Careaga María, Moizé Violeta, Flores Lílliam, Deulofeu Ramon, Andreu Alba, Vidal Josep
Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain.
Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
Surg Obes Relat Dis. 2015 Jul-Aug;11(4):906-11. doi: 10.1016/j.soard.2014.09.028. Epub 2014 Oct 13.
Iron homeostasis is disturbed by the systemic inflammation commonly encountered in morbid obesity. However, inflammatory markers have seldom been considered in studies investigating the prevalence of iron deficiency (ID) in bariatric surgery (BS) candidates. The objective of this study was to evaluate the prevalence of ID and anemia with ID in BS candidates, accounting for inflammatory status as measured using high sensitivity C-reactive protein (hs-CRP), and to further characterize indices of iron status in BS candidates with systemic inflammation.
On the basis of ferritin, hemoglobin, and hs-CRP levels, iron status was categorized in 803 (85%) of 947 consecutive BS candidates. Ferritin<12 ng/mL in females and<15 ng/mL in males irrespective of hs-CRP level was classified as absolute-ID, whereas ferritin between those thresholds and 100 ng/mL was categorized as functional-ID (FID) if hs-CRP>3 mg/L. Anemia was defined as hemoglobin<12 or<13 g/dL in females and males, respectively. Additional iron and hematological indices were assessed in patients with FID.
Prevalence of absolute- and functional-ID was 8.7 and 52.5%, respectively. Anemia was found in 11.2% of the cohort, 80% of which were associated with ID. Among patients with FID, transferrin saturation (T-Sat)<20% was common (70.0%) and associated with larger impairment of hematological indices.
The data show that when hs-CRP as inflammatory marker and ferritin as iron index are considered, impaired iron status could be identified in approximately two thirds of BS candidates. Furthermore, T-Sat<20%, especially along with ferritin<30 ng/mL, appear to be practical cut-offs to identify patients with FID with larger iron status impairment.
病态肥胖中常见的全身炎症会扰乱铁稳态。然而，在调查减肥手术（BS）候选者缺铁（ID）患病率的研究中，很少考虑炎症标志物。本研究的目的是评估BS候选者中ID和ID性贫血的患病率，同时考虑使用高敏C反应蛋白（hs-CRP）测量的炎症状态，并进一步描述有全身炎症的BS候选者的铁状态指标。
根据铁蛋白、血红蛋白和hs-CRP水平，对947例连续的BS候选者中的803例（85%）进行铁状态分类。无论hs-CRP水平如何，女性铁蛋白<12 ng/mL且男性<15 ng/mL被分类为绝对ID，而铁蛋白在这些阈值与100 ng/mL之间且hs-CRP>3 mg/L时被分类为功能性ID（FID）。贫血定义为女性血红蛋白<12 g/dL，男性血红蛋白<13 g/dL。对FID患者评估了额外的铁和血液学指标。
绝对ID和功能性ID的患病率分别为8.7%和52.5%。该队列中11.2%的患者存在贫血，其中80%与ID相关。在FID患者中，转铁蛋白饱和度（T-Sat）<20%很常见（70.0%），并且与血液学指标的更大损害相关。
数据表明，当将hs-CRP作为炎症标志物且将铁蛋白作为铁指标考虑时，约三分之二 的BS候选者可被识别出铁状态受损。此外，T-Sat<20%，尤其是与铁蛋白<30 ng/mL同时出现时，似乎是识别铁状态损害较大的FID患者的实用切点。
