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首页> 外文期刊>BMC Medicine >Diagnostic utility of zinc protoporphyrin to detect iron deficiency in Kenyan pregnant women
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Diagnostic utility of zinc protoporphyrin to detect iron deficiency in Kenyan pregnant women

机译：锌原卟啉对肯尼亚孕妇铁缺乏症的诊断作用

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Background Iron-deficient erythropoiesis results in excess formation of zinc protoporphyrin (ZPP), which can be measured instantly and at low assay cost using portable haematofluorometers. ZPP is used as a screening marker of iron deficiency in individual pregnant women and children, but also to assess population iron status in combination with haemoglobin concentration. We examined associations between ZPP and disorders that are common in Africa. In addition, we assessed the diagnostic utility of ZPP (measured in whole blood and erythrocytes), alone or in combination with haemoglobin concentration, in detecting iron deficiency (plasma ferritin concentration Methods Single blood samples were collected from a population sample of 470 rural Kenyan women with singleton pregnancies, gestational age 13 to 23?weeks, and haemoglobin concentration ≥90?g/L. We used linear regression analysis to assess associations between ZPP and iron markers (including anaemia), factors known or suspected to be associated with iron status, inflammation markers (plasma concentrations of C-reactive protein and α 1-acid glycoprotein), infections ( Plasmodium infection, HIV infection), and other disorders ( α +-thalassaemia, plasma concentrations of total bilirubin, and lactate dehydrogenase). Subsequently, in those without inflammation, Plasmodium infection, or HIV infection, we used logistic discriminant analysis and examined receiver operating characteristics curves with corresponding area-under-the-curve to assess diagnostic performance of ZPP, alone and in combination with haemoglobin concentration. Results Individually, whole blood ZPP, erythrocyte ZPP, and erythrocyte protoporphyrin had limited ability to discriminate between women with and without iron deficiency. Combining each of these markers with haemoglobin concentration had no additional diagnostic value. Conventional cut off points for whole blood ZPP (>70?μmol/mol haem) resulted in gross overestimates of the prevalence of iron deficiency. Conclusions Erythrocyte ZPP has limited value to rule out iron deficiency when used for screening in conditions with a low prevalence (e.g., 10%). ZPP is of unreliable diagnostic utility when discriminating between pregnant women with and without iron deficiency. Based on these findings, guidelines on the use of ZPP to assess iron status in individuals or populations of pregnant women need review. Trial registration NCT01308112 (2 March 2011).
机译：背景技术缺铁的促红细胞生成导致过量的锌原卟啉（ZPP）形成，可以使用便携式血细胞荧光仪以低的测定成本立即进行测定。 ZPP可以用作孕妇和儿童铁缺乏症的筛查指标，还可以结合血红蛋白浓度评估人群铁的状况。我们研究了ZPP与非洲常见疾病之间的关联。此外，我们评估了ZPP（在全血和红血球中测量）单独或与血红蛋白浓度联合使用在检测铁缺乏症（血浆铁蛋白浓度）中的诊断效用。方法从肯尼亚470名农村妇女的人群样本中采集单血样本单胎妊娠，胎龄13至23周，血红蛋白浓度≥90 g / L我们使用线性回归分析评估ZPP与铁标志物（包括贫血），已知或怀疑与铁状态有关的因素之间的关联，炎症标志物（C反应蛋白和α 1 -酸性糖蛋白的血浆浓度），感染（疟原虫感染，HIV感染）和其他疾病（α + -地中海贫血，血浆中总胆红素和乳酸脱氢酶的浓度）。随后，对于没有发炎，疟原虫感染或HIV感染的患者，我们采用逻辑判别分析并检查是否接受r操作特性曲线以及相应的曲线下面积，可单独或结合血红蛋白浓度评估ZPP的诊断性能。结果单独地，全血ZPP，红细胞ZPP和红细胞原卟啉在区分是否患有铁缺乏症的妇女中的能力有限。将这些标记物中的每一个与血红蛋白浓度结合使用均无附加诊断价值。传统的全血ZPP临界点（> 70？μmol/ mol血红素）导致对铁缺乏症患病率的高估。结论当在低患病率（例如10％）的条件下进行筛查时，红细胞ZPP排除铁缺乏的价值有限。当区分有和没有铁缺乏的孕妇时，ZPP的诊断效用不可靠。基于这些发现，需要评估使用ZPP评估孕妇个体或人群中铁状态的指南。试用注册NCT01308112（2011年3月2日）。

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