Di Bisceglie A M, Axiotis C A, Hoofnagle J H, Bacon B R
Liver Diseases Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
Gastroenterology. 1992 Jun;102(6):2108-13. doi: 10.1016/0016-5085(92)90339-z.
Eighty patients with chronic viral hepatitis were screened for evidence of iron overload. Elevated serum iron values were noted in 36% of cases; serum ferritin values were above normal in 30% of men and 8% of women. Twenty-eight additional patients with chronic hepatitis for whom liver tissue was available for determination of iron content were evaluated to study the significance of iron overload in association with chronic hepatitis. Although 46% had elevated serum iron, ferritin, or transferrin-saturation levels, the hepatic iron concentration was elevated in only four cases, and the hepatic iron index was in the range for hereditary hemochromatosis (greater than 2.0) in only two of these. Serum aspartate aminotransferase activities correlated with serum ferritin levels in these patients, suggesting that ferritin and iron levels were increased in serum because of their release from hepatocellular stores associated with necrosis. Thus, in patients with chronic hepatitis in whom hereditary hemochromatosis is suspected, a liver biopsy should be performed with quantitation of hepatic iron and calculation of the hepatic iron index to confirm the diagnosis.
对80例慢性病毒性肝炎患者进行了铁过载证据筛查。36%的病例血清铁值升高；30%的男性和8%的女性血清铁蛋白值高于正常。另外28例有肝组织可用于测定铁含量的慢性肝炎患者接受评估，以研究铁过载与慢性肝炎相关的意义。虽然46%的患者血清铁、铁蛋白或转铁蛋白饱和度水平升高，但仅4例肝铁浓度升高，其中仅2例肝铁指数处于遗传性血色素沉着症范围（大于2.0）。这些患者血清天冬氨酸转氨酶活性与血清铁蛋白水平相关，提示血清中铁蛋白和铁水平升高是由于它们从与坏死相关的肝细胞储存中释放出来。因此，对于疑似遗传性血色素沉着症的慢性肝炎患者，应进行肝活检，对肝铁进行定量并计算肝铁指数以确诊。
