Department of Internal Medicine, Kliniken Essen-Mitte, University Duisburg-Essen, Essen, Germany.
BMC Med. 2012 May 30;10:54. doi: 10.1186/1741-7015-10-54.
Metabolic syndrome (METS) is an increasingly prevalent but poorly understood clinical condition characterized by insulin resistance, glucose intolerance, dyslipidemia, hypertension, and obesity. Increased oxidative stress catalyzed by accumulation of iron in excess of physiologic requirements has been implicated in the pathogenesis of METS, but the relationships between cause and effect remain uncertain. We tested the hypothesis that phlebotomy-induced reduction of body iron stores would alter the clinical presentation of METS, using a randomized trial.
In a randomized, controlled, single-blind clinical trial, 64 patients with METS were randomly assigned to iron reduction by phlebotomy (n = 33) or to a control group (n = 31), which was offered phlebotomy at the end of the study (waiting-list design). The iron-reduction patients had 300 ml of blood removed at entry and between 250 and 500 ml removed after 4 weeks, depending on ferritin levels at study entry. Primary outcomes were change in systolic blood pressure (SBP) and insulin sensitivity as measured by Homeostatic Model Assessment (HOMA) index after 6 weeks. Secondary outcomes included HbA1c, plasma glucose, blood lipids, and heart rate (HR).
SBP decreased from 148.5 ± 12.3 mmHg to 130.5 ± 11.8 mmHg in the phlebotomy group, and from 144.7 ± 14.4 mmHg to 143.8 ± 11.9 mmHg in the control group (difference -16.6 mmHg; 95% CI -20.7 to -12.5; P < 0.001). No significant effect on HOMA index was seen. With regard to secondary outcomes, blood glucose, HbA1c, low-density lipoprotein/high-density lipoprotein ratio, and HR were significantly decreased by phlebotomy. Changes in BP and HOMA index correlated with ferritin reduction.
In patients with METS, phlebotomy, with consecutive reduction of body iron stores, lowered BP and resulted in improvements in markers of cardiovascular risk and glycemic control. Blood donation may have beneficial effects for blood donors with METS.
ClinicalTrials.gov: NCT01328210 Please see related article: http://www.biomedcentral.com/1741-7015/10/53.
代谢综合征（METS）是一种日益普遍但了解甚少的临床病症，其特征为胰岛素抵抗、葡萄糖耐量异常、血脂异常、高血压和肥胖。过量的铁积累所催化的氧化应激增加与 METS 的发病机制有关，但因果关系仍不确定。我们通过一项随机试验检验了这样一个假设，即放血治疗减少体内铁储存会改变 METS 的临床表现。
在一项随机、对照、单盲临床试验中，64 名 METS 患者被随机分为放血治疗组（n=33）或对照组（n=31）。放血治疗组在入组时抽取 300ml 血液，根据入组时的铁蛋白水平，在第 4 周时抽取 250-500ml 血液。铁减少患者的主要结局是 6 周后收缩压（SBP）和胰岛素敏感性（用稳态模型评估指数 HOMA 测量）的变化。次要结局包括 HbA1c、血浆葡萄糖、血脂和心率（HR）。
放血组 SBP 从 148.5±12.3mmHg 降至 130.5±11.8mmHg，对照组从 144.7±14.4mmHg 降至 143.8±11.9mmHg（差值-16.6mmHg；95%CI-20.7 至-12.5；P<0.001）。HOMA 指数未见明显影响。关于次要结局，放血治疗可显著降低血糖、HbA1c、低密度脂蛋白/高密度脂蛋白比值和 HR。BP 和 HOMA 指数的变化与铁蛋白减少相关。
在 METS 患者中，连续减少体内铁储存可降低血压，并改善心血管风险和血糖控制的标志物。献血可能对患有 METS 的献血者有益。
ClinicalTrials.gov：NCT01328210 请参阅相关文章：http://www.biomedcentral.com/1741-7015/10/53。
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