Drakesmith Hal
Nestle Nutr Inst Workshop Ser. 2016;84:59-69. doi: 10.1159/000436955. Epub 2016 Jan 14.
Iron is needed for oxygen transport, muscle activity, mitochondrial function, DNA synthesis, and sensing of hypoxia. The hierarchical master determinant of dietary iron absorption and iron distribution within the body is the peptide hormone hepcidin. Hepcidin itself is regulated by a combination of signals derived from iron stores, inflammation, and erythropoietic expansion. Iron deficiency and iron deficiency anemia are common and important conditions that can be treated with iron preparations. However, other factors besides iron deficiency can cause anemia, especially inflammation, which responds poorly to iron treatment, and inherited disorders of red blood cells, which are associated with accumulation of excess pathogenic iron. Assessment of iron status is challenging, and indices such as serum ferritin, soluble transferrin receptor, and zinc protoporphyrin have specific weaknesses. Moreover, a diagnosis of iron deficiency or iron deficiency anemia is most useful if the diagnosis also leads to effective treatment. Low levels of hepcidin allow iron absorption and effective iron incorporation into red blood cells. The best 'biomarker' to guide treatment may therefore be the physiological 'determinant' of iron utilization. Iron is also important in transplantation medicine and influences clinical outcome of arterial pulmonary hypertension; here too, biomarkers including hepcidin may be useful to actively and beneficially manage iron status.
氧气运输、肌肉活动、线粒体功能、DNA合成以及低氧感应都需要铁。膳食铁吸收及体内铁分布的分级主要决定因素是肽激素铁调素。铁调素自身受来自铁储备、炎症及红细胞生成扩张的多种信号组合调控。缺铁和缺铁性贫血是常见且重要的病症，可用铁制剂治疗。然而，除缺铁外，其他因素也可导致贫血，尤其是炎症，其对铁治疗反应不佳，以及红细胞遗传性疾病，这些疾病与过量致病性铁的蓄积有关。铁状态评估具有挑战性，血清铁蛋白、可溶性转铁蛋白受体及锌原卟啉等指标都有特定缺陷。此外，如果诊断能导向有效治疗，那么缺铁或缺铁性贫血的诊断才最有用。低水平的铁调素可使铁吸收并有效整合到红细胞中。因此，指导治疗的最佳“生物标志物”可能是铁利用的生理“决定因素”。铁在移植医学中也很重要，并影响动脉性肺动脉高压的临床结局；在此方面，包括铁调素在内的生物标志物可能有助于积极且有益地管理铁状态。
