Hershko Chaim, Skikne Barry
Department of Hematology, Shaare Zedek Medical Center and Hebrew University of Jerusalem, Israel.
Semin Hematol. 2009 Oct;46(4):339-50. doi: 10.1053/j.seminhematol.2009.06.002.
The causes of iron deficiency vary significantly during different stages of life, and according to gender and socioeconomic circumstances. Although dietary iron is important, iron deficiency anemia (IDA) is mostly attributed to blood loss and may be the presenting clinical feature of occult bleeding from the gastrointestinal (GI) tract heralding underlying malignancy. Conventional GI diagnostic workup fails to establish the cause of iron deficiency in about one third of patients. However, abnormal iron absorption caused by hereditary iron-refractory iron deficiency anemia (IRIDA) or acquired disease is increasingly recognized as an important cause of unexplained iron deficiency. The recent availability of convenient, non-invasive screening methods to identify celiac disease, autoimmune atrophic gastritis and Helicobacter pylori infection has greatly facilitated the recognition of patients with these entities. Cure of previously refractory IDA by H pylori eradication provides strong evidence supporting a cause-and-effect relation. The intriguing recent observations of H pylori antibodies directed against epitopes on gastric mucosal cells in atrophic gastritis imply an autoimmune mechanism triggered by H pylori and directed against gastric parietal cells by means of antigenic mimicry. Improved understanding of the role of abnormal iron absorption in IDA has important implications for current concepts related to the pathogenesis and management of IDA.
缺铁的原因在生命的不同阶段、根据性别和社会经济状况有很大差异。尽管膳食铁很重要，但缺铁性贫血（IDA）主要归因于失血，可能是胃肠道（GI）隐匿性出血的临床表现，预示着潜在的恶性肿瘤。传统的GI诊断检查在约三分之一的患者中未能确定缺铁的原因。然而，遗传性铁难治性缺铁性贫血（IRIDA）或后天性疾病引起的铁吸收异常越来越被认为是不明原因缺铁的重要原因。最近出现的方便、非侵入性的筛查方法来识别乳糜泻、自身免疫性萎缩性胃炎和幽门螺杆菌感染，极大地促进了对这些疾病患者的识别。通过根除幽门螺杆菌治愈先前难治的IDA提供了支持因果关系的有力证据。最近有趣的观察发现，萎缩性胃炎中针对胃黏膜细胞表位的幽门螺杆菌抗体意味着由幽门螺杆菌触发并通过抗原模拟作用于胃壁细胞的自身免疫机制。对铁吸收异常在IDA中的作用的更好理解对当前与IDA发病机制和管理相关的概念具有重要意义。
