World Vision Cambodia, Phnom Penh, Cambodia.
J Nutr. 2012 Apr;142(4):781-7. doi: 10.3945/jn.111.148189. Epub 2012 Feb 29.
In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α(1)-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.
在柬埔寨，许多因素可能会使缺铁的检测变得复杂。在一项横断面研究中，我们评估了遗传血红蛋白（Hb）异常、缺铁、维生素 A 缺乏、感染和其他因素对柬埔寨年轻儿童 Hb 的影响。从 3 个农村省份和金边市选择了 6 至 59 月龄的儿童（n=3124），收集了有关社会人口统计学状况、发病率和生长的数据。采集了血样（n=2695）进行全血细胞计数、Hb 类型（通过 DNA 分析）、铁蛋白、可溶性转铁蛋白受体（sTfR）、视黄醇结合蛋白（RBP）、C 反应蛋白和α(1)-酸性糖蛋白（AGP）。农村省份的遗传 Hb 异常、贫血和维生素 A 缺乏的发生率高于城市省份（P<0.001）：分别为 60.0%和 40.0%、58.2%和 32.7%、7.4%和 3.1%。Hb 的主要决定因素是年龄组、Hb 类型、铁蛋白、sTfR、RBP、AGP>1.0 g/L（P<0.001）和农村环境（P<0.05）。年龄组、Hb 类型、RBP、升高的 AGP 和农村环境也影响铁蛋白和 sTfR（P<0.02）。多种因素影响贫血状态，包括以下因素：6-11.99 月龄（OR：6.1；95%CI：4.3，8.7）和 12-23.99 月龄（OR：2.7；95%CI：2.1，3.6）；Hb 类型，尤其是 Hb EE（OR：18.5；95%CI：8.5，40.4）；铁蛋白低（OR：3.2；95%CI：2.2，4.7）；AGP 升高（OR：1.4；95%CI：1.2，1.7）；农村环境（OR：2.3；95%CI：1.7，3.1）；RBP 低（OR：3.6；95%CI：2.2，5.9）；和 sTfR 升高（OR：2.1；95%CI：1.7，2.7）。在柬埔寨，遗传 Hb 异常的患病率很高，铁蛋白和 sTfR 对评估缺铁的患病率的作用有限。迫切需要新的低成本方法来检测遗传 Hb 异常。
