McDermid Joann M, Jaye Assan, Schim van der Loeff Maarten F, Todd Jim, Bates Chris, Austin Steve, Jeffries David, Awasana Akum A, Whittlex Akum A, Prentice Andrew
Medical Research Council International Nutrition Group, Nutrition and Public Health Intervention Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, England, WC1E 7HT.
J Acquir Immune Defic Syndr. 2007 Dec 1;46(4):498-507. doi: 10.1097/qai.0b013e31815b2d4b.
To comprehensively assess iron status and determine whether elevated iron status, like anemia, predicts mortality.
We followed 1362 Gambian adults (53% female) in an HIV-seroprevalent clinic-based cohort over 11.5 years to ascertain all-cause mortality. Baseline iron status (iron, soluble transferrin receptor [sTfR], transferrin, ferritin, transferrin saturation, log [transferrin receptor: ferritin]), age, gender, ethnicity, hemoglobin, body mass index, HIV type, absolute CD4 count, malaria status, and [alpha]-(1)-antichymotrypsin were measured.
The mortality rate was 25.9/100 person-years. Elevated iron universally predicted greater mortality compared to normal iron status for all iron status indices, with the exception of sTfR in unadjusted models. In fully adjusted models, transferrin (elevated vs. normal, hazard ratio [HR]: 1.77; 95% confidence interval [CI]: 1.30 to 2.42; P < 0.001), ferritin (elevated vs. normal, HR: 1.40; 95% CI: 1.07 to 1.83; P = 0.014), and the combined iron status index (highly elevated vs. normal, HR: 2.20; 95% CI: 1.16 to 4.18; P = 0.016) remained significant predictors. As expected, hemoglobin (Hb) concentration and absolute CD4 counts were each inversely associated with mortality.
Elevated iron status predicts mortality in HIV infection, even after adjustment for immunosuppression and other confounders. This finding has implications in the clinical monitoring of disease progression and for iron-supplementation practices in areas of high HIV prevalence.
全面评估铁状态，并确定铁状态升高是否像贫血一样可预测死亡率。
我们在一个以诊所为基础的、HIV血清阳性的队列中对1362名冈比亚成年人（53%为女性）进行了11.5年的随访，以确定全因死亡率。测量了基线铁状态（铁、可溶性转铁蛋白受体[sTfR]、转铁蛋白、铁蛋白、转铁蛋白饱和度、log[转铁蛋白受体：铁蛋白]）、年龄、性别、种族、血红蛋白、体重指数、HIV类型、绝对CD4细胞计数、疟疾状态和α-（1）-抗胰凝乳蛋白酶。
死亡率为25.9/100人年。除未调整模型中的sTfR外，所有铁状态指标中，与正常铁状态相比，铁状态升高普遍预示着更高的死亡率。在完全调整模型中，转铁蛋白（升高与正常相比，风险比[HR]：1.77；95%置信区间[CI]：1.30至2.42；P<0.001）、铁蛋白（升高与正常相比，HR：1.40；95%CI：1.07至1.83；P=0.014）以及综合铁状态指数（高度升高与正常相比，HR：2.20；95%CI：1.16至4.18；P=0.016）仍然是显著的预测因素。正如预期的那样，血红蛋白（Hb）浓度和绝对CD4细胞计数均与死亡率呈负相关。
即使在调整了免疫抑制和其他混杂因素后，铁状态升高仍可预测HIV感染中的死亡率。这一发现对疾病进展的临床监测以及HIV高流行地区的铁补充实践具有重要意义。
