Serum ferritin levels as a useful diagnostic marker for the distinction of systemic juvenile idiopathic arthritis and Kawasaki disease

Objectives: The clinical features and laboratory parameters of patients with Kawasaki disease (KD) and systemic juvenile idiopathic arthritis (s-JIA) tend to overlap. Furthermore, there have been no definitive biomarkers for these diseases, making clinical diagnosis difficult. The purpose of this study was to investigate the diagnostic value of serum ferritin levels for differentiating KD from s-JIA and predicting the disease severity of KD.

Methods: We analyzed 228 patients with KD and 81 patients with s-JIA. Serum ferritin levels were compared between patients with s-JIA and KD. Furthermore, serum ferritin levels in patients with KD were compared with respect to clinical features such as responsiveness to intravenous immunoglobulin (IVIG) therapy.

Results: Serum ferritin levels in KD patients with no response to IVIG therapy were significantly higher than those in KD patients with a good response to IVIG therapy. Serum ferritin levels in patients with KD needing plasma exchange (PE) were significantly higher than those in patients not needing PE. However, serum ferritin levels overlapped between severe KD patients with nonresponsiveness to IVIG therapy or needing PE and other patients with mild KD. Furthermore, patients with s-JIA showed a distinct elevation of serum ferritin levels compared with KD patients. The cutoff value of serum ferritin levels for differentiating KD from s-JIA was 369.6?ng/ml.

Conclusions: Serum ferritin levels were significantly elevated in s-JIA patients compared with KD patients. Measurement of serum ferritin levels can be useful for differentiating s-JIA from KD.     

Elevation of serum ferritin levels for predicting a poor outcome in hospitalized patients with influenza infection

ObjectivesThere is increasing evidence that ferritin is a key marker of macrophage activation, but its potential role in influenza infection remains unexplored. Our aim was to assess whether hyperferritinaemia (ferritin ≥500 ng/mL) could be a marker of poor prognosis in hospitalized patients with confirmed influenza A infection.MethodsWe prospectively recruited all hospitalized adult patients who tested positive for the influenza A rRT-PCR assay performed on respiratory samples in two consecutive influenza periods (2016–17 and 2017–18). Poor outcome was defined as the presence of at least one of the following: respiratory failure, admission to the intensive care unit, or in-hospital mortality.ResultsAmong 494 patients, 68 (14%) developed poor outcomes; 112 patients (23%) had hyperferritinaemia (39/68, 57% in the poor-outcome group versus 73/426, 17% in the remaining patients, p < 0.0001). Median serum ferritin levels were significantly higher in the subgroup of patients with poor outcomes (609 ng/mL, range 231–967 versus 217 ng/mL, range 140–394, p < 0.0001). In multivariate analysis, hyperferritinaemia was associated with a five-fold increase in the odds ratio of developing poor outcome. After adjusting for classic influenza risk factors, ferritin remained as a significant predictive factor in all exploratory models. Ferritin levels had a good discriminative capacity with an area under the ROC curve of 0.72 (95% confidence interval (CI) 0.65–0.8, p < 0.001) and an overall diagnostic accuracy for predicting poor outcome of 79.3% (95%CI 75.4–82.7%).ConclusionsSerum ferritin may discriminate a subgroup of patients with influenza infection who have a higher risk of developing a poor outcome.     

乳腺癌患者联合检测CA15—3、CA125、CEA、SF的临床价值

目的探讨糖类抗原（cA）153、CA125、癌胚抗原（CEA）与血清铁蛋白（SF）联合检测对乳腺癌患者的互补诊断价值及在疗效观察中的临床意义。方法利用化学发光免疫方法检测36例乳腺良性疾病（乳腺良性疾病组）和30例健康体检者（对照组）以及70例乳腺癌患者（乳腺癌组）治疗前后血清CA15—3、CA125、CEA和SF的水平，并进行分析。结果乳腺癌组血清CA15—3、CA125、CEA和SF水平明显高于乳腺良性疾病组和对照组（P〈0．05）；乳腺癌组血清CA15—3、CA125、CEA和SF治疗前的水平明显高于治疗后的水平（P〈0．05），且治疗前水平明显高于对照组（P〈0．01）；四种肿瘤标志物联合检测均高于单一检测，其诊断敏感度达82．8％。结论血清CA15—3、CA125、CEA、SF联合检测可提高乳腺癌的阳性检出率和检测特异性，对乳腺癌的早期诊断、疗效监测以及预后判断均有重要意义。     

SERUM FERRITIN IN ASSESSMENT OF IRON NUTRITION IN HEALTHY INFANTS

ABSTRACT. We followed up 238 infants on 7 occasions during their first year of life. The diets of the infants were systematically either supplemented or not supplemented with iron. Developmental changes in serum ferritin were determined from a group with adequate intake of iron and without evidence of iron deficiency by three laboratory criteria: hemoglobin, mean corpuscular volume and transferrin saturation. The data indicate that the average level of serum ferritin correlates well with iron nutrition within groups of infants since the developmental changes are in accordance with the known changes in storage iron, the level of serum ferritin correlates with iron intake, and low ferritin levels are associated with lower transferrin saturation. The usefulness of serum ferritin as the sole criterion of iron deficiency in individual infants is limited, suggesting the use of more than one indicator to refine the diagnosis of iron deficiency without anemia.     

ADA、CEA和Ft联合检测对结核性和癌性胸水的鉴别诊断价值

目的：探讨腺苷脱氨酶（ADA）、癌胚抗原（CEA）和铁蛋白（Ft)对结核性和癌性胸水的诊断价值。方法：检测30例结核性胸膜炎和21例癌性患胸水中的ADA、CEA和Ft含量。结果：单项检测：ADA诊断结核性胸膜炎的敏感性为86.7%，特异性为80.1%，准确度为86.7%；CEA和Ft诊断癌性胸水的敏感性分析为76.2%和66.7%，特异性为93.3%和86.7%，准确度为88．9％和77．8％。联合检测：以三项同时符合结核或癌性胸水为诊断依据时，结核性和癌性胸水的敏感性分别为70％和52．4％，特异性和准确度均为100％。结论：ADA、CEA和Ft联合检测对结核性和癌性胸水有较高的鉴别诊断价值。     

Unusual presentation of congenital disorder of glycosylation type 1a: congenital persistent thrombocytopenia,hypertrophic cardiomyopathy and hydrops-like aspect due to marked peripheral oedema

Of the congenital disorder of glycosylation (CDG) syndromes, type 1a is the most common. CDG 1a is a multisystem disorder with a wide clinical spectrum. We report on a term newborn with a severe and fatal clinical course of CDG 1a syndrome. Skin fibroblasts showed a reduced activity of phosphomannomutase 2 (PMM2) and mutation analysis revealed a compound heterozygous PMM2gene mutation (F119L/F157S). Presenting features at birth were hypertrophic non-obstructive cardiomyopathy, orange-peel skin, inverted nipples and a hydrops-like aspect due to marked peripheral oedema. Suspected hydrops fetalis was not confirmed due to lack of ascites and pleural effusions. Striking clinical problems were therapy-resistant arterial hypertension, recurrent pericardial and pleural effusions and feeding difficulties with failure to thrive. Persistent congenital thrombocytopenia and hyperferritinaemia in the absence of infection were noted. Bone marrow cytology revealed a macrophage activation of unknown aetiology. Conclusion:Congenital thrombocytopenia, unspecific macrophage activation and a hydrops-like aspect without a real hydrops fetalis broaden the already wide phenotypic spectrum of congenital disorder of glycosylation syndrome type 1a.     

Ultrasound-mediated release of iron from ferritin

We investigated the release of iron from ferritin in aqueous solutions exposed to high-frequency ultrasound (US). Our data suggests that superoxide produced as a result of ultrasonic cavitation acts as a reducing agent, enabling the release of iron from ferritin. We also found that the release of ferritin iron during US exposure is enhanced by the addition of 5-hydroxy-1,4-naphthoquinone. We hypothesize that this quinone is ultrasonically transformed into a semiquinone radical capable of directly and indirectly reducing Fe³⁺ in ferritin to soluble Fe²⁺. Our proposed mechanism for the release of iron from ferritin adds new insight to the synergistic effect of quinone-containing cancer drugs with US. (E-mail: jmorrissey@cinci.rr.com)