Jankowich Matthew, Elston Beth, Evans Samuel K, Wu Wen-Chih, Choudhary Gaurav
Vascular Research Laboratory, Providence VA Medical Center, Providence, RI, United States of America.
Department of Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America.
PLoS One. 2016 Dec 14;11(12):e0167987. doi: 10.1371/journal.pone.0167987. eCollection 2016.
Iron deficiency is prevalent in idiopathic pulmonary arterial hypertension (IPAH), but whether iron deficiency or ferritin levels are associated with pulmonary hypertension (PH) in the general population is unknown.
We performed a cross-sectional analysis of data on iron deficiency (exposure), and PH (pulmonary artery systolic pressure>40mmHg on echocardiogram) (outcome) on subjects with complete data on exposures and outcomes as well as covariates (n = 2,800) enrolled in the Jackson Heart Study, a longitudinal prospective observational cohort study of heart disease in African-Americans from Jackson, Mississippi. Iron deficiency was defined as a serum ferritin level < 15ng/mL (females); < 30ng/mL (males). We determined crude prevalence ratios (PRs) for PH in iron deficient versus non-iron deficient groups using modified Poisson regression modeling. We also analyzed the prevalence of PH by sex-specific quartiles of ferritin (Females ≤ 47ng/mL; > 47ng/mL- 95ng/mL; > 95ng/mL- 171ng/mL; > 171ng/mL; Males ≤ 110ng/mL; > 110ng/mL- 182ng/mL; > 182ng/mL- 294ng/mL; > 294ng/mL), using the same modeling technique with the lowest quartile as the referent.
Median pulmonary artery systolic pressure was 27mmHg (interquartile range 23-31mmHg) in the study cohort. 147 subjects (5.2%) had PH and 140 (5.0%) had iron deficiency. However, of the 147 subjects with PH, only 4 were also iron deficient. The crude PH PR was 0.5 (95% CI 0.2-1.4) in iron-deficiency compared to non-deficient. In analysis by quartiles of ferritin, adjusting for age and sex, there was no evidence of association with PH in quartiles 2 (PR 1.1, 95% CI 0.7-1.6), 3 (PR 0.8, 95% CI 0.5-1.3), or 4 (PR 0.8, 95% CI 0.5-1.2) compared with quartile 1 (referent group, PR 1). Further analyses of the relationship between PH and ferritin as a log-transformed continuous variable or by quartiles of serum iron showed similar results.
In the Jackson Heart Study, the prevalence of PH was similar in iron-deficient and non-iron deficient subjects. There was no evidence of association between ferritin (or serum iron) levels and PH.
Iron deficiency has been associated with IPAH, a rare disorder. However, in a large community-based sample of African-Americans, there was no evidence that iron deficiency or low iron levels were associated with PH.
缺铁在特发性肺动脉高压（IPAH）中很常见，但缺铁或铁蛋白水平与普通人群的肺动脉高压（PH）是否相关尚不清楚。
我们对参加杰克逊心脏研究的受试者的数据进行了横断面分析，该研究是一项针对密西西比州杰克逊市非裔美国人心脏病的纵向前瞻性观察队列研究，分析了缺铁（暴露因素）和PH（超声心动图显示肺动脉收缩压>40mmHg）（结果）的数据，以及暴露因素、结果和协变量（n = 2800）完整的数据。缺铁定义为血清铁蛋白水平<15ng/mL（女性）；<30ng/mL（男性）。我们使用修正的泊松回归模型确定缺铁组与非缺铁组中PH的粗患病率比（PRs）。我们还通过铁蛋白的性别特异性四分位数分析了PH的患病率（女性≤47ng/mL；>47ng/mL - 95ng/mL；>95ng/mL - 171ng/mL；>171ng/mL；男性≤110ng/mL；>110ng/mL - 182ng/mL；>182ng/mL - 294ng/mL；>294ng/mL），使用相同的建模技术，以最低四分位数作为参照组。
研究队列中肺动脉收缩压的中位数为27mmHg（四分位间距23 - 31mmHg）。147名受试者（5.2%）患有PH，140名（5.0%）缺铁。然而，在147名患有PH的受试者中，只有4名也缺铁。与非缺铁组相比，缺铁组的粗PH PR为0.5（95%CI 0.2 - 1.4）。在按铁蛋白四分位数进行的分析中，调整年龄和性别后，与第一四分位数（参照组，PR 1）相比，在第二四分位数（PR 1.1，95%CI 0.7 - 1.6）、第三四分位数（PR 0.8，95%CI 0.5 - 1.3）或第四四分位数（PR 0.8，95%CI 0.5 - 1.2）中没有证据表明与PH有关联。将铁蛋白作为对数转换的连续变量或按血清铁四分位数对PH与铁蛋白之间的关系进行的进一步分析显示了相似的结果。
在杰克逊心脏研究中，缺铁和非缺铁受试者中PH的患病率相似。没有证据表明铁蛋白（或血清铁）水平与PH之间存在关联。
缺铁与罕见疾病IPAH有关。然而，在一个基于社区的大型非裔美国人样本中，没有证据表明缺铁或低铁水平与PH有关。
