James Martin W, Chen Chih-Mei, Goddard William P, Scott Brian B, Goddard Andrew F
Wolfson Digestive Diseases Centre, University Hospital, Nottingham, UK.
Eur J Gastroenterol Hepatol. 2005 Nov;17(11):1197-203. doi: 10.1097/00042737-200511000-00008.
Iron-deficiency anaemia (IDA) is common and may be caused by blood loss from gastrointestinal tumours. The aim of this study was to define risk factors for gastrointestinal malignancy in patients with IDA.
Patients with suspected IDA referred for gastrointestinal investigations were prospectively identified from two neighbouring UK hospitals (serving a population of 550,000 patients) between 1 January 1998 and 31 December 1999. Final diagnoses were determined after 2 years, and those patients with and without gastrointestinal cancer as a cause for their IDA were compared. Data collected included sex, age, haemoglobin, serum ferritin, mean cell volume and drug history.
A total of 695 patients (236 men, mean age 68.5 years; 459 women, mean age 66.2 years) with IDA were investigated. Malignancy was diagnosed in 91/695 (13.1%) and gastrointestinal malignancy in 78/91 (11.2%). The most frequently diagnosed cancers were colonic (n = 44, 6.3%), gastric (n = 25, 3.6%) and renal tract (n = 7, 1%). The adjusted odds ratio (+/-95% confidence interval) for gastrointestinal cancer as a cause of IDA was significantly higher for male sex [2.96 (1.80, 4.87)], age over 50 years [7.04 (1.69, 29.32)] and haemoglobin level at presentation (< or =9.0 g/dl) [2.25 (1.29, 3.90)]. There was no significant difference in gastrointestinal malignancy in those taking aspirin (12/111, 10.8%), non-aspirin non-steroidal anti-inflammatory drugs (5/84, 6.0%) or warfarin (4/31, 12.9%) compared with those not taking these drugs (57/470, 12.1%). No cause for IDA was found in 53.7%.
Cancer was diagnosed in 13.1% and gastrointestinal cancer in 11.2% of patients with IDA. Significant risk factors for gastrointestinal malignancy in IDA patients are male sex, age over 50 years and haemoglobin at presentation < or =9.0 g/dl. IDA should not be attributed to aspirin, non-steroidal anti-inflammatory drugs or warfarin use.
缺铁性贫血（IDA）很常见，可能由胃肠道肿瘤失血引起。本研究的目的是确定IDA患者发生胃肠道恶性肿瘤的危险因素。
1998年1月1日至1999年12月31日期间，从英国两家相邻医院（服务于55万患者）前瞻性识别出疑似IDA并接受胃肠道检查的患者。2年后确定最终诊断，并比较那些因IDA而患有和未患有胃肠道癌症的患者。收集的数据包括性别、年龄、血红蛋白、血清铁蛋白、平均红细胞体积和用药史。
共调查了695例IDA患者（236例男性，平均年龄68.5岁；459例女性，平均年龄66.2岁）。91/695（13.1%）例被诊断为恶性肿瘤，其中78/91（11.2%）例为胃肠道恶性肿瘤。最常诊断出的癌症为结肠癌（n = 44，6.3%）、胃癌（n = 25，3.6%）和泌尿道癌（n = 7，1%）。作为IDA病因的胃肠道癌症的校正比值比（±95%置信区间）在男性[2.96（1.80，4.87）]、50岁以上[7.04（1.69，29.32）]以及就诊时血红蛋白水平（≤9.0 g/dl）[2.25（1.29，3.90）]时显著更高。服用阿司匹林（12/111，10.8%）、非阿司匹林非甾体抗炎药（5/84，6.0%）或华法林（4/31，12.9%）的患者与未服用这些药物的患者（57/470，12.1%）相比，胃肠道恶性肿瘤发生率无显著差异。53.7%的患者未发现IDA病因。
IDA患者中13.1%被诊断为癌症，11.2%被诊断为胃肠道癌症。IDA患者发生胃肠道恶性肿瘤的显著危险因素为男性、50岁以上以及就诊时血红蛋白≤9.0 g/dl。IDA不应归因于阿司匹林、非甾体抗炎药或华法林的使用。
