... 1 Abstract... 3... 5... 6... 10... 10... 10... 14... 14... 16 stfr stfr/sf... 19 stfr stfr/sf... 27... 29... 29 stfr... 31 stfr/sf... 34 stfr stfr/sf... 36... 38... 39... 44... 45... 60... 61
stfr : stfr stfr/sf stfr stfr/sf stfr stfr/sf stfr stfr/sf 942 18-45 SF ZPP Hb Normal IDs IDE IDA 189 stfr ELISA stfr/sf stfr ROC (ROC) 34.8%IDs IDE 1
IDA 23.4% 6.7% 4.7% IDs IDE IDA stfr stfr/sf stfr stfr stfr stfr 95% 16.73 19.22 nmol/l ROC stfr 83% 20.2nmol/L 79% 63% 80 64 Log(sTfR/SF) 99% 0.047 93% 100% 91 100 34.8 13.4 stfr stfr/sf stfr 95 16.73 19.22 nmol/l stfr stfr/sf 2
Iron Status of Women at Reproductive Age and the Role of stfr in Screening Iron Deficiency Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, P.R.China. Graduate Student: Zhang Juan Supervisor: Lin Xiaoming Abstract Objectives and Contents: To observe the iron status of the women in our study, and analyze the factors for iron deficiency; To study the reliability of stfr and stfr/sf in evaluating iron status and screening iron deficiency; To explore new indices for monitoring early iron deficiency, then control iron deficiency effectively. We observed the common status of the subjects, determined the conventional iron status parameters and levels of stfr, and stfr/sf was calculated. We observed the levels of stfr and stfr/sf in women with different iron status, changes of them in women with IDA after iron supplementation, further to analyze the diagnostic efficacy of them in identifying iron deficiency. Subjects and Methods: We selected the subjects from Hebei Province and Shunyi County, and 942 women at reproductive age were included in our study. We determined the Serum Ferritin(SF,radioimmunoassay) Zinc Protoporphyrin(ZPP, fluorometry) and Hemoglobin(Hb, cyanmethemoglobin method), divided them into four groups: Iron Normal, IDs(Iron Deficiency Store) IDE(Iron Deficiency Erythropoiesis) IDA(Iron Deficiency Anemia), according to the current criteria for assessing iron status. We randomly selected 189 aliquotes of serum from the four groups to determine their stfr( a Sandwich Enzyme Linked Immunosorbent Assay, ELISA), calculated the ratio of stfr/sf, ie, stfr/logsf Log(sTfR/SF).The main statistical method were analysis of variation, analysis of correlativity and Receiver Operator Characteristic(ROC) curve analysis. 3
Results In the study, 34.8 percent women at reproductive age were diagnosed iron deficiency. The prevalence of IDs, IDE, IDA in the population were 23.4%, 6.7% and 4.7% respectively. The factors affecting iron deficiency were the mean income of family, the contraception method, the status of menses, the weekly frequency of meat intake and milk, frequency of dinning in a day and knowledge of diet. stfr increased significantly in women with iron deficiency of different stages; In contrast, stfr/sf greatly increased; After supplementation, the levels of stfr and stfr/sf decreased significantly. stfr correlated with the conventional iron status parameters significantly, can reflect the different aspects of iron status. No significant difference of stfr was found in the age-specific groups. The 95% confidence interval of stfr in iron normal women was 16.73 19.22 nmol/l.the efficacy of Log(sTfR/SF) in identifying iron store deficiency was higher then stfr/logsf and stfr, the cut-off value was 0.047, with the Se 93%, Sp 100%, PPV 91%, NPV 100%. stfr can effectively identify functional iron deficiency, with the cut-off value 20.2nmol/L, Se 79%, Sp 63%, PPV 80%, NPV 64%. Conclusions: The prevalence of ID in the population was 34.8%, and IDA was 13% of ID; stfr and stfr/sf were reliable indices for assessing iron status and screening iron deficiency. The 95% confidence interval of stfr was 16.73 19.22 nmol/l. stfr and stfr/sf all were promising for assessing iron status and screening iron deficiency in women at reproductive age. Key Words: Women at Reproductive Age, Iron Deficiency, Functional Iron Deficiency, stfr 4
Abbreviation AUC ROC Area Under the ROC Curve CI Confidence Interval ELISA Enzyme Linked Immunosorbent Assay Hb Hemoglobin ID Iron Deficiency IDs Iron Deficiency Store IDE Iron Deficiency Erythropoiesis IDA Iron Deficiency Anemia Log(sTfR/SF) Log (Serum Transferrin Receptor / Serum Ferritin) / NPV Negative Predictive Value PPV Positive Predictive Value ROC Receiver Operator Character stfr Serum Transferrin Receptor stfr/log SF Serum Transferrin Receptor/Log Serum Ferritin stfr/sf The Ratio of Serum Transferrin Receptor/Serum Ferritin Se Sensitivity Sp Specificity SF Serum Ferritin TfR Transferrin Receptor ZPP Zinc Protoporphyrin 5
[1] 3 [2,3] Iron Deficiency Store, IDs Iron Deficiency Erythropoiesis, IDE Iron Deficiency Anemia, IDA [4] WHO 1990-1995 10.3 42.3 2 5 [5] 1999 43.32% 11.39% [6,7] [8] [9,10] [5] 6
[11,12] Hb(Haemoglobin) SF(Serum Ferritin) FEP(Free Erythrocyte Protoporphyrin) ZPP(Zinc Protoporphyrin) [13] [5] WHO [14] Hb Hb [15] Serum Transferrin Rreceptor stfr Transferrin Receptor,TfR 89 98 95kDa [16] [17] TfR, - (Tf) TfR [18,19] TfR, TfR 80% 75-80% TfR [20] Johnstone 7
TfR [21] 1% 100 1 1 80% 20% [22] stfr TfR 5 6 2 [23] stfr [24] [25,26] 1990 Skikne stfr [27] stfr [25,26,28] stfr stfr [27] stfr [24,29-32] [33,34] stfr stfr [35] stfr stfr Marita [36] stfr 8
stfr stfr stfr stfr/sf 9
18 45 942 33.25 7.36 SF ZPP Hb IDs 220 IDE 63 IDA 44 56 IDs56 IDE41 IDA36 stfr stfr/sf stfr/log SF Log(sTfR/SF) 12 3 4 0.02 ZPP 0.02 Hb 70 SF stfr 41 L- 7mg 4 / 12 3 6 9 12 stfr 39 10
1 (1) (2) (3) (KCN)0.05 [K 3 Fe(CN) 6 ]0.20 (KH 2 PO 4 )0.14 1000 1 (Triton-100) 1000 (4) 12500 0.9% 50 (5) (6) R&D System 2 (1) 724 (2) HZ-881K (3) ZK380 Hermle-CaborTechNik (4) SN-695B (5) (Zpp-3800 ) (6) Model 450 BIO-RAD 3 (1)Hb [37] 5.0 0.02 11
5 6 Hb 10 724 540nm Hb (2)SF 125 I [38,39] SF (T) (NSB) (B0) (ml) 0.2 0.1 (ml) 0.1 (ml) 0.1 (ml) 0.1 0.1 0.1 125 I (ml) 0.1 0.1 0.1 0.1 0.1 37 1 (ml) 0.5 0.5 0.5 0.5 (B) 15 3500 / 15 (3)ZPP [40] 0.5ml EP 5 6-4,24 15 g/g Hb 2 l 12
(4)sTfR (ELISA) [32] R&D System stfr stfr 96 100 l 20 l 1 100 lstfr 1 30 100 l 30 450nm [41-43] 1. ID SF<20 g/l 2. IDE SF<20 g/l ZPP>1.5 g/g Hb Hb 120g/L 3. IDA SF<20 g/l ZPP>1.5 g/g Hb Hb<120g/L EPI SPSS10.0 PC Step-wise Logistic t shapiro-wilk P<0.05 13
33.25 7.36 34.8% IDs IDE IDA 23.4% 6.7% 4.7% 1 1 1 N( ) ID s 220 23.4 IDE 63 6.7 IDA 44 4.7 614 65.2 942 100 23.4% 6.7% 4.7% 65.2% IDA IDE ID s 1 2 3 14
2 x 2 P OR OR95%CI 420(59.5%) 286(40.5%) - - 1-93(64.1%) 52(35.9%) 1.085 >0.05 0.821 0.567-1.190 71(78.0%) 20(22.0%) 5.084 <0.05 0.504 0.276-0.919 108(71.5%) 43(28.5%) 6.928 <0.01 1.662 1.136-2.433 436(60.2%) 315(39.8%) <500 198(69.7%) 86(30.3%) - - 1-500-1000 ( ) 234(58.9%) 163(41.1%) 8.289 <0.01 1.604 1.162-2.214 1000 152(58.2%) 109(41.8%) 0.032 >0.05 1.029 0.750-1.413 182(69.7) 79(30.3%) 402(59%) 279(41%) 9.170 <0.01 1.599 1.179-2.169 446(60.3%) 294(39.7%) 138(68.3%) 64(31.7%) 4.361 <0.05 1.421 1.021-1.979 434(59.9%) 290(40.1%) 150(68.8%) 68(31.2%) 5.586 <0.05 1.474 1.067-2.036 291(56.4%) 225(43.6%) 293(68.8%) 133(31.2%) 15.189 <0.01 0.581 0.449-0.768 <2 92(53.8%) 79(46.2%) - - 1-2-3 105(59.0%) 73(41.0%) 0.955 >0.05 0.810 0.530-1.237 >3 387(65.3%) 206(34.7%) 7.453 <0.01 0.620 0.0.439-0.87 377(58.8%) 264(41.2%) 8.618 <0.01 0.648 0.485-0.867 207(68.8%) 94(31.2%) 412(64.7%) 225(35.3%) - - 1 - <3 86(60.6%) 56(39.4%) 0.853 >0.05 1.192 0.821-1.733 3-6 63(56.3%) 49(43.7%) 2.917 >0.05 1.424 0.948-2.140 7 23(45.1%) 28(54.9%) 7.786 <0.01 2.229 1.254-3.961 108(75.5%) 35(24.5%) 476(59.6%) 323(40.4%) 73(77.7%) 21(22.3%) 13.097 <0.01 2.094 1.394-3.144 511(60.3%) 337(39.7%) 10.874 <0.01 2.293 1.384-3.797 111(68.9%) 50(31.1%) 473(60.6%) 308 (39.4%) 3.979 <0.05 1.446 1.005-2.079 2 5 15