Barton James C, Barton J Clayborn, Bertoli Luigi F
Southern Iron Disorders Center, Birmingham, Alabama, USA.
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
BMC Blood Disord. 2010 Dec 22;10:9. doi: 10.1186/1471-2326-10-9.
There are many descriptions of the association of pica with iron deficiency in adults, but there are few reports in which observations available at diagnosis of iron deficiency were analyzed using multivariable techniques to identify significant predictors of pica. We sought to identify clinical and laboratory correlates of pica in adults with iron deficiency or depletion using univariable and stepwise forward logistic regression analyses.
We reviewed charts of 262 non-pregnant adult outpatients (ages ≥18 y) who required treatment with intravenous iron dextran. We tabulated their sex, age, race/ethnicity, body mass index, symptoms and causes of iron deficiency or depletion, serum iron and complete blood count measures, and other conditions at diagnosis before intravenous iron dextran was administered. We excluded patients with serum creatinine >133 μmol/L or disorders that could affect erythrocyte or iron measures. Iron deficiency was defined as both SF <45 pmol/L and TS <10%. Iron depletion was defined as serum ferritin (SF) <112 pmol/L. We performed univariable comparisons and stepwise forward logistic regression analyses to identify significant correlates of pica.
There were 230 women (184 white, 46 black; ages 19-91 y) and 32 men (31 white, 1 black; ages 24-81 y). 118 patients (45.0%) reported pica; of these, 87.3% reported ice pica (pagophagia). In univariable analyses, patients with pica had lower mean age, black race/ethnicity, and higher prevalences of cardiopulmonary and epithelial manifestations. The prevalence of iron deficiency, with or without anemia, did not differ significantly between patients with and without pica reports. Mean hemoglobin and mean corpuscular volume (MCV) were lower and mean red blood cell distribution width (RDW) and platelet count were higher in patients with pica. Thrombocytosis occurred only in women and was more prevalent in those with pica (20.4% vs. 8.3%; p = 0.0050). Mean total iron-binding capacity was higher and mean serum ferritin was lower in patients with pica. Nineteen patients developed a second episode of iron deficiency or depletion; concordance of recurrent pica (or absence of pica) was 95%. Predictors of pica in logistic regression analyses were age and MCV (negative associations; p = 0.0250 and 0.0018, respectively) and RDW and platelet count (positive associations; p = 0.0009 and 0.02215, respectively); the odds ratios of these predictors were low.
In non-pregnant adult patients with iron deficiency or depletion, lower age is a significant predictor of pica. Patients with pica have lower MCV, higher RDW, and higher platelet counts than patients without pica.
关于异食癖与成人缺铁之间的关联已有诸多描述，但很少有报告使用多变量技术分析缺铁诊断时可获得的观察结果，以确定异食癖的显著预测因素。我们试图通过单变量和逐步向前逻辑回归分析，确定缺铁或铁耗竭成人中异食癖的临床和实验室相关因素。
我们回顾了262名需要接受右旋糖酐铁静脉治疗的非妊娠成年门诊患者（年龄≥18岁）的病历。在给予右旋糖酐铁静脉治疗前，我们将他们的性别、年龄、种族/族裔、体重指数、缺铁或铁耗竭的症状和原因、血清铁和全血细胞计数指标以及诊断时的其他情况制成表格。我们排除了血清肌酐>133μmol/L或可能影响红细胞或铁指标的疾病患者。缺铁定义为血清铁蛋白（SF）<45pmol/L且转铁饱和度（TS）<10%。铁耗竭定义为血清铁蛋白（SF）<112pmol/L。我们进行了单变量比较和逐步向前逻辑回归分析，以确定异食癖的显著相关因素。
有230名女性（184名白人，46名黑人；年龄19 - 91岁）和32名男性（31名白人，1名黑人；年龄24 - 81岁）。118名患者（45.0%）报告有异食癖；其中，87.3%报告有食冰癖（嗜冰症）。在单变量分析中，有异食癖的患者平均年龄较低、为黑人种族/族裔，心肺和上皮表现的患病率较高。有无异食癖报告的患者中，缺铁（无论有无贫血）的患病率无显著差异。有异食癖的患者平均血红蛋白和平均红细胞体积（MCV）较低，平均红细胞分布宽度（RDW）和血小板计数较高。血小板增多仅发生在女性中，且在有异食癖的女性中更常见（20.4%对8.3%；p = 0.0050）。有异食癖的患者平均总铁结合力较高，平均血清铁蛋白较低。19名患者出现了第二次缺铁或铁耗竭发作；复发性异食癖（或无异食癖）的一致性为95%。逻辑回归分析中异食癖的预测因素为年龄和MCV（负相关；分别为p = 0.0250和0.0018）以及RDW和血小板计数（正相关；分别为p = 0.0009和0.02215）；这些预测因素的优势比很低。
在缺铁或铁耗竭的非妊娠成年患者中，年龄较低是异食癖的显著预测因素。有异食癖的患者比无异食癖的患者MCV更低、RDW更高且血小板计数更高。
