Department of Pediatrics, University Medical Center Groningen, The Netherlands.
J Pediatr Gastroenterol Nutr. 2010 Dec;51(6):708-13. doi: 10.1097/MPG.0b013e3181da4d8b.
Allowing children with inflammatory bowel disease (IBD) to live with subnormal hemoglobin (Hb) levels affects their quality of life. The therapeutic approach to normalize Hb varies according to the cause of IBD-associated anemia. In exclusive iron-deficiency anemia (IDA) repletion of iron stores is obligatory, whereas controlling inflammation is the treatment of choice for anemia of chronic disease (ACD). In daily practice the focus is on control of intestinal inflammation, and spontaneous hematological recovery is awaited. The aim of the present study was to evaluate the hematological effect of "expectant management" on newly diagnosed pediatric patients with IBD with anemia.
Medical records of children with IBD were reviewed. Study endpoints were the difference in Hb from the moment of IBD diagnosis (T0) to the end of the induction phase (T1), and time until normalization of Hb, stratified for the type of anemia at T0.
A total of 103 children were included in the study, of whom 80 (78%) had anemia at T0. Exclusive IDA was found in 58% of them. Expectant management caused a modest increase in Hb between T0 and T1 for both types of anemia (IDA 0.4 mmol/L; ACD 0.5 mmol/L), but 65 of 80 children (81%) still had anemia at T1. The proportion of children with exclusive IDA had increased to 74%. One third of the cases initially classified as having ACD had progressed to exclusive IDA. There was no significant difference in time until normalization of Hb between children with exclusive IDA and ACD. Twelve months after IBD diagnosis 24% of the group initially diagnosed as having exclusive IDA and 50% of the ACD group were still anemic.
Hematological recovery in children with IBD-associated anemia is slow with expectant management, regardless of the type of anemia at T0. Present results underline the need for a more active approach to improve Hb.
允许炎症性肠病（IBD）患儿的血红蛋白（Hb）水平处于亚正常状态会影响其生活质量。纠正 Hb 水平的治疗方法因 IBD 相关贫血的病因而异。在单纯缺铁性贫血（IDA）中，补充铁储备是必需的，而控制炎症是治疗慢性病贫血（ACD）的首选方法。在日常实践中，重点是控制肠道炎症，并等待自发性血液学恢复。本研究旨在评估“期待治疗”对新诊断为 IBD 伴贫血的儿科患者的血液学影响。
回顾了患有 IBD 的儿童的病历。研究终点是从 IBD 诊断时（T0）到诱导期结束时（T1）Hb 的差异，以及根据 T0 时的贫血类型分层的 Hb 正常化时间。
共有 103 名儿童纳入研究，其中 80 名（78%）在 T0 时存在贫血。他们中 58%存在单纯 IDA。期待治疗导致两种类型的贫血在 T0 和 T1 之间 Hb 适度增加（IDA 0.4mmol/L；ACD 0.5mmol/L），但 80 名儿童中有 65 名（81%）在 T1 时仍存在贫血。单纯 IDA 的儿童比例增加到 74%。最初归类为 ACD 的病例中有三分之一进展为单纯 IDA。单纯 IDA 和 ACD 患儿的 Hb 正常化时间无显著差异。在 IBD 诊断后 12 个月，最初诊断为单纯 IDA 的患儿中有 24%和 ACD 组中有 50%仍存在贫血。
无论 T0 时的贫血类型如何，采用期待治疗方法，IBD 相关贫血儿童的血液学恢复都较为缓慢。目前的结果强调需要采取更积极的方法来提高 Hb 水平。
