Przybylowski P, Wasilewski G, Golabek K, Bachorzewska-Gajewska H, Dobrzycki S, Koc-Zorawska E, Malyszko J
Department of Cardiac Surgery and Transplantology, Collegium Medicum, Jagiellonian University, Cracow, Poland.
Department of Cardiac Surgery and Transplantology, Collegium Medicum, Jagiellonian University, Cracow, Poland.
Transplant Proc. 2016 Jan-Feb;48(1):173-6. doi: 10.1016/j.transproceed.2015.12.023.
Anemia is relatively common in patients with heart failure and heart transplant recipients. Both absolute and functional iron deficiency may contribute to the anemia in these populations. Functional iron deficiency (defined as ferritin greater than 200 ng/mL with TSAT (Transferrin saturation) less than 20%) is characterized by the presence of adequate iron stores as defined by conventional criteria, but with insufficient iron mobilization to adequately support. The aim of this study was to determine prevalence of absolute and functional iron deficiency in patients with heart failure (n = 269) and after heart transplantation (n = 130) and their relation to parameters of iron status and inflammation.
Iron status, complete blood count, and creatinine levels were assessed using standard laboratory methods. C-reactive protein, hepcidin and hemojuvelin were measured using commercially available kits.
Absolute iron deficiency was present in 15% of patients with heart failure and 30% in heart transplant recipients, whereas functional iron deficiency was present in 18% of patients with heart failure and 17% in heart transplant recipients. Functional iron deficiency was associated with significantly higher C-reactive protein and hepcidin levels in heart failure patients, and higher hepcidin and lower estimate glomerular filtration rates in heart transplant recipients. Prevalence of anemia (according to the World Health Organization) was significantly higher in heart transplant recipients (40% vs 22%, P < .001), they were also younger, but with worse kidney function than patients with heart failure.
Both absolute and functional iron deficiency were present in a considerable group of patients. This population should be carefully screened for possible reversible causes of inflammation.
贫血在心力衰竭患者和心脏移植受者中相对常见。绝对铁缺乏和功能性铁缺乏都可能导致这些人群出现贫血。功能性铁缺乏（定义为铁蛋白大于200 ng/mL且转铁蛋白饱和度（TSAT）小于20%）的特征是按照传统标准存在充足的铁储备，但铁动员不足，无法提供充分支持。本研究的目的是确定心力衰竭患者（n = 269）和心脏移植后患者（n = 130）中绝对铁缺乏和功能性铁缺乏的患病率，以及它们与铁状态和炎症参数的关系。
使用标准实验室方法评估铁状态、全血细胞计数和肌酐水平。使用市售试剂盒测量C反应蛋白、铁调素和血色素沉着蛋白。
15%的心力衰竭患者和30%的心脏移植受者存在绝对铁缺乏，而18%的心力衰竭患者和17%的心脏移植受者存在功能性铁缺乏。在心力衰竭患者中，功能性铁缺乏与显著更高的C反应蛋白和铁调素水平相关，在心脏移植受者中与更高的铁调素水平和更低的估计肾小球滤过率相关。心脏移植受者中贫血（根据世界卫生组织标准）的患病率显著更高（40%对22%，P <.001），他们也更年轻，但肾功能比心力衰竭患者更差。
相当一部分患者同时存在绝对铁缺乏和功能性铁缺乏。应对这一人群仔细筛查可能导致炎症的可逆原因。
