Olsen A, Nawiri J, Magnussen P, Krarup H, Friis H
DBL - Institute for Health Research and Development, Jaegersborg Allé 1 D, DK-2920 Charlottenlund, Denmark.
Ann Trop Med Parasitol. 2006 Apr;100(3):251-63. doi: 10.1179/136485906X91486.
In order to increase the intestinal absorption of iron whilst simultaneously minimising the side-effects and thus increasing compliance, once- or twice-weekly, instead of daily, iron supplementation has been widely recommended. In a randomized, placebo-controlled, double-blind study in western Kenya, a tablet of ferrous dextran (containing 60 mg elemental iron) or an identical-looking placebo tablet was provided twice-weekly for 12 months to each child or adult investigated. At baseline each subject had a moderately low blood concentration of haemoglobin (Hb). Initial Hb and serum ferritin (SF) concentrations were determined and each subject was tested for malarial and helminth infection and treated, if necessary, with the appropriate anthelminthic drug(s). Overall, 200 children (aged 4-15 years) and 129 adults (aged 16-63 years) completed the 12-month study. At baseline, 47.5% of the children and 58.1% of the adults were anaemic, hookworm (detected in 60.0% of the children and 69.9% of the adults) was the most common helminth infection, and malaria was endemic. The results of bivariate analyses indicated that twice-weekly iron supplementation had no significant effect on blood Hb or SF concentrations, either in the children or the adults investigated. The results were confirmed in multiple linear-regression analyses, which revealed that the predictors of the final Hb concentration in the children investigated were age and infection, after enrollment, with Ascaris lumbricoides. Gender and the serum concentration of alpha-1-antichymotrypsin (ACT) at final follow-up were predictors of the final SF concentration in the children. In adults, the predictors of the final Hb concentration were gender and HIV infection, and the predictors of the final SF concentration were age and the serum concentration of ACT at the final follow-up. Twice-weekly iron supplementation did not increase Hb or iron stores in children or adults. Since compliance appeared to be high, this lack of effect may be the result of an inadequate dose of iron or of subjects who have deficiencies in micronutrients other than iron.
为了提高铁的肠道吸收，同时尽量减少副作用，从而提高依从性，人们广泛推荐每周补充一次或两次铁剂，而非每日补充。在肯尼亚西部进行的一项随机、安慰剂对照、双盲研究中，每周两次为每位接受调查的儿童或成人提供一片右旋糖酐铁（含60毫克元素铁）或外观相同的安慰剂片，持续12个月。在基线时，每个受试者的血红蛋白（Hb）血浓度均处于中度偏低水平。测定了初始Hb和血清铁蛋白（SF）浓度，并对每个受试者进行疟疾和蠕虫感染检测，如有必要，用适当的驱虫药进行治疗。总体而言，200名儿童（4至15岁）和129名成人（16至63岁）完成了为期12个月的研究。在基线时，47.5%的儿童和58.1%的成人贫血，钩虫感染（在60.0%的儿童和69.9%的成人中检测到）是最常见的蠕虫感染，且疟疾为地方病。双变量分析结果表明，每周两次补充铁剂对所调查儿童或成人的血液Hb或SF浓度均无显著影响。多元线性回归分析证实了该结果，分析显示，在所调查儿童中，最终Hb浓度的预测因素为年龄和入组后感染蛔虫；在最终随访时，性别和α-1抗糜蛋白酶（ACT）血清浓度是儿童最终SF浓度的预测因素。在成人中，最终Hb浓度的预测因素为性别和HIV感染，最终SF浓度的预测因素为年龄和最终随访时的ACT血清浓度。每周两次补充铁剂并未增加儿童或成人的Hb或铁储备。由于依从性似乎较高，这种无效可能是铁剂量不足或受试者除铁之外还缺乏其他微量营养素所致。
