在柬埔寨波罗勉省农村地区，遗传性血红蛋白疾病而非缺铁是育龄妇女血红蛋白浓度的主要预测因素。

Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey Veng, Cambodia.

作者信息

Karakochuk Crystal D, Whitfield Kyly C, Barr Susan I, Lamers Yvonne, Devlin Angela M, Vercauteren Suzanne M, Kroeun Hou, Talukder Aminuzzaman, McLean Judy, Green Timothy J

机构信息

Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada;

Food, Nutrition, and Health, Departments of.

出版信息

J Nutr. 2015 Jan;145(1):134-42. doi: 10.3945/jn.114.198945. Epub 2014 Nov 19.

DOI:10.3945/jn.114.198945

PMID:25527668

Abstract

BACKGROUND

Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease.

OBJECTIVES

We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers.

METHODS

Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and α1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders.

RESULTS

Overall, 54% of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α(3.7)-thalassemia). Of the 420 nonpregnant women, 29.5% had anemia (hemoglobin <120 g/L), 2% had depleted iron stores (ferritin <15 μg/L), 19% had tissue iron deficiency (sTfR >8.3 mg/L), <3% had folate deficiency (<3 μg/L), and 1% had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2% and 1.5% in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8% (CRP >5 mg/L) and 26% (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12.

CONCLUSIONS

Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.

摘要

背景

贫血在柬埔寨女性中很常见。潜在原因包括微量营养素缺乏、遗传性血红蛋白疾病、炎症和疾病。

目的

我们旨在调查柬埔寨农村女性（18 - 45岁）贫血（血红蛋白浓度低）的相关因素，并研究血红蛋白疾病与其他铁生物标志物之间的关系。

方法

采集了450名女性的血样。进行了全血细胞计数，并分析血清和血浆中的铁蛋白、可溶性转铁蛋白受体（sTfR）、叶酸、维生素B - 12、视黄醇结合蛋白（RBP）、C反应蛋白（CRP）和α1酸性糖蛋白（AGP）。采用血红蛋白电泳和多重聚合酶链反应来确定遗传性血红蛋白疾病的患病率和类型。

结果

总体而言，54%的女性患有遗传性血红蛋白疾病，包括25种不同基因型（最常见的是血红蛋白E变异体和α(3.7)-地中海贫血）。在420名未怀孕女性中，29.5%患有贫血（血红蛋白<120 g/L），2%铁储备耗尽（铁蛋白<15 μg/L），19%存在组织缺铁（sTfR>8.3 mg/L），<3%患有叶酸缺乏（<3 μg/L），1%患有维生素B - 12缺乏（<150 pmol/L）。患有和未患有血红蛋白疾病的女性中，缺铁性贫血（IDA）的患病率分别为14.2%和1.5%。没有维生素A缺乏的生化证据（RBP<0.7 μmol/L）。非怀孕女性中，急性和慢性炎症的患病率分别为8%（CRP>5 mg/L）和26%（AGP>1 g/L）。通过使用调整后的线性回归模型，血红蛋白浓度的最强预测因素是血红蛋白E纯合子疾病和妊娠状态。其他预测因素包括另外2种杂合性状（血红蛋白E和Constant Spring）、产次、RBP、铁蛋白对数和维生素B - 12。