Wolf Abraham W, Jimenez Elias, Lozoff Betsy
Department of Psychiatry, MetroHealth Medical Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44109, USA.
J Pediatr. 2003 Dec;143(6):789-95. doi: 10.1067/S0022-3476(03)00540-7.
To determine the effects of iron therapy on blood lead levels in infants with mildly elevated lead levels and varied iron status.
Infants from a community-derived sample in Costa Rica were categorized into five groups. Group 1 had iron-deficiency anemia with hemoglobin levels <or=105 g/L. Infants in group 2 were iron-deficient with intermediate hemoglobin levels (between 106-119 g/L). These groups were treated with intramuscular iron or 3 months of oral iron. Group 3 (nonanemic iron-deficient) and group 4 (nonanemic iron-depleted) were treated with 3 months of oral iron. Group 5 (iron-sufficient) received oral placebo.
After 3 months of oral iron therapy, nonanemic iron-depleted infants had the greatest decrease in lead levels, followed by nonanemic iron-deficient infants and iron-deficient infants with hemoglobin levels <120 g/L. Lead levels increased among iron-deficient infants with hemoglobin levels <120 g/L who received intramuscular iron and iron-sufficient nonanemic infants who received placebo.
Changes in lead levels corresponded closely to changes in iron status and were plausible in terms of absorption mechanisms for lead and iron. Correcting and/or preventing iron deficiency appear to be rapid and effective means of improving infant lead levels, even in nonanemic infants.
确定铁疗法对血铅水平轻度升高且铁状态各异的婴儿血铅水平的影响。
来自哥斯达黎加社区样本的婴儿被分为五组。第1组为缺铁性贫血,血红蛋白水平≤105 g/L。第2组婴儿缺铁且血红蛋白水平处于中间范围(106 - 119 g/L)。这些组接受了肌肉注射铁剂或为期3个月的口服铁剂治疗。第3组(非贫血缺铁)和第4组(非贫血铁耗竭)接受了3个月的口服铁剂治疗。第5组(铁充足)接受口服安慰剂。
经过3个月的口服铁剂治疗后,非贫血铁耗竭的婴儿血铅水平下降幅度最大,其次是非贫血缺铁的婴儿以及血红蛋白水平<120 g/L的缺铁婴儿。接受肌肉注射铁剂的血红蛋白水平<120 g/L的缺铁婴儿和接受安慰剂的铁充足非贫血婴儿的血铅水平升高。
血铅水平的变化与铁状态的变化密切相关,从铅和铁的吸收机制来看是合理的。纠正和/或预防缺铁似乎是改善婴儿血铅水平的快速有效方法,即使对于非贫血婴儿也是如此。