优化费里下限对铁缺乏症诊断和治疗模式的影响:使用EHR数据进行干预前后研究
Ali Abdelhay1, Mouna Reghis1, Tamer Salhab2
1Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.
American journal of hematology
|January 6, 2026
概括
提高费里的正常水平的下限改善了铁缺乏症的诊断和治疗,特别是在女性中. 这一变化增强了早期检测和干预缺乏缺铁而没有贫血 (IDWA) 和缺铁性贫血 (IDA).
科学领域:
- 临床化学和实验室医学
- 血液学 血液学 血液学
- 公共卫生 公共卫生
背景情况:
- 铁缺乏,带有或没有贫血 (IDWA/IDA) 是一个普遍的全球健康问题,经常被诊断不足,特别是在妇女中.
- 罗切斯特地区卫生局 (RRH) 在2023年9月更新了所有成年人的铁素下限正常值 (LLN) 到30ng/mL,与新兴指南保持一致.
- 这一变化旨在改善铁缺乏症的识别和管理.
研究的目的:
- 评估修订后的,更高的,独立于性别的费里丁LLN对铁缺乏与或没有贫血 (IDWA/IDA) 的诊断和治疗模式的影响.
- 评估诊断率的变化,铁处方,血液学转诊,内镜手术和干预后红细胞输血 (pRBC).
主要方法:
- 进行了一项回顾性队列研究,比较了费里LLN更新之前和之后的两个1.5年时期.
- 用Epic公司的SlicerDicer工具分析了患者数据,重点关注ferritin水平低于30 ng/mL的个体.
- 统计分析包括主要和次要结果的相对风险 (RR) 与置信区间 (CI),以及维尔奇对费里和血红素水平变化的t测试.
主要成果:
- 在费里LLN更新后,IDWA或IDA诊断的总比率从51.0%增加到58.5% (RR 1.15).
- 这种诊断改善在女性 (49.4%至58.0%) 中更为显著,导致IDWA诊断增加了47%.
- 口服和静脉注射铁的处方分别增加了15%和17%,内镜手术增加了23%. 平均费里水平也显示在随访时显著增加.
结论:
- 实施基于证据的,更高的,独立于性别的费里LLN显著提高了铁缺乏症的检测和治疗,特别是在女性和非贫血个体中.
- 这些发现支持更广泛地采用修订的费里丁值,以改善临床实践中早期识别和治疗铁缺乏症.
- 这种干预措施对治疗模式产生了积极的影响,包括增加铁处方和诊断程序.
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