Sogni Philippe, Buffet Catherine
Assistance publique-Hôpitaux de Paris, hôpital Cochin, université Paris-Descartes, institut Cochin, CNRS (UMR 8104), Inserm U-1016, Sorbonne Paris Cité, service d'hépatologie, 75014 Paris, France.
Presse Med. 2013 Apr;42(4 Pt 1):405-10. doi: 10.1016/j.lpm.2012.05.015. Epub 2012 Jul 12.
A hyperferritinemia has to be interpreted in relation with age and sex. The clinical evaluation begins with the interpretation of transferrine saturation which has to be controlled with a second fasting blood test. In case of high transferrine saturation associated with hyperferritinemia, HFE testing has first to be realized since the first diagnosis suspected is a HFE hemochromatosis. In case of normal transferrine saturation associated with a hyperferritinemia, the more frequent diagnosis is a metabolic syndrome, an inflammatory syndrome, a syndrome of cellular lysis or an excessive alcohol consumption. In case of HFE hemochromatosis, phlebotomy prevents complications. The goal is to obtain and to maintain a normal-low ferritin level. In case of metabolic syndrome, phlebotomy could be useful in case of high hepatic iron concentration measured with MRI or in case of on-alcoholic steato-hepatitis.
高铁蛋白血症必须结合年龄和性别来解读。临床评估始于对转铁蛋白饱和度的解读，这需要通过第二次空腹血液检测来控制。如果转铁蛋白饱和度高且伴有高铁蛋白血症，由于首先怀疑的诊断是HFE血色素沉着症，所以必须首先进行HFE检测。如果转铁蛋白饱和度正常但伴有高铁蛋白血症，最常见的诊断是代谢综合征、炎症综合征、细胞溶解综合征或过量饮酒。对于HFE血色素沉着症，放血可预防并发症。目标是获得并维持正常低水平的铁蛋白。对于代谢综合征，如果通过MRI测量的肝脏铁浓度高或患有非酒精性脂肪性肝炎，放血可能会有用。
