Mulaw Tadele, Tariku Amare, Tsegaye Adino Tesfahun, Abebe Zegeye
1University of Gondar Specialized Hospital, Gondar, Ethiopia.
2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Hematol. 2018 Sep 21;18:29. doi: 10.1186/s12878-018-0123-2. eCollection 2018.
An individual with visceral Leishmaniasis (VL) commonly present with anemia and one of the VL treatment center in northwest Ethiopia has been recommended iron-folic acid supplementation to these patients. But there is no documented evidence whether iron-folic acid supplementation improves the hematological profile of patients. Therefore, the study aimed to assess change in hemoglobin (Hb) and its determinant factors among VL patients with and without iron-folic acid supplementation in northwest Ethiopia.
A retrospective cohort study was conducted from January 2015 to December 2016. Data were entered into Epi-Data version 3.1 and transferred to Statistical Package for Social Science (SPSS) version 20 for analysis. Independent sample T-test and linear regression were used to compare the change in Hb and identify factors associated with a change in Hb, respectively. A 95% confidence level and -values less than 0.05 were used determine statistically significant.
From a total of 602 VL patients, 299 (49.7%) were from University of Gondar hospital. The mean (±SD) change of Hb from baseline to end of treatment was 0.99(±1.64) and 1.61(±1.88) g/dl with and without iron-folate supplementation, respectively, with mean difference 0.62, 95% CI (0.34, 0.90) and a -value of < 0.0001. In multiple linear regressions, combination therapy of sodium stibogluconate-paramomycin (SSG-PM) was positively associated with a change of Hb (β [SE, p]: 0.710/0.15, < 0.0001). Whereas age (- 0.030/0.009, 0.001), nasal bleeding (- 0.261/0.123, 0.035), baseline white blood cell (- 0.139/0.044, 0.002) and hemoglobin (- 0.513/0.031, < 0.0001), end of treatment spleen size (- 0.059/0.015, < 0.0001) and iron-folic acid supplementation (- 0.574/0.163, < 0.0001) were negatively associated with change of Hb.
Iron-folic acid supplementation had a negative effect on the change of Hb. A combination therapy of SSG-PM, age, nasal bleeding, baseline white blood cells and Hb, and iron-folic acid supplementation were the determinants of change of Hb. Therefore, avoiding iron-folic acid supplementation and strengthening VL treatment with a combination of SSG-PM and, and early identification of complications is recommended for a better outcome.
内脏利什曼病（VL）患者通常伴有贫血，埃塞俄比亚西北部的一个VL治疗中心已建议对这些患者补充铁叶酸。但尚无记录证据表明补充铁叶酸是否能改善患者的血液学指标。因此，本研究旨在评估埃塞俄比亚西北部接受和未接受铁叶酸补充的VL患者血红蛋白（Hb）的变化及其决定因素。
进行了一项回顾性队列研究，时间跨度为2015年1月至2016年12月。数据录入Epi-Data 3.1版本，并转移到社会科学统计软件包（SPSS）20版本进行分析。分别使用独立样本T检验和线性回归来比较Hb的变化并确定与Hb变化相关的因素。采用95%置信水平和小于0.05的P值来确定统计学显著性。
在总共602例VL患者中，299例（49.7%）来自贡德尔大学医院。补充铁叶酸和未补充铁叶酸的患者从基线到治疗结束时Hb的平均（±标准差）变化分别为0.99（±1.64）和1.61（±1.88）g/dl，平均差异为0.62，95%置信区间（0.34，0.90），P值<0.0001。在多元线性回归中，葡萄糖酸锑钠-巴龙霉素（SSG-PM）联合治疗与Hb变化呈正相关（β[标准误，P]：0.710/0.15，<0.0001）。而年龄（-0.030/0.009，0.001）、鼻出血（-0.261/0.123，0.035）基线白细胞（-×0.1××/0.044，0.002）和血红蛋白（-0.5××/0.031，<0.0001）、治疗结束时脾脏大小（-0.059/0.015，<0.0001）和铁叶酸补充（-0.574/0.163，<0.0001）与Hb变化呈负相关。
补充铁叶酸对Hb变化有负面影响。SSG-PM联合治疗、年龄、鼻出血、基线白细胞和Hb以及铁叶酸补充是Hb变化的决定因素。因此，建议避免补充铁叶酸，加强SSG-PM联合治疗VL，并尽早识别并发症以获得更好的治疗效果。
