion, and it can induce free radical formation, which leads to formation of various lesions in DNA, proteins, and lipids. The aim of this study was to investigate baseline oxidative DNA damage and to clarify the role of the administration of a therapeutic dose of iron on DNA oxidation in children with iron deficiency anemia (IDA). Twenty-seven children with IDA and 20 healthy children were enrolled in the study. Leukocyte DNA damage (strand breaks and Fpg-sensitive sites) was assessed using comet assay before and after 12 weeks of daily iron administration. Before the iron administration, the frequency of DNA strand breaks in the children with IDA was found to be lower than those in the control group (P < 0.05), but there was not a significant difference for frequency of Fpg-sensitive sites. After 12 weeks of iron administration, the frequency of both DNA strand breaks and Fpg-sensitive sites were found to be increased (P < 0.01). No significant association was determined between DNA damage parameters and hemoglobin, hematocrit, serum iron, total iron binding capacity, and ferritin. In conclusion, basal level of DNA strand breaks is at a low level in children with IDA. After iron administration, DNA strand breaks and Fpg-sensitive sites, which represent oxidatively damaged DNA, increased. However, this increase was unrelated to serum level of iron and ferritin.     

Is there a relationship between childhood Helicobacter pylori infection and iron deficiency anemia?

An association between Helicobacter pylori infection and iron deficiency anemia has been reported in children, and it has been proposed that H. pylori infection needs to be eradicated to treat absolutely iron deficiency anemia (IDA). We investigated whether there was any correlation between H. pylori infection and iron deficiency (ID) and IDA in children, and whether the eradication of H. pylori infection without iron treatment would lead to the resolution of ID. Hemoglobin and ferritin levels, H. pylori stool antigen test and (14)C urea breath test were measured in 140 children aged 6--16 years (median 9.5 years). Children with H. pylori infection were divided into three groups on the basis of hemoglobin, mean corpuscular volume (MCV), and serum ferritin levels: groups of IDA, ID, and control. All the children received anti-H. pylori combination therapy consisting of amoxicillin, clarithromycin, and lansoprazole. Hemoglobin and MCV values rose significantly compared with baseline values after H. pylori eradication without iron supplementation in children with IDA (p=0.002 and p=0.003, respectively). Ferritin values increased significantly after H. pylori eradication in children with ID (p<0.001). We conclude that complete recovery of ID and IDA can be achieved with H. pylori eradication without iron supplementation in children with H. pylori infection.     

Effect of twice weekly versus daily iron treatment in Turkish children with iron deficiency anemia

This study was designed to propose a more practical, effective, safer, inexpensive, and manageable alternative treatment of iron deficiency anemia (IDA) for the developing countries. The study involves 94 children between the ages of 5 months and 6 years who had been seen in the authors' hospital and diagnosed as having iron deficiency anemia. Ninety-four children with IDA were randomly divided into two groups: 48 children comprised the first group, which was administered conventional treatment, and 46 children comprised the second group, which was administered intermittent treatment involving iron administration 2 days a week. Twenty-three children whose age and gender distribution were compatible with the other groups were included in the study as the control group. Both groups were reevaluated for their initial hematologic parameters at the end of the treatment. When the parameters of both groups were compared with the parameters of the control group after the treatment, there were no differences between hemoglobin, hematocrit, red blood cell, mean corpuscular volume, mean corpuscular hemoglobin concentration, serum iron, and ferritin levels of conventional and intermittent treatment groups. With respect to certain parameters, such as red cell distribution, serum iron binding capacity, transferrin saturation, transferrin receptor, and transferrin receptor/log ferritin, however, intermittent treatment was superior to the conventional treatment method (p <.05). In IDA, when a conventional treatment method or an intermittent treatment method is used, there are no differences between the hematological parameters. In fact, the intermittent treatment method has been found to be superior in many parameters.     

Serum lipid and lipoprotein profile in children with iron deficiency anemia

BACKGROUND: A close association has been found between serum lipoprotein abnormalities and the risk of atherosclerosis. In adults, high stored body iron, high serum iron concentrations and low iron binding capacity were found to be risk factors for coronary heart disease. Iron-deficient diets have caused contradictory lipid changes in rats. This report investigates the relationships between iron deficiency, macronutrient intake and the serum lipid and lipoprotein profiles in children with iron deficiency anemia (IDA). METHODS AND RESULTS: Fifty-six children with IDA, aged 3.0 +/- 1.3 years and 60 healthy age- and sex-matched controls were evaluated. The mean total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C), lipoprotein (a) levels and LDL-C/high density lipoprotein cholesterol (HDL-C) and TC/HDL-C ratios of the IDA group were significantly lower than those of controls. While there were no differences in triglycerides and apolipoprotein B (apoB) values between patients and controls, apolipoprotein A-1 (apoA-1) and HDL-C levels were higher in the IDA group. Dietary energy, carbohydrates, total fat and protein intakes of the IDA group were lower than those of controls. After oral iron supplementation, the lipoprotein profile of patients with IDA became similar to controls. In the multivariate analysis, while energy was taken as a covariate, there was no difference in the lipid profile of patients and controls. CONCLUSIONS: Patients with IDA are also deficient in macronutrients. The low atherogenic serum lipid profile of IDA is not a direct result of iron deficiency itself, but related to decreased energy and protein intakes.     

Interaction between anemia and blood levels of iron,zinc, copper,cadmium and lead in children

Objective Anemia is a widespread problem among infants and children in many parts of the world, and it is often associated with some trace elements (iron, zinc, copper) and heavy metals (cadmium and lead). Aim of this study was to investigate the relationship between anemia and these elements. Methods This research was performed on 256 children (mean age 6.8 ± 0.2) living in Denizli city center. We observed iron deficiency anemia (IDA) in 23 children, iron deficiency without anemia (ID) in 36 children and only anemia (ferritin level normal) (OA) in 18 children, and 179 children were found healthy and they were regarded as controls (C). Blood samples were taken from subjects and the concentrations of zinc, copper, iron, cadmium and lead in serum were measured with atomic absorption spectrophotometer. Results The levels of copper, cadmium and lead in serum were significantly higher in children with IDA than those of controls (p<0.05, p<0.05, p<0.01, respectively). The other elements in the serum of ID were not different from controls.     

Developmental profile in children with iron deficiency anemia and its changes after therapeutic iron supplementation

Objective  

To evaluate the developmental profile of children with iron deficiency anemia (IDA) and the changes following iron supplementation.     

Iron deficiency anemia among children: Addressing a global public health problem within a Canadian context

Despite current Canadian pre- and perinatal nutrition programs, the prevalence of both iron deficiency and iron deficiency anemia (IDA) is very high among young Aboriginal children from Canada’s remote north. The major risk factors for IDA include prolonged consumption of evaporated cow’s milk, chronic infection and prolonged exclusive breastfeeding. In the present article, the authors discuss IDA as a significant public health problem in Canadian Aboriginal communities. Whereas the prevalence of IDA in Canadian children is between 3.5% and 10.5% in the general population, in two Northern Ontario First Nations communities and one Inuit community, the anemia rate was 36%, with 56% having depleted iron stores. Traditional methods of preventing IDA, including targeted fortification, dietary diversification and supplementation, have not solved the problem. The authors’ research group at The Hospital for Sick Children in Toronto, Ontario, conceived of the strategy of ‘home fortification’ with ‘Sprinkles’ – single-dose sachets containing micronutrients in a powder form, which are easily sprinkled onto any foods prepared in the household. In Sprinkles, the iron (ferrous fumarate) is encapsulated within a thin lipid layer to prevent the iron from interacting with food. Sprinkles have been shown to be efficacious in the treatment of anemia in many developing countries. Their use in Aboriginal communities to treat and prevent anemia is described in the present paper. The authors believe that children in Aboriginal communities across Canada would potentially benefit if Sprinkles were incorporated into Health Canada’s current distribution system, in combination with a social marketing strategy to encourage their use.     

Incidence of high erythrocyte count in infants and young children with iron deficiency anemia: re-evaluation of an old parameter

PURPOSE: To investigate the frequency of high erythrocyte count (red blood cell count >or=5.0 x 106/microL) in infants and young children with iron deficiency anemia and to document the differences in hematologic parameters at diagnosis and during iron therapy in IDA patients with and without a high erythrocyte count. PATIENTS AND METHODS: A total of 140 infants and young children aged 6 to 48 months with nutritional IDA without a history of any bleeding disorder were the subjects of this study. The patients were divided into three groups according to the severity of anemia. Group A1 children had Hb values 8.0 g/dL or less (severe anemia); group A2, 8.1 to 10.0 g/dL (moderate anemia); and group A3, 10.1-11.0 g/dL (mild anemia). All children received oral iron (3-5 mg/kg per day) for 12 weeks. Complete blood counts were done weekly during treatment. RESULTS: A total of 36 of the 140 patients (26%) had a high erythrocyte count. Of the 140 patients, 37 were in group A1, 80 in A2, and 23 in A3. The frequency of high erythrocyte count was 11%, 23%, and 61% in groups A1, A2, and A3, respectively. The patients with a high erythrocyte count had significantly higher Hb and Hct but significantly lower mean corpuscular volume and mean corpuscular hemoglobin (MCH) values than those with a low erythrocyte count (n = 104). A continuous elevation in the erythrocyte count has been observed in patients with a high red cell count, as in those with a low red cell count, after the institution of iron therapy. CONCLUSIONS: A high erythrocyte count is a common feature of iron deficiency anemia in infants and young children, with an increasing frequency from severe to moderate to mild anemia. High erythrocyte count cannot be regarded as a reliable preliminary parameter in differentiating iron deficiency from thalassemias in infants and children aged up to 48 months.     

福建省儿童铁缺乏症流行病学调查报告

目的 　了解我省儿童铁营养的现状 ,为使儿童缺铁性贫血的患病率在 2 0 0 0年的基础上下降 1 / 3掌握基数。方法 　在全省范围分三个层次九个流调点对 2 584名儿童作Hb(血红蛋白 )、ZPP(锌原卟啉 )及SF(血清铁蛋白 )的测定。结果 　我省儿童总的铁缺乏症发生率 37 2 3% ;铁减少发生率 2 2 87% ;缺铁性贫血发生率 1 4 36 %。结论 　铁缺乏、铁减少及缺铁性贫血的发生率 ,与饮食的合理性有密切关系。     

Reversal of iron deficiency anemia-induced peripheral neuropathy by iron treatment in children with iron deficiency anemia

The effects of iron deficiency anemia (IDA) on nerve conduction and efficiency of iron therapy were investigated by peripheral nerve-electrophysiological measurements. Eighteen children (10 boys, eight girls; mean age 31 +/- 1.3 months) with IDA and 12 healthy children (six boys, six girls; mean age 29 +/- 1.3 months) were enrolled into the study. Nerve conduction velocity was measured in the median and posterior tibial nerve. After nerve conduction values were determined in the patients and controls, 6 mg/kg/24 h ferrous sulphate was given orally to the patients for 3 months and nerve conduction velocity tests were performed again. Median/motor and sensory nerve conduction velocity and tibial/motor nerve distal-amplitute values of children with IDA were lower than for the control group (p < 0.05, p < 0.01 and p < 0.001 respectively). With iron supplementation these values increased to the normal levels and even higher than control levels for some parameters. In correlation studies between whole blood parameters and nerve conduction velocity results, there was a correlation between median/sensory nerve conduction velocity values and serum iron levels. Additionally there was a correlation between some nerve conduction velocity values and age. In conclusion, the evidence from this preliminary study suggests that peripheral neuropathy may develop in children with IDA. Peripheral neuropathy symptoms in these patients may be improved by iron therapy.     

中国7个月～7岁儿童铁缺乏症流行病学的调查研究

目的　调查我国儿童铁减少 (ID)、缺铁性贫血 (IDA)及铁缺乏症患病率。方法　采用分层抽样的方法 ,以全国 15个省 ,2 6个市县为调查点 ,随机抽取 9118名 7个月～ 7岁儿童为调查对象 ,检测末梢血血红蛋白 (Hb)、锌原卟啉 (ZPP)、血清铁蛋白 (SF)等指标。结果　 7个月～ 7岁儿童ID32 5 %、IDA 7 8% ;7～ 12个月ID 4 4 7%、IDA 2 0 8% ;13～ 36个月ID 35 9%、IDA 7 8% ;37个月～ 7岁ID 2 6 5 %、IDA 3 5 %。不同年龄组儿童ID、IDA、铁缺乏症患病率由高到低依次为 7～ 12个月 (婴儿组 ) ,13～ 36个月 (幼儿组 ) ,37个月～ 7岁 (学前组 ) ,各年龄组差异有显著意义 (P <0 0 1)。农村婴儿组ID 35 8%、IDA 30 1%、Hb ( 98 8± 9 1)g/L ;城市婴儿组ID 4 8 1%、IDA 16 8%、Hb ( 10 1 0± 6 8)g/L。农村幼儿组ID 31 0 %、IDA 15 5 %、Hb ( 98 2± 10 5 )g/L ;城市幼儿组ID 38 0 %、IDA 4 4 %、Hb( 10 2 8± 6 9)g/L。农村学前儿童组ID 2 7 6 %、IDA 6 3%、Hb( 10 1 2± 8 6 )g/L ;城市学前儿童组ID2 6 0 %、IDA 1 9%、Hb( 10 4 2± 4 4 )g/L。农村 7个月～ 7岁儿童铁缺乏症患病率 4 2 0 % ,城市 7个月～ 7岁儿童铁缺乏症患病率 39 5 % (P <0 0 1)。城市婴儿和幼儿ID患病率显著高于农村 (P <0     

汉中市儿童、孕妇铁缺乏症流行病学调查研究分析

目的调查了解儿童、妇女铁减少(ID)、缺铁性贫血(IDA)及铁缺乏症(IDD)患病率。方法随机抽取汉中市城区7月～7岁儿童532名,30岁以下妊娠38周以内孕妇203名,30岁以下未孕育龄妇女200名为调查对象。检测了血红蛋白(Hb)、锌原卟啉(ZPP)、血清铁蛋白(SF)等指标。结果7个月～7岁儿童ID平均43.80%,IDA平均9.96%。其中7个月～12个月婴儿ID71.67%,IDA22.50%;3个月～36个月幼儿ID33.13%,IDA8.13%;37个月～7岁儿童ID37.30%,IDA5.16%。孕妇ID平均82.17%,IDA平均37.93%。其中早孕组ID75.91%,IDA14.46%,中孕组ID77.14%,IDA51.43%;晚孕组ID100.00%,IDA58.00%。未孕育龄妇女ID49.50%,IDA25.00%。儿童ID、IDA不同年龄组有显著差异(P<0.01),即年龄越小、患病率越高。孕妇孕龄组之间有显著性差异(P<0.01)。即孕龄越大,患病率越高。孕妇ID、IDA患病率与育龄妇女有显著性差异(P<0.01)。孕妇患病率明显高于育龄妇女。不同年龄组儿童、不同孕期孕妇及育龄妇女ID患病率均大于IDA患病率。结论本市儿童、孕妇、育龄妇女铁缺乏症比较普遍,ID、IDA患病率均高于国外和全国平均水平。隐性缺铁十分严重,已成为营养性铁缺乏症的主要问题。婴幼儿和晚期孕妇是铁缺乏症高发人群。     

Controlling iron deficiency anemia through the use of home-fortified complementary foods

Iron deficiency anemia (IDA) is more common in South Asian countries including India, Bangladesh and Pakistan than anywhere else in the world. During infancy and early childhood, IDA is associated with impaired psycho-motor development and cognitive function that may be irreversible. As a consequence, there is a growing awareness that IDA is one of many factors impeding socio-economic prosperity of developing nations. The combination of unacceptably high prevalence rates and inadequate preventative programs highlights the need for new effective sustainable strategies to control IDA. The burden of iron deficiency can be reduced by taking a more holistic approach that would include promotion of healthy weaning practices and use of appropriate complementary foods, together with improving the nutritional value of such foods. There is an increasing body of peer-reviewed literature to support the contention that “micronutrient Sprinkles” is an effective strategy to improve the nutritional value of home-prepared complementary foods and thus to reduce the burden of iron deficiency among children. By combining data from recently conducted randomised control trials, Sprinkles were shown to be as efficacious as iron drops for treating childhood anemia. The iron in Sprinkles is well absorbed, and Sprinkles are easy to use and well accepted by young children and their caregivers. Integrated into existing public health programs, Sprinkles has the potential to improve the effectiveness of such programs.     

Effects of iron deficiency versus iron deficiency anemia on brainstem auditory evoked potentials in infancy

There has been little or no evidence of brainstem auditory evoked potentials (BAEPs) among infants with iron deficiency (ID) that is not severe enough to cause anemia. To our knowledge, the effect of ID on auditory functions and/or potentials has not been investigated previously, though it seems reasonable that it should be associated with BAEP measures intermediate between those observed in iron deficiency anemia (IDA) and in iron sufficiency, considering the role of iron in myelin formation and maintenance. We therefore aimed in this study to investigate the effect of ID on BAEPs by comparing three groups of infants with ID, IDA and iron sufficiency (control) both before and after iron treatment (in iron-deficient groups). Three groups of infants (IDA, n = 25; ID, n = 24; Control, n = 44) were compared on the basis of hematological laboratory parameters and BAEP measurements both at entry into and after (12 weeks treatment with oral iron in IDA and ID groups) the study. BAEP measurements recorded at 85 dB both at entry into and after the study were not significantly different among the groups, although a sufficient response to iron treatment was achieved in iron-deficient groups (Group I and Group II). The only positive finding determined in our study was a slight decrease in latencies obtained at the end of the study when compared to the pre-study values in all three groups of the study in accordance with the expected age-dependent developmental changes. Although no negative electrophysiological effect of ID on brainstem auditory functions was found in the present study, further longer term (late childhood or adult) studies are necessary to elucidate the relationships among anemia (maybe other than IDA), ID and auditory functions, and clinical implications of hearing loss (if any) should be questioned.     

Prevention of Iron Deficiency Anemia (IDA): How Far Have We Reached?

Anemia is a global problem of immense public health significance. Iron deficiency anemia is the most common nutritional disorder seen all over the world, more in the developing countries, particularly, affecting young children of 6–24 months of age, adolescents, women of reproductive age group and pregnant/ lactating women. Basic approach in prevention of IDA should include education and associated measures to increase the dietary intake of iron, dietary modification to enhance the iron absorption, fortification of food articles, in addition to control the infection and worm infestations. Supplemenldelim 1, of medicinal iron is key to success which can be achieved by daily or intermittent (biweekly/weekly) administration of oral iron to the target group. Reduction of nutritional anemia should receive top priority through proper planning by using better utilization of existing health infrastructure.     

缺铁性贫血伴幽门螺杆菌感染68例的治疗

目的：缺铁性贫血目前在我国仍是最常见的贫血类疾病,该研究旨在了解缺铁性贫血伴幽门螺杆菌感染的患儿抗幽门螺杆菌加铁剂治疗的疗效。方法：143例缺铁性贫血病例均做13C-呼气试验,其中阳性68例,将68例患者随机分为A,B二组。A组(35例):口服硫酸亚铁加2周治疗幽门螺杆菌的三联疗法;B组(33例):口服硫酸亚铁。结果：接受治疗的68例患者中,A,B二组在疗程结束后第8周复查血红蛋白、血清铁及血清铁蛋白均较治疗前有明显上升,且A组患者治疗后血红蛋白、血清铁及血清铁蛋白上升明显高于B组,差异有显著性,均P<0.01。结论：幽门螺杆菌感染与缺铁性贫血关系密切,与单独铁剂治疗相比较,加用抗幽门螺杆菌的治疗可加快提高血红蛋白的水平,二者配伍才是治疗缺铁性贫血伴幽门螺杆菌感染患者的最佳方案。     

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目的探讨网织红细胞平均血红蛋白质量在小儿缺铁性贫血中的诊断价值。方法采用拜耳ADVIA120全自动血液分析仪检测50名健康儿童和59例临床诊断为缺铁性贫血患儿的外周血细胞和网织红细胞血红蛋白质量,同时用BeckmanCx9测定血清铁蛋白质量浓度,将所得数据进行统计学分析。结果血红蛋白(Hb)、平均红细胞体积(MCV)、单个网织红细胞平均血红蛋白(CHr)质量、血清铁蛋白(SF)在缺铁性贫血患儿明显低于健康儿童,而平均红细胞体积分布宽度(RDW)在缺铁性贫血患儿明显高于健康儿童。结论CHr质量作为诊断儿童缺铁性贫血的指标,具有重要的临床价值。