Terlouw Dianne J, Desai Meghna R, Wannemuehler Kathleen A, Kariuki Simon K, Pfeiffer Christine M, Kager Piet A, Shi Ya Ping, Ter Kuile Feiko O
Division of Parasitic Diseases, National Center for Infectious Diseases, Atlanta, GA, USA.
Am J Clin Nutr. 2004 Mar;79(3):466-72. doi: 10.1093/ajcn/79.3.466.
Iron supplementation has been associated with greater susceptibility to malaria and lower hematologic responses in pregnant Gambian women with sickle cell trait (HbAS) than in similar women with the normal (HbAA) phenotype. It is not known whether a similar interaction exists in children.
Our aim was to determine the influence of the HbAS phenotype on hematologic responses and malaria after iron supplementation in anemic (hemoglobin: 70-109 g/L) children aged 2-35 mo.
We conducted a double-blind, randomized, placebo-controlled trial (HbAS, n = 115; HbAA, n = 408) of intermittent preventive treatment with sulfadoxine pyrimethamine (IPT-SP) at 4 and 8 wk and daily supervised iron for 12 wk.
The mean difference in hemoglobin concentrations at 12 wk between children assigned iron and placebo iron, after adjustment for the effect of IPT-SP, was 9.1 g/L (95% CI: 6.4, 11.8) and 8.2 g/L (4.0, 12.4) in HbAA and HbAS children, respectively (P for interaction = 0.68). Although malaria parasitemia and clinical malaria occurred more often in HbAS children in the iron group than in those in the placebo iron group, this difference was not significant; incidence rate ratios were 1.23 (95% CI: 0.64, 2.34) and 1.41 (0.39, 5.00), respectively. The corresponding incidence rate ratios in HbAA children in the same groups were 1.07 (95% CI: 0.77, 1.48) and 0.59 (0.35, 1.01), respectively. The corresponding interactions between the effects of iron and hemoglobin phenotype were not significant.
There was no evidence for a clinically relevant modification by the hemoglobin S phenotype of the effects of iron supplementation in the treatment of mild anemia. The benefits of iron supplementation are likely to outweigh possible risks associated with malaria in children with the HbAA or HbAS phenotype.
与具有正常（HbAA）表型的类似孕妇相比，补充铁剂与镰状细胞性状（HbAS）的冈比亚孕妇对疟疾的易感性增加以及血液学反应降低有关。尚不清楚儿童中是否存在类似的相互作用。
我们的目的是确定HbAS表型对2至35个月贫血（血红蛋白：70 - 109 g/L）儿童补充铁剂后血液学反应和疟疾的影响。
我们进行了一项双盲、随机、安慰剂对照试验（HbAS组，n = 115；HbAA组，n = 408），在4周和8周时采用磺胺多辛 - 乙胺嘧啶进行间歇性预防治疗（IPT - SP），并每天监督补充铁剂12周。
在调整IPT - SP的影响后，HbAA和HbAS儿童中，分配铁剂组与安慰剂铁剂组儿童在12周时血红蛋白浓度的平均差异分别为9.1 g/L（95% CI：6.4，11.8）和8.2 g/L（4.0，12.4）（交互作用P值 = 0.68）。虽然铁剂组中HbAS儿童的疟原虫血症和临床疟疾发生率高于安慰剂铁剂组儿童，但差异不显著；发病率比值分别为1.23（95% CI：0.64，2.34）和1.41（0.39，5.00）。同一组中HbAA儿童的相应发病率比值分别为1.07（95% CI：0.77，1.48）和0.59（0.35，1.01）。铁剂和血红蛋白表型效应之间的相应交互作用不显著。
没有证据表明血红蛋白S表型对补充铁剂治疗轻度贫血的效果有临床相关的改变。补充铁剂的益处可能超过HbAA或HbAS表型儿童中与疟疾相关的潜在风险。
