Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
J Clin Rheumatol. 2013 Sep;19(6):324-8. doi: 10.1097/RHU.0b013e31829ce01f.
A markedly elevated serum ferritin level has been associated with inflammatory conditions such as adult-onset Still's disease, systemic juvenile idiopathic arthritis, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Hyperferritinemia, however, can also be caused by a wide variety of disparate conditions, often with impressively high serum levels. The objective of this analysis was to investigate the underlying etiology of markedly elevated ferritin levels in a large group of patients treated as outpatients and inpatients in a tertiary-care medical center.
Data of all adult patients from 2008 through 2010 with at least 1 serum ferritin level greater than 1000 μg/L were reviewed. If a patient had multiple qualifying levels, the highest one was used. For each case, the most likely cause of the elevated ferritin was assessed based on the available clinical data using a simple algorithmic approach.
Six hundred twenty-seven patients were found. The average serum ferritin level was 2647 μg/L. The most frequent condition was malignancy (153/627), with iron-overload syndromes the second most common (136/627). There were 6 cases of adult-onset Still's disease, systemic juvenile idiopathic arthritis, or hemophagocytic lymphohistiocytosis/macrophage activation syndrome. The average ferritin level in these syndromes was 14242 μg/L. Seven patients appeared to have anemia of chronic inflammation, and in 5 patients, there was no clearly definable cause for hyperferritinemia.
Although extremely elevated ferritin levels may be associated with rheumatologic diseases, more often they are found in patients with other conditions such as malignancy or infection. In addition, extremely high ferritin levels can be found in patients with seemingly indolent disease or levels of chronic inflammation.
血清铁蛋白水平显著升高与成人斯蒂尔病、全身型幼年特发性关节炎和噬血细胞性淋巴组织细胞增生症/巨噬细胞活化综合征等炎症性疾病有关。然而，高血铁蛋白症也可由多种不同的疾病引起，其血清铁蛋白水平往往非常高。本分析的目的是研究在一家三级医疗中心接受门诊和住院治疗的大量患者中，显著升高的铁蛋白水平的潜在病因。
回顾了 2008 年至 2010 年间所有血清铁蛋白水平至少为 1000μg/L 的成年患者的数据。如果患者有多个符合条件的水平，则使用最高值。对于每个病例，根据可用的临床数据，使用简单的算法评估升高的铁蛋白最可能的原因。
共发现 627 例患者。平均血清铁蛋白水平为 2647μg/L。最常见的疾病是恶性肿瘤（153/627），其次是铁过载综合征（136/627）。有 6 例成人斯蒂尔病、全身型幼年特发性关节炎或噬血细胞性淋巴组织细胞增生症/巨噬细胞活化综合征。这些综合征的平均铁蛋白水平为 14242μg/L。7 例患者似乎患有慢性炎症性贫血，5 例患者的高血铁蛋白血症无明确病因。
虽然铁蛋白水平极度升高可能与风湿性疾病有关，但更常见于恶性肿瘤或感染等其他疾病的患者。此外，在看似惰性疾病或慢性炎症水平的患者中也可以发现极高的铁蛋白水平。
