Stevens R G, Jones D Y, Micozzi M S, Taylor P R
Battelle, Pacific Northwest Laboratories, Richland, Wash. 99352.
N Engl J Med. 1988 Oct 20;319(16):1047-52. doi: 10.1056/NEJM198810203191603.
Because of evidence that increased body iron stores are associated with an increased risk of cancer, we examined iron status and cancer risk in the first National Health and Nutrition Examination Survey, a survey of more than 14,000 adults begun in 1971, with follow-up between 1981 and 1984. Among 242 men in whom cancer developed, the mean total iron-binding capacity was significantly lower (61.4 vs. 62.9 mumol per liter; P = 0.01) and transferrin saturation was significantly higher (33.1 vs. 30.7 percent; P = 0.002) than among 3113 men who remained free of cancer. The risk of cancer in men in each quartile of transferrin-saturation level relative to the lowest quartile was 1.00, 1.01, 1.10, and 1.37 (P = 0.02 for trend). The serum albumin level was significantly lower in men in whom cancer developed than in those who remained cancer-free. Among women, those in whom cancer developed did not have significantly lower total iron-binding capacity or higher transferrin saturation than those who remained cancer-free. However, a post hoc examination of 5367 women (203 with cancer) yielded a relative risk of 1.3 (95 percent confidence interval, 0.9 to 1.9) associated with a very high transferrin saturation (greater than or equal to 36.8 percent, a value in the highest quartile among men); in 5228 women with at least six years of follow-up (149 with cancer), the relative risk associated with transferrin saturation above this level was 1.5 (1.0 to 2.2). These results are consistent with the hypothesis that high body iron stores increase the risk of cancer in men. The possibility that a similar association exists in women requires further study.
由于有证据表明体内铁储存增加与癌症风险升高相关，我们在第一次全国健康和营养检查调查中研究了铁状态与癌症风险，该调查始于1971年，涉及14000多名成年人，并在1981年至1984年进行了随访。在242名患癌症的男性中，其平均总铁结合力显著较低（61.4比62.9微摩尔/升；P = 0.01），转铁蛋白饱和度显著较高（33.1%比30.7%；P = 0.002），而在3113名未患癌症的男性中则不然。转铁蛋白饱和度水平处于各四分位数的男性患癌风险相对于最低四分位数分别为1.00、1.01、1.10和1.37（趋势P = 0.02）。患癌症的男性血清白蛋白水平显著低于未患癌症的男性。在女性中，患癌症的女性与未患癌症的女性相比，其总铁结合力没有显著降低，转铁蛋白饱和度也没有显著升高。然而，对5367名女性（203名患癌症）进行的事后检查显示，转铁蛋白饱和度非常高（大于或等于36.8%，这是男性最高四分位数中的一个值）时，相对风险为1.3（95%置信区间为0.9至1.9）；在5228名至少随访6年的女性（149名患癌症）中，转铁蛋白饱和度高于此水平时的相对风险为1.5（1.0至2.2）。这些结果与体内铁储存量高会增加男性患癌风险这一假设一致。女性中是否存在类似关联需要进一步研究。
