铁负荷、饮酒与死亡率：一项前瞻性研究。
Iron loading, alcohol and mortality: A prospective study.
机构信息
Department of Medical Science and Public Health, Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
出版信息
Clin Nutr. 2019 Jun;38(3):1262-1268. doi: 10.1016/j.clnu.2018.05.008. Epub 2018 May 16.
BACKGROUND & AIMS: The relationship between total body iron and cardiovascular disease remains controversial and information absent in black sub-Saharan Africans in whom alcohol consumption tends to be high. The level of total body iron is tightly regulated, however this regulation is compromised by high alcohol intake causing iron loading. The aim of this study is to investigate total body iron, as represented by serum ferritin, and its interaction with measures of alcohol intake in predicting all-cause and cardiovascular mortality.
METHODS
We followed health outcomes for a median of 9.22 years in 877 randomly selected HIV negative African women (mean age: 50.4 years).
RESULTS
One hundred and five deaths occurred of which 40 were cardiovascular related. Ferritin averaged 84.0 (5th to 95th percentile interval, 7.5-533.3) ng/ml and due to the augmenting effect of inflammation, lowered to 75.3 (6.9-523.2) ng/ml after excluding 271 participants with high-sensitivity C-reactive protein (CRP) levels (above 8 mg/l). CRP increased by quartiles of ferritin in the total group (P trend = 0.002), but this relationship was absent after excluding the 271 participants with high CRP values (P trend = 0.10). Ferritin, gamma-glutamyl transferase and carbohydrate deficient transferrin (all P < 0.0001) were higher in drinkers compared to non-drinkers, but CRP was similar (P = 0.77). In multivariable-adjusted analyses, ferritin predicted both all-cause (hazard ratio, 2.08; 95% confidence interval, 1.62-2.68; P < 0.0001) and cardiovascular (1.94; 1.29-2.92; P = 0.002) mortality. In participants with CRP levels below or equal to 8 mg/l, the significant relationship remained between ferritin and all-cause (2.51; 1.81-3.49; P < 0.0001) and cardiovascular mortality (2.34; 1.45-3.76; P = 0.0005). In fully adjusted models, interactions existed between ferritin and gamma-glutamyl transferase, self-reported alcohol use and carbohydrate deficient transferrin in predicting all-cause (P ≤ 0.012) and cardiovascular mortality (P ≤ 0.003).
CONCLUSIONS
Iron loading in African women predicted all-cause and cardiovascular mortality and the intake of alcohol seems mechanistically implicated.
背景与目的
铁总量与心血管疾病之间的关系仍存在争议，在铁总量易升高的撒哈拉以南非洲黑人中，缺乏相关信息。铁总量受到严格的调控，但大量饮酒会导致铁过载，从而破坏这种调控。本研究的目的是调查铁总量（以血清铁蛋白表示）及其与饮酒量指标之间的关系，以预测全因和心血管死亡率。
方法
我们对 877 名随机选择的 HIV 阴性非洲女性（平均年龄：50.4 岁）进行了中位 9.22 年的健康结局随访。
结果
共发生 105 例死亡，其中 40 例与心血管疾病相关。铁蛋白平均为 84.0（5 至 95 百分位区间为 7.5-533.3）ng/ml，但由于炎症的增强作用，在排除 271 名高敏 C 反应蛋白（CRP）水平（高于 8 mg/l）的参与者后，铁蛋白降低至 75.3（6.9-523.2）ng/ml。在总人群中，CRP 随铁蛋白四分位数增加（趋势 P 值=0.002），但在排除 271 名 CRP 值高的参与者后，这种关系不存在（趋势 P 值=0.10）。与非饮酒者相比，饮酒者的铁蛋白、γ-谷氨酰转移酶和糖缺失转铁蛋白（均 P<0.0001）均升高，但 CRP 相似（P=0.77）。在多变量调整分析中，铁蛋白预测了全因（危险比，2.08；95%置信区间，1.62-2.68；P<0.0001）和心血管（1.94；1.29-2.92；P=0.002）死亡率。在 CRP 水平低于或等于 8 mg/l 的参与者中，铁蛋白与全因（2.51；1.81-3.49；P<0.0001）和心血管死亡率（2.34；1.45-3.76；P=0.0005）之间仍存在显著关系。在完全调整的模型中，铁蛋白与 γ-谷氨酰转移酶、自我报告的饮酒量和糖缺失转铁蛋白之间存在交互作用，可预测全因（P≤0.012）和心血管死亡率（P≤0.003）。
结论
非洲女性的铁过载可预测全因和心血管死亡率，饮酒似乎是其发病机制的一部分。
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