Martínez-Quintana Efrén, Rodríguez-González Fayna
Cardiology Service, Insular-Materno Infantil University Hospital, Las Palmas de Gran Canaria, Spain.
Congenit Heart Dis. 2013 Mar-Apr;8(2):117-23. doi: 10.1111/j.1747-0803.2012.00708.x. Epub 2012 Aug 14.
Iron deficiency anemia is the most common single cause of anemia worldwide. The purpose of our study was to estimate the prevalence of anemia in adult congenital heart disease (ACHD) patients, compare different hematology parameters between hypoxemic and nonhypoxemic ACHD patients, and determine which parameters detect iron deficiency anemia in hypoxemic ACHD patients.
ACHD patients were studied and blood samples collected for determination of hemoglobin, derived red cell indices, serum iron, apoferritin, total iron-binding capacity, transferrin saturation index, C-reactive protein (CRP), and N-terminal proB-type natriuretic peptide (NT-proBNP) levels.
Two hundred seventy-eight ACHD patients, mean age 31.6 ± 14.3 years old, were studied. One hundred sixty-seven (60%) patients were male. Two hundred forty-five patients were nonhypoxemic and 33 patients were hypoxemic. Hypoxemic ACHD patients had significant higher hemoglobin concentration (g/dL) (17.5 ± 3.5 vs. 14.6 ± 1.7, P <.001), red cell distribution width (RDW) (%) (17.0 ± 3.3 vs. 14.1 ± 7.6, P <.034), apoferritin (ng/mL) (19.8 [4.1-147.2] vs. 38.0 [6.7-191.2], P =.019), CRP (mg/dL) (0.50 [0.0-3.8] vs. 0.12 [0.0-1.4], P <.001), and NT-proBNP (pg/mL) (409.3 [33.3-9830.8] vs. 5.2 [0.0-1068.4], P <.001) levels than nonhypoxemic ACHD patients. Serum iron, total iron-binding capacity, and transferrin saturation index were not statistically significant between hypoxemic and nonhypoxemic ACHD patients. In the hypoxemic group, 15 (45%) patients had apoferritin levels <20 ng/mL and eight (24%) patients developed microcytosis and hypochromia. A RDW above the normal range (>14.5%) in hypoxemic ACHD patients allowed the detection of an apoferritin level <20 ng/mL with a sensitivity of 93%.
RDW seems to be a useful and economic tool to detect low serum apoferritin levels in hypoxemic ACHD patients.
缺铁性贫血是全球范围内贫血最常见的单一病因。我们研究的目的是评估成人先天性心脏病（ACHD）患者贫血的患病率，比较低氧血症和非低氧血症ACHD患者之间不同的血液学参数，并确定哪些参数可检测低氧血症ACHD患者的缺铁性贫血。
对ACHD患者进行研究并采集血样，以测定血红蛋白、衍生红细胞指数、血清铁、脱铁铁蛋白、总铁结合力、转铁蛋白饱和度指数、C反应蛋白（CRP）和N末端B型利钠肽原（NT-proBNP）水平。
研究了278例ACHD患者，平均年龄31.6±14.3岁。167例（60%）患者为男性。245例患者无低氧血症，33例患者有低氧血症。低氧血症ACHD患者的血红蛋白浓度（g/dL）（17.5±3.5对14.6±1.7，P<.001）、红细胞分布宽度（RDW）（%）（17.0±3.3对14.1±7.6，P<.034）、脱铁铁蛋白（ng/mL）（19.8[4.1 - 147.2]对38.0[6.7 - 191.2]，P =.019）、CRP（mg/dL）（0.50[0.0 - 3.8]对0.12[0.0 - 1.4]，P<.001）和NT-proBNP（pg/mL）（409.3[33.3 - 9830.8]对5.2[0.0 - 1068.4]，P<.001）水平显著高于非低氧血症ACHD患者。低氧血症和非低氧血症ACHD患者之间的血清铁、总铁结合力和转铁蛋白饱和度指数无统计学差异。在低氧血症组中，15例（45%）患者的脱铁铁蛋白水平<20 ng/mL，8例（24%）患者出现小红细胞症和低色素性。低氧血症ACHD患者中RDW高于正常范围（>14.5%）可检测到脱铁铁蛋白水平<20 ng/mL，敏感性为93%。
RDW似乎是检测低氧血症ACHD患者低血清脱铁铁蛋白水平有用且经济的工具。
