Jin Peng, Shi Jun, Li Xing-xin, Shao Ying-qi, Nie Neng, Ge Mei-li, Zhang Jing, Huang Zhen-dong, Huang Jin-bo, Zheng Yi-zhou
Institute of Hematology and Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2013 Oct;34(10):877-82. doi: 10.3760/cma.j.issn.0253-2727.2013.10.011.
To investigate the abnormalities of iron metabolism, the prevalence and risk factors of iron overload and clinical characteristics of patients with aplastic anemia (AA).
A cross-sectional study was conducted on 520 newly diagnosed AA patients.
Iron overload was observed in 66(13%) of 520 AA patients,in which a higher prevalence of iron overload was seen not only in patients with infections(19/86, 22%)than those without infections (47/434, 11%, P<0.01), but also in patients with hepatitis associated AA(HAAA) (6/22, 19%) than the idiopathic cases (60/488, 12%, P>0.05). Excluded the patients with infections and/or HAAA, 43 of 405(11%)cases had iron overload, including 14 of 248(6%) cases without history of blood transfusion and 29 of 157 patients (18%, P<0.01) with transfusion. In univariate analysis, higher levels of serum ferritin (SF), serum iron (SI) and transferrin saturation (TS) were mainly observed in adult male patients with severe AA (SAA) and significantly upward with increasing blood transfusion (P<0.01). No differences of soluble transferrin receptor (sTfR) were observed between adults and children, males and females, hepatitis and idiopathic AA. However, patients with infections had significantly lower level of sTfR (0.50 mg/L) than cases without infections (0.79 mg/L, P<0.01). The level of sTfR in SAA patients (0.70 mg/L) was only half of that in non-SAA (NSAA) (1.36 mg/L, P<0.01). Patients with increasing blood transfusion had significantly downward levels of sTfR (P<0.01). In multivariate analysis, more than 8 U blood transfusion (OR=10.52, P<0.01), adults (OR=3.48, P<0.01), males (OR=3.32, P<0.01) and infections (OR=2.09, P<0.01) were independent risk factors.
AA patients had higher iron burden and were high-risk populations occurring iron overload. The iron overload occurred in 18% of patients with blood transfusion and in 6% of patients without transfusion.
探讨再生障碍性贫血（AA）患者铁代谢异常、铁过载的发生率及危险因素和临床特征。
对520例新诊断的AA患者进行横断面研究。
520例AA患者中66例（13%）存在铁过载，其中感染患者铁过载发生率（19/86，22%）高于未感染患者（47/434，11%，P<0.01），肝炎相关性AA（HAAA）患者铁过载发生率（6/22，19%）高于特发性病例（60/488，12%，P>0.05）。排除感染和/或HAAA患者后，405例中有43例（11%）存在铁过载，其中248例未输血患者中有14例（6%），157例输血患者中有29例（18%，P<0.01）。单因素分析显示，血清铁蛋白（SF）、血清铁（SI）和转铁蛋白饱和度（TS）水平较高主要见于成年男性重型AA（SAA）患者，且随输血次数增加显著升高（P<0.01）。可溶性转铁蛋白受体（sTfR）在成人与儿童、男性与女性、肝炎相关性AA与特发性AA之间未见差异。然而，感染患者的sTfR水平（0.50 mg/L）显著低于未感染患者（0.79 mg/L，P<0.01）。SAA患者的sTfR水平（0.70 mg/L）仅为非SAA患者（NSAA）（1.36 mg/L，P<0.01）的一半。输血次数增加的患者sTfR水平显著降低（P<0.01）。多因素分析显示，输血超过8 U（OR=10.52，P<0.01）、成人（OR=3.48，P<0.01）、男性（OR=3.32，P<0.01）和感染（OR=2.09，P<0.01）是独立危险因素。
AA患者铁负荷较高，是发生铁过载的高危人群。铁过载在18%的输血患者和6%的未输血患者中出现。
