可溶性转铁蛋白受体在运动医学中的应用

目的:总结可溶性转铁蛋白受体在促红细胞生成素检测、高原训练的效果评价和运动性贫血的监测方面的作用。资料来源:应用网络www.ncbi.nlm.nih.gov/PubMed检索1999-01/2004-12国内外有关可溶性转铁蛋白受体在促红细胞生成素检测、高原训练的效果评价和运动性贫血的监测中的应用方面的相关文献,检索词:solubletransferrinreceptor,sportsmedicine,erythropoietindetection,altitudetraining,sportsanemia。限定文章语种为“English”。同时在中国期刊网上检索2001-01/2005-06相关中文文献,检索词:可溶性转铁蛋白受体,运动医学,促红细胞生成素检测,高原训练,运动性贫血。资料选择:选择有关可溶性转铁蛋白受体在促红细胞生成素检测、高原训练的效果评价和运动性贫血监测中应用的文献83篇,未排除非随机研究原著性文献和非盲法研究原著性文献。资料提炼:在的83篇文献中,内容不同程度重复的有37篇,给予删除,对剩下的46篇进行分类整理,用于综述,其中18篇选为参考文献。资料综合:组织细胞摄取铁是通过血液中携带铁的转铁蛋白与细胞表面的转铁蛋白受体介导的。可溶性转铁蛋白受体是存在血清中完整的转铁蛋白受体单体的截断形式,与体内细胞的铁代谢和红细胞的生成有密切关系。可溶性转铁蛋白受体能准确反映出机体内红细胞生成的能力和缺铁的情况,故临床上在缺铁性贫血的检测和治疗效果评价中应用较多。除机体内红细胞生成的能力和铁储备状态外,其他因素对可溶性转铁蛋白受体的影响很小,相对稳定,运动对其浓度的影响也甚微。结论:可溶性转铁蛋白受体在重组人促红细胞生成素检测、高原训练效果的评价和缺铁性贫血的监测中具有重要价值,相关的研究需进一步深入。     

转铁蛋白受体及可溶性转铁蛋白受体

转铁蛋白受体（TfR）是由两个同源二聚体（180kDa）的亚基通过两条二硫键交联而成的一种II型跨膜糖蛋白,其功能是通过与转铁蛋白（If）的相互作用介导铁的吸收,其表达主要是根据细胞内铁水平进行转录后水平的调节。TfR还在细胞生长和增殖中发挥作用。最近的研究发现TfR在T细胞的激活中发挥了选择性的作用,但是具体的作用还不是完全清楚。可溶性转铁蛋白受体（sTiR）是细胞膜TfR经蛋白酶作用水解生成的分泌到血液中的组织片段,是细胞内Tffi被切断后的单体。是近年来TtR研究的一个新领域,一个新的铁代谢参数,且较稳定,不受炎症性疾病、感染、恶性肿瘤或溶血的影响,其含量与细胞的TIR量呈平行关系。本文就Tffi的结构、表达、功能以及sTiR的测定,参数界定及临床应用进行综述。     

慢性肾病患者可溶性转铁蛋白受体测定的临床意义及影响因素的研究

目的探讨慢性血液透析（HD），并用重组人促红细胞生成素（rHuEpo）治疗的患者，体内可溶性转铁蛋白受体水平（sTIR）测定的临床意义及其相关的影响因素。方法随机观察35例慢性HD患者和18例贫血但肾功能正常的患者，测定：血红蛋白（HB）、红细胞压积（HCT）、网织红细胞百分比（Ret％）、血清铁蛋白（SF）、血清铁（SI）、总铁结合力（TIBC）、转铁蛋白饱和度（TS）、血清促红细胞生成素（sEpo）、sTIR，并将结果两组对比。结果两组在HB、HCT、SF、SI、TIBC以及TS方面均无差异（P〉0．05），HD组sTIR、sEpo和Ret％则低于对照组（P〈0．05）。单变量相关分析表明HD组sTIR水平与sE-po呈正相关（r=0．770，P〈0．001）。多变量逐步回归分析表明sEpo、SF是两个能够独立影响sTIR水平的因素。结论在HD患者接受rHuEpo治疗时，循环中sTIR水平是反映骨髓红细胞生成活性的良好指标，sTIR的水平反映了HD患者铁的贮存和红细胞生成刺激的综合效应。     

可溶性转铁蛋白受体及其在临床诊断中的价值

可溶性转铁蛋白受体（ｓＴｆＲ）是血清中转铁蛋白受体的水解片断,其表达是由铁在ｍＲＮＡ 水平上来调节,与铁蛋白共同反映红细胞生成速率和铁贮存状态。ＳＴｆＲ可鉴别诊断小细胞性贫血、慢性炎症继发性贫血等疾病,并可监测肾衰性贫血的药物治疗效果。     

可溶性转铁蛋白受体在缺铁性贫血中的临床应用

目的 阐述可溶性转铁蛋白受体在缺铁性贫血中的临床应用.方法 采用免疫透射比浊法定量检测缺铁性贫血(IDA)组、慢性病贫血(ACD)组和正常对照组的血清可溶性转铁蛋白受体(sTfR)水平,并结合MCV和RDW这两个血常规指标对结果进行分析比较.结果 IDA组:sTfR(5.50±0.22)mg/L,RDW(19.4± 6.2)%,MCV(71.7±12.8)fl;对照组:sTfR(1.30±0.41)mg/L,RDW(13.1±1.3)%,MCV(85.0±4.5)fl;ACD组:sTfR(1.16±0.54)mg/L,RDW(16.3± 4.0)%,MCV(84.6±13.6)fl.IDA组sTfR,RDW均高于对照组,与ACD组比较差异具有统计学意义(P<0.05),MCV则显著低于对照组及ACD组(P<0.05).ACD组的sTfR和MCV值与正常对照组比较差异无统计学意义(P>0.05),而RDW则高于正常对照组.结论 sTfR是一个灵敏、可靠的缺铁诊断的定量指标,较MCV,RDW更适用于对IDA和ACD的鉴别诊断以及在危险人群的铁状况评估方面具有重要的临床价值.     

可溶性转铁蛋白受体在铁缺乏疾病诊断中的应用

目的探讨可溶性转铁蛋白受体(sTfR)检测在鉴别缺铁性贫血(IDA)和非缺铁性贫血(ACD)诊断中的意义.方法以免疫比浊法测定IDA和ACD患者和正常对照组血清中sTfR水平.结果正常对照组血清中sTfR水平为0.96～2.32 mg/L,中位数为1.55 mg/L;ACD组血清中sTfR水平为0.99～2.48 mg/L,中位数为1.84 mg/L;IDA组血清中sTfR水平为1.58～8.79 mg/L,中位数为4.30 mg/L.以ACD组中患者最高值2.50 mg/L为判断限,sTfR对诊断IDA的特异性为100%;灵敏度为95%.结论以sTfR2.50 mg/L为判断限,对鉴别IDA和ACD有明显的临床诊断意义.     

血清可溶性转铁蛋白受体在儿童铁缺乏中的应用

目的　探讨血清可溶性转铁蛋白受体 (sTfR)的检测在儿童铁缺乏诊断中的应用价值。方法　测定正常对照组 (5 0名 )和患儿组 (10 8例 )血红蛋白、sTfR以及有关铁参数。结果　sTfR静脉血、手指血检测结果经统计呈高度相关 (P <0 .0 0 1)。正常对照组、缺铁性贫血组和非缺铁性贫血组的sTfR测定结果分别为 (1.31± 0 .33)mg/L、(9.6 7± 6 .97)mg/L和 (1.79± 1.14 )mg/L ;缺铁性贫血组的sTfR与其他各组比较差异有显著性 (P <0 .0 1)。以 3.2mg/L为临界值 ,sTfR在未确定病因的贫血组和非贫血组中的阳性率分别为 34.6 %和15 .9%。随访的 5例缺铁性贫血患儿治疗前后sTfR检测结果差异有显著性 (P <0 .0 5 )。结论　血清sTfR检测可用于诊断和鉴别诊断缺铁性贫血与非缺铁性贫血 ,反映儿童铁缺乏的状况 ,作为疗效监测的指标。sTfR可用手指血检测 ,尤其适合儿科临床应用     

可溶性转铁蛋白受体在铁缺乏疾病诊断中的应用

目的　探讨可溶性转铁蛋白受体 (sTfR)检测在鉴别缺铁性贫血 (IDA)和非缺铁性贫血 (ACD)诊断中的意义。方法　以免疫比浊法测定IDA和ACD患者和正常对照组血清中sTfR水平。结果　正常对照组血清中sTfR水平为 0 .96～ 2 .3 2mg/L,中位数为 1.5 5mg/L;ACD组血清中sTfR水平为 0 .99～ 2 .48mg/L,中位数为1.84mg/L;IDA组血清中sTfR水平为 1.5 8～ 8.79mg/L,中位数为 4.3 0mg/L。以ACD组中患者最高值2 .5 0mg/L为判断限 ,sTfR对诊断IDA的特异性为 10 0 % ;灵敏度为 95 %。结论　以sTfR 2 .5 0mg/L为判断限 ,对鉴别IDA和ACD有明显的临床诊断意义     

可溶性转铁蛋白受体的临床应用及研究进展

可溶性转铁蛋白受体 (solubletransferrinreceptor,sTfR)是一种跨膜糖蛋白 ,它直接反映了机体内转铁蛋白的代谢情况 ,与细胞的铁代谢有密切关系 ,在贫血症的鉴别诊断中尤为重要。本文主要介绍其临床应用进展     

血清可溶性转铁蛋白受体在儿童铁缺乏中的应用

目的探讨血清可溶性转铁蛋白受体(sTfR)的检测在儿童铁缺乏诊断中的应用价值.方法测定正常对照组(50名)和患儿组(108例)血红蛋白、sTfR以及有关铁参数.结果 sTfR静脉血、手指血检测结果经统计呈高度相关(P<0.001).正常对照组、缺铁性贫血组和非缺铁性贫血组的sTfR测定结果分别为(1.31±0.33) mg/L、(9.67±6.97) mg/L和(1.79±1.14) mg/L;缺铁性贫血组的sTfR与其他各组比较差异有显著性(P<0.01).以3.2 mg/L为临界值,sTfR在未确定病因的贫血组和非贫血组中的阳性率分别为34.6%和15.9%.随访的5例缺铁性贫血患儿治疗前后sTfR检测结果差异有显著性(P<0.05).结论血清sTfR检测可用于诊断和鉴别诊断缺铁性贫血与非缺铁性贫血,反映儿童铁缺乏的状况,作为疗效监测的指标.sTfR可用手指血检测,尤其适合儿科临床应用.     

Biological and clinical aspects of soluble transferrin receptor

Soluble transferrin receptor (sTfR), one of the main regulators of cellular iron homeostasis, is the truncated form of the tissue receptor that is encoded by the human TfR gene (chromosome 3). Serum sTfR levels are determined to detect iron deficiency (ID) in inflammatory states and in anemia of chronic disease (ACD) and to monitor the efficiency of erythropoietin (EPO) treatment. The levels of sTfR reflect the receptor density on cells (tissue iron status) and the number of cells with receptors (erythropoietic activity). Currently assays for the measurements of sTfR are standardized using different reference materials, give different results, and have different reference ranges. The recent development of a lyophilized preparation of recombinant soluble transferrin receptor (rsTfR) as a World Health Organization (WHO) reference reagent should help in the standardization of sTfR immunoassays. This article reviews the general characteristics of (s)TfR, the assays for sTfR, biological confounders in the assays, and the clinical applications for measuring sTfR.     

Clinical significance of determining the soluble transferrin receptor

The aim of the study was to work out a method for determining the soluble transferrin receptor (TfR) on the basis of the direct immune-enzyme analysis, including its dynamic testing in patients with anemia of various etiologies. Reagents, needed for the above analysis, i.e. TfRs and antibodies to them, were obtained to implement the set goal. TfR was isolated by Kanevsky's affine chromatography from the homogenate of patients. The thus isolated TfR was used to immunize and to obtain the monoclonal antibodies. The conjugate of horseradish peroxidase (HP) and antibodies to TfR were made use of to determine the quantity of bound antibodies. One type of antibodies were immobilized in plates of the "Nunk" company (Denmark), and the other type of monoclonal antibodies were conjugated with HP. A reliably higher TfR in iron-deficiency anemia was shown during the determination of the TfR level in 36 donors and 266 patients. After a conducted ferrotherapy, the TfR level went down approaching the normal value. The TfR level was related with a disease stage and activity of the prolipherative process in cases of autoimmune hemolytic anemia, B12-folate-dependent anemia, lympho- and myeloprolipherative diseases and in oncology patients. The elaborated method opens up new possibilities for the differential diagnosis of anemia and provide for objective criteria of a conducted therapy.     

Measurement of soluble transferrin receptor by immunoturbidimetry and immunonephelometry

OBJECTIVE: To evaluate and compare two new commercially available immunoturbidimetric and immunonephelometric assays for measuring soluble transferrin receptor (sTfR) in serum. To adapt the immunonephelometric assay to an automated chemistry analyzer. DESIGN AND METHODS: Total imprecisions and detection limits were calculated and compared. Fifty-six samples were used for methods comparison. The nephelometric assay was adapted to the Hitachi 911 analyzer. RESULTS: Both methods displayed acceptable imprecisions and detection limits. Their correlation was good but a proportional bias was observed. The adaptation of the nephelometric assay to the Hitachi 911 was successful. CONCLUSIONS: These two new immunoassays are analytically acceptable and more practicable than previously developed methods. The differences observed between both methods underscores the need for standardization. The nephelometric assay was easily adaptable to an automated chemistry analyzer.     

Evaluation of kits for measurement of the soluble transferrin receptor

Three commercially available kits for determination of the soluble serum transferrin receptor (sTfR), R&D Systems, UK, Ramco Laboratories, USA and Orion, Finland were compared with respect to practicability, comparability and ability to discriminate between iron deficient and non-iron deficient subjects. Serum samples representing different concentrations of sTfR were tested. The three kits involved virtually the same laboratory procedures except for a pre-dilution step for Ramco. Both the absolute amounts and the units (mg/L and nmol/L) differed among the kits, emphasizing the need for internationally accepted reference material and comparable units. The correlation coefficients were 0.974 (Ramco and R&D), 0.769 (R&D and Orion) and 0.759 (Ramco and Orion), indicating a lower comparability for Orion compared to the other two kits. The differences between the kits may be attributed to uncertainties in the reference intervals and to variations in kit format. This may have implications for studies of the usefulness of sTfR as a marker of iron deficiency.     

Soluble transferrin receptor and soluble transferrin receptor-ferritin index for evaluation of the iron status in elderly patients

We aimed to evaluate the diagnostic values of soluble transferrin receptor (sTfR) concentration, transferrin-ferritin index (soluble transferrin receptor concentration/log ferritin), ferritin levels and other related parameters in geriatric patients with anemia of chronic disease (ACD) and iron deficiency (IDA). Forty-four elderly subjects (median age 73 [63-94]) and twenty healthy subjects (median age 49 [44-56]) were enrolled into this study, divided into four groups: twenty middle aged healthy subjects (group A), fifteen elderly patients with IDA (group B), fourteen elderly patients with ACD (group C) and fifteen nonanemic geriatric subjects (group D). Hemoglobin, mean corpuscular volume, serum iron concentration and transferrin saturation levels of the patients in IDA group were found significantly lower than those in both non-anemic group and healthy subjects. Serum sTfR concentrations of the patients in IDA group were significantly higher than those in non-anemic geriatric group, ACD group and healthy subjects. Transferrin-ferritin index of the patients with IDA was significantly higher than that in non-anemic geriatric and ACD group. Serum ferritin levels of the patients in IDA group did not show any differences when compared with the other groups. Serum ferritin was highly specific for IDA (95%) when compared with ACD, although its sensitivity was low (38%). STfR values were negatively correlated with both transferrin and ferritin levels (p = 0.042 r = -0.40; and p = 0.034 r = -0.41, respectively). In conclusion, serum soluble transferrin receptor and transferrin-ferritin index may be used together with serum ferritin to distinguish the iron deficiency state in the elderly.     

可溶性转铁蛋白受体检测对非成年人缺铁性贫血的诊断价值

目的：探讨可溶性转铁蛋白受体（sTfR）对非成年人缺铁性贫血（IDA）的诊断价值及其与慢性病贫血（ACD）的鉴别诊断价值。方法 IDA 组26例,男12例,女14例,年龄1月至15．5岁;ACD 组33例,男17例,女16例,年龄2月至14．0岁;对照组30例,男15例,女15例,年龄1月至15．5岁。sTfR、铁蛋白（SF）检测方法为免疫比浊法,血清铁（SI）为亚铁嗪比色法。结果各组患儿的性别比例、年龄无显著性差异;ACD 组的 SI 均值介于 IDA 组和对照组之间;IDA 组的 SF 显著低于 ACD 组（P ＜0．001）和对照组（P ＜0．001）,而 sTfR 显著高于 ACD 组（P ＜0．001）和对照组（P ＜0．001）。sTfR 鉴别诊断 IDA 和 ACD 的截值为3．56 mg/L,其敏感性、特异性、阴性预测值、阳性预测值、准确性分别为95．12％、93．92％、94．11％、97．53％、95．50％。结论sTfR 对 IDA 具有较高的敏感性及特异性,有助于诊断 IDA 及鉴别诊断 ACD。     

Evaluation of kits for measurement of the soluble transferrin receptor.

Three commercially available kits for determination of the soluble serum transferrin receptor (sTfR), R&D Systems, UK, Ramco Laboratories, USA and Orion, Finland were compared with respect to practicability, comparability and ability to discriminate between iron deficient and non-iron deficient subjects. Serum samples representing different concentrations of sTfR were tested. The three kits involved virtually the same laboratory procedures except for a predilution step for Ramco. Both the absolute amounts and the units (mg/L and nmol/L) differed among the kits, emphasizing the need for internationally accepted reference material and comparable units. The correlation coefficients were 0.974 (Ramco and R&D), 0.769 (R&D and Orion) and 0.759 (Ramco and Orion), indicating a lower comparability for Orion compared to the other two kits. The differences between the kits may be attributed to uncertainties in the reference intervals and to variations in kit format. This may have implications for studies of the usefulness of sTfR as a marker of iron deficiency.