贫血患者骨髓铁染色临床研究

目的：探讨骨髓铁染色在贫血鉴别诊断中的价值。方法：骨髓涂片甲醛蒸气固定用酸性亚铁氰化钾染色３０ｍｉｎ。一张作外铁检查，一张用苏木精复杂１５ｍｉｎ～２０ｍｉｎ，油镜下观察。结果，以内铁降低或消失而外铁阴性作为诊断缺铁性贫血（ＩＤＡ）的可靠指标，外铁阴性内铁正常为ＩＤＡ铁剂治疗后所致，内铁百分数低外铁正常可见于感染、肿瘤、类风湿性关节炎、尿毒症等疾病，而内外铁均增高往往见于溶血性贫血或再生障碍性贫血多     

骨髓铁染色与急性白血病化疗效果相关性研究

目的 探讨骨髓铁染色与急性白血病化疗效果之间的相互关系.方法 采用显微镜计数骨髓原始细胞+幼稚细胞百分比、骨髓铁染色内外铁含量.结果 急性白血病初治组、部分缓解组、完全缓解组和正常对照组的骨髓原始细胞+幼稚细胞分别为73.73±20.59%、12.13±4.12%、2.27±1.36%、1.33±0.59%,细胞外铁平均等级分别为2.8、2.125、1.167、1.4,内铁积分分别为85.28±15.92分、50.69±11.05分、32.47±7.06分、20.80±8.52分.结论 急性白血病骨髓铁染色含量和急性白血病的化疗效果之间呈正相关,由此可用骨髓铁染色作为观察急性白血病疗效的又一个参考指标.     

铁代谢异常在骨髓增生异常综合征中的临床价值

目的探讨铁代谢异常改变对骨髓增生异常综合征(MDS)诊断和鉴别诊断的意义,以期为临床干预和预后提供重要参考。方法回顾性分析该院115例MDS、80例再生障碍性贫血(AA)及100例健康体检者的临床基线资料,收集其外周血常规指标,血清铁蛋白和血清铁等铁代谢相关指标,并观察细胞化学铁染色、骨髓组织铁染色观察病理学形态,以及荧光原位杂交技术分析染色体核型。结果 MDS、AA和健康者间,在铁代谢指标如血清铁蛋白(SF)、血清铁(SI)、血清未饱和铁结合力(UIBC)、总铁结合力(TIBC)、可溶性转铁蛋白受体(sTfR)、转铁蛋白饱和度(TS)、铁粒幼红细胞等参数方面差异有统计学意义(P0.05)。未接受红细胞输注组和应急性接受少量红细胞输注组的MDS患者,在SI、UIBC、TIBC、sTfR、TS、铁粒幼红细胞等参数方面差异有统计学意义(P0.05)。结论铁代谢指标具有简单易行且可重复检测的特点,是诊断铁过载和监测去铁治疗疗效的首选方法,可为MDS的临床辅助诊断、病情监测、预后评估等提供可靠的理论依据。     

网织红细胞血红蛋白含量在铁缺乏疾病诊断中的应用价值

目的:研究血细胞分析仪检测网织红细胞血红蛋白舍量对铁缺乏疾病的诊断价值.方法:采用Bayer ADVIA 120血细胞分析仪检测常用血液学指标,包括血红蛋白含量、平均红细胞体积、红细胞分布宽度和网织红细胞血红蛋白含量,同时测定血清铁代谢指标,包括血清铁、总铁结合力及血清铁蛋白.以骨髓铁染色结果为标准,应用ROC曲线分析网织红细胞血红蛋白含量对铁缺乏的诊断效率.结果:与健康对照组及铁正常患者比较,铁缺乏患者网织红细胞血红蛋白含量明显减低.尤以缺铁性贫血患者网织红细胞血红蛋白舍量降低明显.ROC曲线显示网织红细胞血红蛋白含量对铁缺乏诊断效率高.结论:网织红细胞血红蛋白含量指标是铁缺乏和缺铁性贫血诊断的早期、有价值的指标,其检测方法简便、快速、可重复性好,可用于铁缺乏疾病的筛查.     

一氧化氮对慢性病贫血大鼠铁代谢影响

本研究探讨一氧化氮(NO)在慢性病贫血(ACD)发病中的作用及对铁代谢影响的机制，为ACD的防治提供实验依据。在建立传统的类风湿性关节炎大鼠动物模型的基础上，通过反复注射弗氏完全佐剂，建立ACD大鼠动物模型。利用此模型观察不同处理组NO浓度的改变与贫血及铁代谢的关系。结果表明：ACD组血清NO浓度和一氧化氮合酶(NOS)活性显增高，贫血明显，血清铁、总铁结合力、转铁蛋白饱和度、红细胞内铁蛋白、骨髓血细胞转铁蛋白受体、骨髓内铁及肝脏顺鸟头酸酶活性降低，血清铁蛋白及肝脏储铁增加，与对照组比较差异显；用NOS抑制剂后，NO和NOS水平降低，贫血改善，铁代谢指标介于ACD与正常对照组之间，统计学处理有显性差异。结论：NO参与了ACD的发病及ACD时铁代谢的调节，为从NO对铁代谢影响角度进一步认识ACD的发病机制提供了实验依据；及早降低NO水平，有利于阻止贫血的发展，为ACD的治疗提供了一条新策略。     

血清铁指标检测项目和骨髓铁染色在炎症性贫血中的诊断价值比较

目的比较血清铁指标检测项目[铁蛋白、血清铁(SI)、总铁结合力(TIBC)]和骨髓铁染色在炎症性贫血(AI)中的诊断价值,提高临床医师对该病的诊治水平。方法回顾性分析我院门诊及住院贫血患者67例,均进行血清铁指标检测和骨髓铁染色,比较两种方法在临床诊断中的价值。结果 AI患者组⑴细胞内铁及SI水平略高于缺铁性贫血(IDA)患者组且低于正常对照组及铁粒幼细胞贫血(SA)患者组;⑵细胞外铁及SF水平同时高于IDA患者组及正常对照组,低于SA患者组;⑶TIBC水平低于IDA患者组及正常对照组,差异有统计学意义(P0.05);⑷经Spearman等级相关分析,骨髓细胞外铁与SF呈高度正相关,骨髓细胞内铁与SF、SI均呈高度正相关且与TIBC呈负相关。结论血清铁指标检测项目能较准确反映体内储存铁和铁利用的情况,与骨髓铁染色有良好的相关性,且操作简便,时效性好。骨髓铁染色为诊断铁储存及铁缺乏的金标准,但因其具有创伤性且结果易受操作影响,故临床普及率不如前者。二者联合检测,更有助于提高AI的诊断率。     

铁代谢指标在骨髓增生异常综合征无效造血中的临床研究

本研究探讨骨髓增生异常综合征(MDS)铁代谢的改变及临床意义。收集38例非输血依赖性MDS患者的临床资料,选取21例再生障碍性贫血(AA)患者和28例正常体检者为对照组,检测其血清铁蛋白(SF)、血清铁(SI)、转铁蛋白(Tf)、总铁结合力(TIBC)、转铁蛋白饱和度(TS)、血清可溶性转铁蛋白受体(sTfR)等铁代谢相关指标,在显微镜下观察细胞内外铁分布,并应用荧光原位杂交技术分析染色体核型。结果表明,MDS组的血清SF、SI、TS值低于AA组,血清SF值高于正常对照组,而SI、TS值与正常对照组差异无统计学意义,且血清SI、TS水平与SF水平呈正相关(r=0.281,P=0.007;r=0.338,P=0.001)。MDS组的血清TIBC值与对照组相比均无统计学差异;血清Tf值高于AA组和正常对照组,后两组之间无统计学差异;MDS组铁粒幼红细胞比例(57.19%±19.11)%高于AA组(35.00±20.67)%。MDS组细胞外铁(+++～++++)比例(24%)低于AA组(33%),且细胞外铁增多(+++～++++)患者显微镜下观察到骨髓小粒可染铁主要呈球菌状分布,而AA组患者主要呈小珠或块状分布。此外,19例MDS患者中染色体异常者15例(79%),依据国际预后积分系统WPSS分组,MDS组的中、高危组与低危组之间铁代谢指标均无差异。结论:非输血依赖MDS患者铁负荷明显增高,体现在SF、Tf、细胞内外铁,但较AA患者减低,提示MDS患者在铁利用、储存、排出过程中发生异常。     

骨髓增生异常综合征输血依赖患者铁代谢状况分析

目的探讨骨髓增生异常综合征(MDS)输血依赖患者铁代谢情况。方法选择38例MDS患者,按就诊前是否接受红细胞输注分为研究组(接受红细胞输注者20例)和对照组(未接受红细胞输注者18例),按血清SF值高低将MDS患者分为<500ng·mL-1和≥500ng·mL-12个亚组。比较各组SF、血清铁(SI)、总铁结合力(TIBC)、血清未饱和铁(UIBC)、铁饱和度(TS)及部分肝功能指标改变。结果 SF、SI、TS在研究组显著高于对照组,而UIBC在研究组显著低于对照组(均P<0.001)。不论在研究组还是对照组,SF≥500ng·mL-1的患者在SI、UIBC、TS、细胞外铁染色增高比例均与SF<500ng·mL-1患者的差异有统计学意义(均P<0.001),且SF≥500ng·mL-1的患者出现ALT、AST增高(P<0.01)。结论 MDS输血依赖可致铁过载,SF值>500ng·mL-1时可导致肝功能损害,因此应联合各项指标合理评估MDS患者铁代谢的状况进行治疗。 更多还原     

测定网织红细胞血红蛋白含量诊断妇女早期铁缺乏

骨髓铁染色是诊断铁缺乏的金指标,但具创伤性,操作繁琐,价格昂贵.目前临床诊断铁缺乏主要依赖Hb、MCV,以及SF(铁蛋白)、SI(血清铁)、TS(转铁蛋白饱和度)、TIBC(总铁结合力)等检查,但如果仅根据Hb＜110g/L及MCV＜80 fl等作为判断指标,容易漏诊已缺铁尚未发生贫血的患者.而SF、SI、TS、TIBC的常规检测又受到很多限制.为此,本文探讨网织红细胞血红蛋白含量(CHr)水平对早期诊断女性铁缺乏的价值.     

两种骨髓铁染色方法的比较

<正>铁染色是骨髓细胞形态学检查常用的细胞化学染色方法之一,它反映机体内铁的储存和利用情况,用于诊断和鉴别缺铁性贫血、非缺铁性贫血、铁粒幼细胞性贫血等。铁染色原理是正常人骨髓中的储存铁主要存在于骨髓小粒和幼红细胞中,骨髓中的铁在酸性环境下与亚铁氰化钾作用,形成普鲁士蓝色的亚铁氰化铁沉淀,定位于含铁的部位[2]。本文就     

慢性肾功能衰竭贫血与缺铁性贫血患者血清铁相关参数改变的比较

目的比较慢性肾功能衰竭（CRF）贫血与缺铁性贫血患者血清铁参数改变的差异。方法选取CRF贫血、缺铁性贫血（IDA）患者及体检健康者,测定红细胞相关参数、肾功能生化指标和铁相关参数,然后分组统计分析比较。结果CRF贫血组与IDA组血红细胞相关参数都显著低于NC组（P〈0．01）,CRF贫血组与IDA组间表现相似,没有明显差别。CRF贫血组肾功能生化指标都显著高于IDA组和NC组（P〈0．01）。CRF贫血组血清铁、总铁结合力（TIBC）、铁饱和度（Ts）和铁蛋白依次为（8．4±2．4）mol／L、（32．2±8．4）μmol／L、（22．7±8．4）％和（119．5士42．4）μg／L,都显著低于NC组（P〈0．01）;IDA组血清铁、TIBC、TS和铁蛋白依次为（4．6±2．3）mol／L、（74．6±14．3）μmol／L、（5．8±2．1）％和（16．8±17．4）／μg／L;CRF贫血组血清铁、TS和铁蛋白显著高于IDA组（P〈O．01）,TIBC则显著低于IDA组（P〈0．01）。结论CRF贫血患者与IDA患者血清铁参数改变具有差异,CRF患者主要表现为铁代谢、利用能力降低,而IDA患者主要为铁及其贮存、转运贫乏。     

Relationship between serum ferritin,iron stores and disease activity in rheumatoid arthritis

Summary Bone marrow aspirate from the sternum of 40 patients with active or inactive rheumatoid arthritis (RA) was stained with Perls’ Prussian blue for iron determination. In these patients serum ferritin concentrations were correlated with other indices of iron stores and disease activity. In patients with active RA and without bone marrow iron stores, serum ferritin was significantly lower than in patients with either active or inactive RA and iron stores. In patients with bone marrow iron stores, serum ferritin was directly correlated with erythrocyte sedimentation rate (ESR), Ritchie index, α₁-antitrypsin, α₁-acid glycoprotein and desferrioxamine (DFO)-induced sideruria, while an inverse correlation of serum ferritin with hemoglobin and serum iron was observed. In all patients serum ferritin was significantly correlated only with DFO-induced sideruria and unsaturated iron-binding capacity (UIBC). Thus, serum ferritin is an index of iron stores also in rheumatoid arthritis. In active disease, higher than expected values of serum ferritin are probably due to a shifting of iron from the circulating pool to the reticuloendothelial cells of the synovial membrane.     

A comparison between concentrations of free erythrocyte protoporphyrin and serum ferritin during development of iron deficiency by phlebotomy in polycythaemia vera patients

Therapeutic venesection for polycythaemia vera (PV) produces iron deficiency. If iron supplementation is avoided, the frequency of venesections can be kept lower than if iron is given. This is the standard treatment for PV in our department, and this model for iron deficiency was used to compare serum ferritin, free erythrocyte protoporphyrin (FEP), serum iron and transferrin as indicators of iron deficiency. Eleven patients with PV were studied on a total of 90 occasions. Five patients were followed from normal iron status to iron deficiency, the other six were iron deficient at the start of the study. Serum ferritin and FEP became abnormal approximately simultaneously during the development of iron deficiency, serum ferritin in all patients, FEP in 8 out of 11 patients. There was a correlation between the two in all specimens (r=0.75, p<0.001), but serum ferritin showed fewer false negative results. Serum transferrin alone was elevated only in 25% of the patients, and serum iron, although mostly subnormal, was rather inconsistent. It is concluded that serum ferritin and FEP can both be used to diagnose iron deficiency during venesection treatment of PV, whereas serum iron and transferrin are of little value.;     

慢性阻塞性肺疾病患者铁营养状况的初步研究

目的对慢性阻塞性肺疾病患者的铁营养状况进行初步研究。方法选择慢性阻塞性肺疾病(COPD)患者和健康对照者各45例,测定血红蛋白(Hb)、血清铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)、转铁蛋白饱和度(TS)、血清超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-PX)活性,以及血清丙二醛(MDA)浓度。结果与对照组相比,COPD患者SF、SI和TS水平显著升高(t分别=15.40、4.43、2.40,P均<0.05),TIBC显著降低(t=6.87,P<0.05),SOD和GSH-PX活性明显升高(t分别=2.98、4.56,P均<0.05),血清MDA水平也明显高于对照组(t=4.18,P<0.05)。结论 COPD患者铁负荷较高,并伴随抗氧化酶活性升高而升高,可能与COPD的病理进程及发病相关。     

维生素AD联合铁剂治疗婴幼儿缺铁性贫血的效果

目的:观察维生素AD滴剂联合蛋白琥珀酸铁口服液治疗婴幼儿缺铁性贫血的临床效果。方法:选取安徽省庐江县人民医院儿童保健门诊缺铁性贫血患儿102例,性别不限,采用随机数字表法分为观察组(n=52)和对照组(n=50)。观察组治疗采用蛋白琥珀酸铁口服液联合维生素AD滴剂口服,对照组治疗仅采用蛋白琥珀酸铁口服液口服。治疗前分析缺铁性贫血患儿维生素A和25-羟维生素D缺乏情况,于治疗1个月后对2组治疗效果进行比较并对贫血相关指标进行分析。结果:治疗前两组缺铁性贫血患儿维生素A和25-羟维生素D缺乏严重。治疗后,观察组的显效率为61.54%,明显高于对照组的44%(P<0.05);总有效率为94.23%,也明显高于对照组的84%(P<0.05);观察组血红蛋白、血清铁和血清铁蛋白较对照组明显改善(P<0.05)。结论:维生素AD滴剂联合蛋白琥珀酸铁口服液用于婴幼儿缺铁性贫血治疗时可有效改善患儿相关的贫血指标,显著提高临床治疗效果。     

Body iron status in critically ill patients: significance of serum ferritin

Serial measurements of blood haemoglobin, serum iron, serum transferrin, total iron-binding capacity, transferrin per cent saturation and serum ferritin were determined in 51 post-operative critically ill patients to investigate body iron status in severely stressed patients. The results showed decreased blood haemoglobin, serum iron, serum transferrin and transferrin saturation compared to an increase in serum ferritin levels. These results indicate that there is inadequate availability of iron to tissues (secondary to rearrangement of body iron to the advantage of the iron storage compartment), which is often present in severely critically ill patients. A positive correlation was found between the initial (ferritin) levels and SAPS (r=0.41,p< 0.01). In addition, the increase of ferritin concentration parallels a worsening of the clinical status in severely ill patients. This is due to enhanced release by the macrophage system. From this, we consider serum ferritin as an acute-phase protein and a useful marker of the severity of the clinical status. It appears to be useful in predicting the patient's outcome, but is not reliable in evaluating iron stores in stressed patients.     

轻型珠蛋白生成障碍性贫血患者铁沉积状态的研究

目的了解轻型珠蛋白生成障碍性贫血(简称地贫)患者铁负荷的状态,为临床干预提供依据。方法选取经基因检测确诊的轻型地贫患者458例,分为α-地贫组及β-地贫组;以血常规正常的120例体检者为对照组。比较3组间血清铁、铁蛋白水平差异,分析铁蛋白与患者年龄、基因型别及血红蛋白的相关性。结果血清铁含量在3组间差异无统计学意义(P0.05),而血清铁蛋白在3组间差异有统计学意义(P0.05),且β-地贫组高于α-地贫组(P0.05);各年龄段之间铁蛋白水平存在明显差异(P0.05),且在小于或等于20岁及老年患者中水平较高;在大于20岁的患者中,铁蛋白水平与年龄存在一定程度的正相关;α-地贫组各基因型间血清铁蛋白水平比较,差异有统计学意义(P=0.006);β-地贫组血清铁蛋白与血红蛋白存在较弱的负相关(r=-0.252,P=0.001)。结论血清铁蛋白是评价地贫铁负荷的较敏感指标;血清铁蛋白在大于或等于20岁的患者中与年龄呈正相关;α-地贫与β-地贫患者铁负荷呈现不同的特征。     

A comparison between serum ferritin concentration and the amount of bone marrow stainable iron

There was good parallelism between serum ferritin levels and the amount of bone marrow stainable iron in 123 patients with gastritis, gastric ulcer and duodenal ulcer. A serum ferritin concentration of about 20-25 μg/l is the approximate level below which stainable iron cannot be demonstrated in the bone marrow.     

Pro-inflammatory states and IGF-I level in ischemic heart disease with low or high serum iron

BACKGROUND: Serum iron overload or iron deficiency appears to be associated with atherosclerosis and ischemic myocardial damage. Roles of low or high serum iron in patients with ischemic heart diseases are still controversial. METHODS: Serum samples for biochemical and immunologic analyses were collected from the 73 normal subjects and the 90 patients with ischemic heart disease (IHD), the latter of which were selected from 142 patients and classified by low, normal and high serum iron. RESULTS: Tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), high sensitive C-Reactive protein (hsCRP), and interleukin-10 (IL-10) were increased and insulin-like growth factor (IGF)-I was decreased in IHD patients with low serum iron, whereas these parameters were not changed in IHD patients with normal or high serum iron, compared with normal subjects. Total bilirubin was increased in IHD patients with high serum iron but was not changed in IHD patients with low or normal serum iron, compared with normal subjects. CONCLUSION: The IHD patients with low serum iron were associated with a pro-inflammatory state, such as increased TNF-alpha, IL-6, and hsCRP; increased anti-inflammatory activities, such as increased IL-10; decreased cardiac protective factor, such as decreased IGF-I. These findings may imply that IHD patients with low serum irons were associated with less cardiac protection and more pro-inflammatory states than normal subjects or IHD patients with either normal or high serum iron.     

Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review

The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL^?1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.