疟疾使炎症相关的铁蛋白和可溶性转铁蛋白受体升高，而对赞比亚农村儿童的缺铁和缺铁性贫血仅有适度影响。

Malaria exacerbates inflammation-associated elevation in ferritin and soluble transferrin receptor with only modest effects on iron deficiency and iron deficiency anaemia among rural Zambian children.

机构信息

Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.

Tropical Diseases Research Centre, Ndola, Zambia.

出版信息

Trop Med Int Health. 2018 Jan;23(1):53-62. doi: 10.1111/tmi.13004. Epub 2017 Nov 24.

DOI:10.1111/tmi.13004

PMID:29121448

Abstract

OBJECTIVE

In 4- to 8-year-old Zambian children (n = 744), we evaluated the effects of adjusting for inflammation (α1-acid glycoprotein >1 g/l), with or without additional adjustment for malaria, on prevalence estimates of iron deficiency (ID) and iron deficiency anaemia (IDA) during low malaria (LowM) and high malaria (HighM) transmission seasons.

METHODS

To estimate adjustment factors, children were classified as: (i) reference (malaria negative without inflammation), (ii) inflammation without malaria (I), (iii) malaria without inflammation (M) and (iv) inflammation with malaria (IM). We estimated the unadjusted ID or IDA prevalence, and then adjusted for inflammation alone (ID or IDA ) or inflammation and malaria (ID or IDA ).

RESULTS

Mean ferritin was 38 (reference), 45 (I), 43 (M) and 54 μg/l (IM) in LowM, increasing to 44, 56, 96 and 167 μg/l, respectively, in HighM. Corresponding mean sTfR was 6.4, 6.9, 7.9 and 8.4 mg/l in LowM, increasing to 8.2, 9.2. 8.7 and 9.7 mg/l in HighM. Ferritin-based ID, ID and ID were 7.8%, 8.7% or 9.1%, respectively, in LowM and 4.6%, 10.0% or 11.7%, respectively, in HighM. Corresponding soluble transferrin receptor (sTfR)-based estimates were 27.0%, 24.1% and 19.1%, respectively, in LowM, increasing to 53.6%, 46.5% and 45.3%, respectively, in HighM. Additional adjustment for malaria resulted in a ~1- to 2-percentage point change in IDA, depending on biomarker and season.

CONCLUSIONS

In this population, malaria substantially increased ferritin and sTfR concentrations, with modest effects on ID and IDA prevalence estimates.

摘要

目的

在赞比亚 4 至 8 岁儿童中（n=744），我们评估了在低疟疾（LowM）和高疟疾（HighM）传播季节，调整炎症（α1-酸性糖蛋白>1 g/L）以及是否进一步调整疟疾对缺铁（ID）和缺铁性贫血（IDA）患病率估计的影响。

方法

为了估计调整因素，儿童被分类为：（i）参考（疟疾阴性无炎症）、（ii）炎症无疟疾（I）、（iii）疟疾无炎症（M）和（iv）炎症伴疟疾（IM）。我们估计了未经调整的 ID 或 IDA 患病率，然后单独调整炎症（ID 或 IDA）或炎症和疟疾（ID 或 IDA）。

结果

在 LowM 中，平均铁蛋白为 38（参考）、45（I）、43（M）和 54μg/l（IM），在 HighM 中分别增加到 44、56、96 和 167μg/l。相应的平均可溶性转铁蛋白受体（sTfR）在 LowM 中分别为 6.4、6.9、7.9 和 8.4mg/l，在 HighM 中分别增加到 8.2、9.2、8.7 和 9.7mg/l。基于铁蛋白的 ID、IDA 和 ID 的患病率分别为 7.8%、8.7%或 9.1%，在 LowM 中，分别为 4.6%、10.0%或 11.7%，在 HighM 中。相应的可溶性转铁蛋白受体（sTfR）估计值分别为 27.0%、24.1%和 19.1%，在 LowM 中，在 HighM 中分别增加到 53.6%、46.5%和 45.3%。进一步调整疟疾使 IDA 的患病率估计值增加了约 1-2 个百分点，具体取决于生物标志物和季节。