一氧化氮对慢性病贫血大鼠转铁蛋白受体及铁蛋白的影响

目的 探讨一氧化氮(NO)在慢性病贫血(ACD)发病中的作用以及对铁代谢影响的机制.方法 用福氏完全佐剂建立传统的类风湿性关节炎大鼠动物模型,在此基础上通过反复注射福氏完全佐剂,建立符合ACD特征的大鼠动物模型.利用此模型观察不同处理组NO浓度的改变与贫血及铁蛋白(Fn)、转铁蛋白受体(TfR)的关系.结果 炎症组NO、一氧化氮合酶(NOS)浓度显著增高,贫血明显,红细胞内Fn、骨髓血细胞TfR降低,血清Fn增加,与对照组比较差异有显著性意义(P＜0.01);用NOS抑制剂后,NO、NOS水平降低,贫血改善,铁代谢指标介于炎症组与正常对照组之间,差异有显著性意义(P＜0.01).结论 NO通过对TfR、Fn的影响参与了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途径.     

慢性病贫血患者细胞因子变化的研究

目的　探讨肿瘤坏死因子α(tumornecrosisfactor α,TNF α)、干扰素γ(interferonγ ,INF γ)、白细胞介素 6 (interleukin 6 ,IL 6 )在慢性病贫血 (anemiaofchronicdiseases ,ACD)发生机制中的作用。方法　测定31例ACD患者的铁代谢指标 (血清铁、血清铁蛋白、骨髓铁 ) ,采用双抗体酶联免疫吸附法 (ELISA)检测ACD患者血清中TNF α、INF γ、IL 6。结果　与对照组比较 ,ACD组血清中TNF α、INF γ、IL 6均显著增高 (P <0 0 1)。TNF α、IL 6与血清铁、血红蛋白浓度呈负相关。结论　免疫及炎症反应所产生的细胞因子INF γ、TNF α、IL 6等可能通过干扰铁代谢和抑制EPO(erythropoietin)生成、钝化对EPO的反应等途径介导了慢性病贫血的发生和发展过程     

多发性骨折患者血清铁离子浓度下降的原因分析

目的探讨多发性骨折对铁代谢的影响。方法分别收集多发性骨折患者、缺铁性贫血患者及健康体检人群的血清标本,检测铁代谢相关项目,包括血清铁、转铁蛋白(TRF)、铁蛋白、转铁蛋白不饱铁结合力(UIBC)、铁调素,并计算转铁蛋白铁饱和度(TS),并增加检测了白细胞介素-6(IL-6),统计并分析3组人群各项目检测结果的差异。结果多发性骨折组患者铁离子和TRF浓度低于健康对照组及缺铁性贫血组,而铁蛋白高于健康体检组及缺铁性贫血组,差异均有统计学意义(P0.05);且多发性骨折患者血清铁调素及IL-6浓度升高。结论多发性骨折患者血清铁浓度下降与细菌感染有关,是人体为了抵御细菌感染自我调节的结果。     

慢性感染导致贫血的机理——NO对细胞铁代谢的作用

慢性感染情况下,由于细胞铁代谢的动态平衡受到破坏,铁被大量转移进入网状内皮细胞中贮存并释放障碍,引起血清铁浓度下降,细胞内可利用铁减少,骨髓造血供铁不足,导致贫血。其调控机制与正常细胞铁代谢不同,可能与感染情况下大量产生的一氧化氮(NO)有关。NO可在转录后水平调节细胞铁代谢,在慢性感染时,NO可能是通过下调铁调节蛋白2的活性而引起细胞铁代谢紊乱的。     

可溶性转铁蛋白受体的研究进展

可溶性转铁蛋白受体是细胞转铁蛋白受体的水解片段,检测它在血清中的含量,可以评价机体铁的代谢状况和总体红细胞生成情况,其与铁蛋白的联合运用可鉴别缺铁性贫血(IDA)和慢性疾病性贫血(ACD),对亚临床缺铁的诊断也具有特殊的意义,可溶性转铁蛋白受体的测定是评估功能铁状况的一项重要指标。     

血清可溶性转铁蛋白受体参考范围的建立及其在缺铁性贫血诊断中的意义

贫血是临床多发病之一．常见的有缺铁性贫血（iron deficiency anemia。IDA）、巨幼细胞性贫血（megaloblastic anemia．MA）、溶血性贫血、慢性病贫血（anemia of chronic disease．ACD）和再生障碍性贫血等。临床上常用血常规、铁蛋白（SF）及骨髓铁染色等方法判断贫血类型，但在IDA与ACD的鉴别中仍存在困难。可溶性转铁蛋白受体（solute transferring receptor，sTfR）是转铁蛋白受体（TTR）的脱落片段，其作为功能性铁的一项特异性检测指标．常用于鉴别IDA与ACD。本研究旨在探讨sTfR在IDA诊断中的临床意义。     

慢性病贫血患者血清铁指标及骨髓内外铁检测的临床意义

目的了解血清铁（SI）、血清铁蛋白（SF）、总铁结合力（TIBC）、血清转铁蛋白受体（sTFR）等外周血铁指标和骨髓内外铁染色对缺铁性贫血（IDA）、慢性病贫血（ACD）和慢性病贫血并发缺铁（ACD/ID）的鉴别诊断意义。方法病例为IDA患者32例、ACD患者67例,其中41例ACD/ID患者。SI、TIBC测定采用日立7600全自动生化分析仪法,SF测定采用化学发光法,sTFR采用双夹心抗体酶联免疫吸附法。结果67例慢性病贫血中骨髓可染铁缺乏有41例,占（61.5%）。缺铁性贫血组与慢性病贫血组或慢性病贫血并发缺铁SI,TIBC,SF值相比差异有显著性（P〈0.01,P〈0.05）,与慢性病贫血不伴缺铁组相比差异无显著性（P〉0.05）;慢性病贫血伴缺铁组与慢性病贫血不伴缺铁组相比差异无显著性（P〉0.05）。sTFR值在缺铁性贫血组、慢性病贫血组及慢性病贫血伴缺铁组。与健康对照组相比差异有显著性（P〈0.01）,而慢性病贫血不伴缺铁组与健康对照组相比差异有显著性（P〈0.05）;缺铁性贫血组与慢性病贫血组或慢性病贫血不伴缺铁组相比差异有显著性（P〈0.01）,而与慢性病贫血伴缺铁组相比差异无显著性（P〉0.05）,慢性病贫血伴缺铁组与不伴缺铁二组相比差异有显著性（P〈0.01）。结论慢性病贫血病人半数以上存在缺铁。骨髓铁染色是鉴别铁缺乏最可靠的方法。新的铁代谢指标sTFR是传统铁代谢指标的必要补充,联合应用上述指标可对ACD、IDA和ACD/ID患者进行准确的鉴别诊断。     

酚妥拉明对吗啡戒断大鼠血清和下丘脑NO含量和NOS活力的影响

目的：探讨酚妥拉明对吗啡戒断大鼠血清及下丘脑一氧化氮（NO）含量和一氧化氮合酶（NOS）活力的影响.方法：大鼠皮下注射递增剂量吗啡,建立吗啡依赖动物模型.在自然戒断症状最明显时,侧脑室注射酚妥拉明,测定血清和下丘脑匀浆NO含量和NOS活力.结果：吗啡戒断大鼠血清NO含量和NOS活力显著升高,下丘脑NO含量和NOS活力无显著变化.侧脑室注射酚妥拉明可使吗啡戒断大鼠血清NO含量和NOS活力明显下降,而对下丘脑NO含量和NOS活力无显著影响.结论：NO/NOS系统可能参与吗啡戒断,并且受α1肾上腺素能神经系统影响.     

一氧化氮、一氧化氮合成酶及血小板参数与脑梗死面积的相关性研究

目的：探讨脑梗死患发病过程中一氧化氮（NO）、一氧化氮合成酶（NOS）及血小板（PLT）、血小板分布宽度（PDW）、平均血小板体积（MPV）的意义及与梗死面积的相关性。方法：检测53例脑梗死患和40例健康对照血清中NO、NOS、PLT、PDW、MPV的含量。结果：脑梗死急性期MPV、NOS显增高（P＜0．05）；PDW、NO显增高（P＜0．01）；PLT显减低（P＜0．01）；NO、NOS分别与PDW、MPV之间呈显正相关，与PLT呈负相关。结论：PDW、MPV、NO、NOS的变化值随梗死面积的增加而增加，PLT则随梗死面积增加而减少。     

铁代谢、铁评估指标和补铁治疗策略

铁是体内重要的微量元素。生理状态下铁含量需要保持在理想范围内。膳食铁的吸收及铁的转运是复杂的过程,对体内铁平衡至关重要。网状内皮系统通过红细胞吞噬作用回收铁。肝脏衍生的肽类激素铁调素是铁代谢的主要调节剂,该激素作用于许多靶组织,并通过负反馈机制调节全身铁水平。血清铁蛋白是衡量全身铁状态的基本指标,在慢性炎症背景下则需要更高的血清铁蛋白阈值和转铁蛋白饱和度、可溶性/血清转铁蛋白受体、铁调素等额外的实验室诊断指标的协同评估。在炎症、慢性肾脏病病理情况下的铁缺乏和贫血的补铁决策需遵循最佳证据和经验。     

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

Iron transport in the plasma is carried out by transferrin, which donates iron to cells through its interaction with a specific membrane receptor, the transferrin receptor (TfR). A soluble form of the TfR (sTfR) has been identified in animal and human serum. Soluble TfR is a truncated monomer of tissue receptor, lacking its first 100 amino acids, which circulates in the form of a complex of transferrin and its receptor. The erythroblasts rather than reticulocytes are the main source of serum sTfR. Serum sTfR levels average 5.0+/-1.0 mg/l in normal subjects but the various commercial assays give disparate values because of the lack of an international standard. The most important determinant of sTfR levels appears to be marrow erythropoietic activity which can cause variations up to 8 times below and up to 20 times above average normal values. Soluble TfR levels are decreased in situations characterized by diminished erythropoietic activity, and are increased when erythropoiesis is stimulated by hemolysis or ineffective erythropoiesis. Measurements of sTfR are very helpful to investigate the pathophysiology of anemia, quantitatively evaluating the absolute rate of erythropoiesis and the adequacy of marrow proliferative capacity for any given degree of anemia, and to monitor the erythropoietic response to various forms of therapy, in particular allowing to predict response early when changes in hemoglobin are not yet apparent. Iron status also influences sTfR levels, which are considerably elevated in iron deficiency anemia but remain normal in the anemia of inflammation, and thus may be of considerable help in the differential diagnosis of microcytic anemia. This is particularly useful to identify concomitant iron deficiency in a patient with inflammation because ferritin values are then generally normal. Elevated sTfR levels are also the characteristic feature of functional iron deficiency, a situation defined by tissue iron deficiency despite adequate iron stores. The sTfR/ferritin ratio can thus describe iron availability over a wide range of iron stores. With the exception of chronic lymphocytic leukemia (CLL) and high-grade non-Hodgkin's lymphoma and possibly hepatocellular carcinoma, sTfR levels are not increased in patients with malignancies. We conclude that soluble TfR represents a valuable quantitative assay of marrow erythropoietic activity as well as a marker of tissue iron deficiency.     

骨髓铁与常用血清铁指标的相关性研究

目的 探讨血清铁(SI)、血清铁蛋白(SF)、总铁结合力(TIBC)、不饱和铁结合能力(UIBC)、转铁蛋白(TRF)等血清铁指标和骨髓内、外铁的相关性.方法 对112例贫血患者进行骨髓铁染色及血清常用铁指标的检测.将骨髓内、外铁与常用铁指标进行等级相关统计分析.按骨髓内、外铁变化的情况将病例分组:骨髓内、外铁均下降为...     

Transferrin index: an alternative method for calculating the iron saturation of transferrin.

We surveyed 140 clinical chemistry laboratories in Australia to establish which laboratory methods they used to determine serum iron status: 125 measured serum iron (Fe), 85 measured transferrin (TRF), 47 measured total iron-binding capacity (TIBC), and 14 measured both TRF and TIBC. Of the 55 laboratories routinely reporting TRF saturation (TS), 16 calculated TS directly as (Fe/TIBC) x 100, and 9 used [Fe/(TRF x 2)] x 100. Thirty laboratories measured TRF and converted it to an equivalent TIBC concentration; the derived TIBC was then used to calculate TS. We measured iron, TIBC, and TRF concentrations in 94 control subjects, 59 patients with alcoholic liver disease (ALD), and 20 with proven genetic hemochromatosis (GH). TS was compared with a transferrin index (TI = Fe/TRF) to determine whether both methods were sensitive for GH screening and which method gave the fewest false-positive results with discrimination limits of > 55% and > 1.0, respectively. All GH patients were detected by both TS and TI at these limits. One control subject had a TI > 1.0, whereas three control subjects had a TS > 55%. Nine patients with ALD had a TI > 1.0 and 11 ALD patients had a TS > 55%. Some iron-overload patients had lower than expected TS values compared with TI, possibly because of ferritin interference in the TIBC assay. Also, the precision of the TRF assay was better than that of the TIBC assay: CVs of 1.85-3.68% vs 6.17%. We therefore recommend that calculated TI replace TS in screening for iron overload.     

多参数分析在缺铁性贫血和慢性病性贫血鉴别诊断中的应用价值

目的研究缺铁性贫血(IDA)和慢性病性贫血(ACD)鉴别诊断中多参数分析方法的应用价值。方法回顾性分析2017年10月至2020年10月廊坊市人民医院收治的70例贫血患者,根据贫血类型分为ACD组(37例)与IDA组(33例);选取同期入院进行体检的35例健康志愿者作为对照组。采用生化与酶联免疫吸附试验法检测铁调素血清(Hepcidin)含量、血清可溶性转铁蛋白受体(sTfR)、肿瘤坏死因子-β(TNF-β)、白细胞介素-6(IL-6)、白细胞介素1(IL-1)、C反应蛋白(CRP)、血清铁蛋白(SF)、转铁蛋白(TF)、总铁结合力(TIBC)、血清铁(SI)水平与sTfR/logSF比值,并分析Hepcidin、sTfR/logSF比值与其他因素相关性;同时比较3组胃窦组织内膜铁转运蛋白表达水平。结果ACD组的Hepcidin、CRP、SF、SI水平明显高于IDA组,TF、TIBC水平与sTfR/logSF明显低于IDA组,差异均有统计学意义(P<0.05);ACD组Hepcidin、sTfR、TNF-β、IL-6、IL-1、CRP、SF水平与sTfR/logSF比值明显高于对照组,TF、TIBC、SI水平明显低于对照组,差异均有统计学意义(P<0.05);IDA组的sTfR、TNF-β、IL-6、IL-1、CRP、TF、TIBC水平与sTfR/logSF比值明显高于对照组,Hepcidin、SF、SI水平明显低于对照组,差异均有统计学意义(P<0.05)。sTfR/logSF比值与TRF、TIBC呈正相关,与SI呈负相关(P<0.05);Hepcidin与SI呈负相关,与TNF-β、IL-6呈正相关,且Hepcidin与sTfR/logSF比值呈正相关(P<0.05)。与对照组比较,IDA组膜铁转运蛋白水平呈高表达,而ACD组膜铁转运蛋白水平呈低表达,差异均有统计学意义(P<0.05)。结论多参数分析方法可为IDA和ACD的鉴别诊断提供重要依据。     

类风湿关节炎伴慢性贫血患者相关细胞因子检测分析

目的探讨白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、干扰素γ(IFN-γ)对类风湿关节炎(RA)伴慢性贫血(ACD)患者造血功能的影响。方法以酶联免疫吸附试验检测RA患者血清IL-1、TNF-α和IFN-γ水平,并检测RA患者血清铁、总铁结合力(TIBC)、铁蛋白(SF)及可溶性转铁蛋白受体(sTfR)水平;对RA伴贫血患者行骨髓涂片铁染色检测。结果无贫血组、ACD不伴缺铁组、ACD伴缺铁组的血清IL-1、TNF-α和IFN-γ水平显著高于健康对照组,差异有统计学意义(P<0.01);ACD不伴缺铁组、ACD伴缺铁组的血清IL-1、TNF-α和IFN-γ水平显著高于无贫血组,差异有统计学意义(P<0.05)。ACD不伴缺铁组血清铁、TIBC、sTfR水平明显低于健康对照组,SF明显高于健康对照组,差异有统计学意义(P<0.05);ACD伴缺铁组血清铁、SF显著低于ACD不伴缺铁组,TIBC和sTfR显著高于ACD不伴缺铁组,差异有统计学意义(P<0.01)。骨髓涂片铁染色示ACD不伴缺铁组细胞内、外铁均高于ACD伴缺铁组。结论 RA患者血清IL-1、TNF-α和IFN-γ水平异常增高是导致ACD的重要原因。     

铁蛋白降低的男性定期单采血小板捐献者的铁代谢指标的变化

目的 探究铁蛋白＜30 jg/L出现储存铁降低的男性定期血小板献血者的铁代谢指标的变化情况.方法 测定北京市红十字血液中心137例男性铁蛋白水平＜ 30 μg/L的定期血小板献血者铁代谢相关指标,包括游离铁(Fe)、血红蛋白(Hb)、不饱和铁结合力(UIBC)、总铁结合力(TIBC)、转铁蛋白(TRF)、前白蛋白(PA...     

Total iron binding capacity or transferrin concentration alone outperforms iron and saturation indices in predicting iron deficiency

BACKGROUND: Although serum ferritin measurement is the investigation of choice in iron deficiency, many laboratories continue to offer iron and TIBC/transferrin measurements. With increasing use of direct transferrin measurement, the possibility of reporting transferrin concentration alone without iron or transferrin saturation arises. This study compared the diagnostic utility of iron, transferrin and transferrin saturation measurements in the diagnosis of iron deficiency METHODS: Details of all laboratory requests for simultaneous serum iron, transferrin/TIBC and ferritin measurement were analysed to assess the diagnostic performance of iron, transferrin or TIBC, and transferrin saturation or TIBC saturation in identifying unequivocal iron deficiency (using 2 different serum ferritin cutoffs: <12 and <15 microg/l). The dataset was divided into 3 groups based on various reagent combinations. RESULTS: Across inpatient and outpatient populations and all 3 reagent combinations, transferrin or TIBC measurement outperformed iron measurement and saturation index. Mean areas under ROC curves across the study were: transferrin or TIBC: 0.94; Fe 0.77; saturation 0.87. There was no difference in diagnostic performance between transferrin and the 2 TIBC formulations. CONCLUSIONS: Transferrin or TIBC measurement outperforms iron and saturation in predicting iron deficiency. This approach offers a cost-effective, evidence-based approach to the investigation of iron deficiency.     

红细胞参数及铁指标鉴别慢性病贫血与慢性系统疾病性贫血的评价

目的了解贫血红细胞参数中红细胞平均体积(MCV)、平均红细胞血红蛋白量(MCH)、平均血红蛋白浓度(MCHC)、红细胞分布宽度变异系数(RDW-CV)和铁指标血清铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)、未饱和铁结合力(UIBC)、铁饱和度(ISAT)对慢性病贫血(ACD)与慢性系统疾病性贫血鉴别诊断的临床价值。方法分别测定ACD组35例患者与慢性系统疾病性贫血组33例患者红细胞参数MCV、MCH、MCHC、RDW-CV和铁指标SF、SI、TIBC、UIBC、ISAT,两组比较采用非配对组间t检验,P0.05为差异有统计学意义。结果 ACD组与慢性系统疾病性贫血组比较,红细胞参数MCV、MCH显著减低(P0.05),RDW-CV显著增高(P0.05),MCHC差异无统计学意义(P0.05),铁指标SI、ISAT显著减低(P0.05),UIBC显著增高(P0.05),SF、TIBC差异无统计学意义(P0.05)。结论联合红细胞参数及铁指标对ACD与慢性系统疾病性贫血鉴别有一定的临床价值。     

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.