Rathi Vidushi, Ish Pranav, Singh Gulvir, Tiwari Mani, Goel Nitin, Gaur Shailendra Nath
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
Monaldi Arch Chest Dis. 2020 Feb 6;90(1). doi: 10.4081/monaldi.2020.1126.
Non-anemic iron deficiency has been studied in heart failure, but studies are lacking in chronic obstructive pulmonary disease (COPD). The potential clinical implications of association of iron deficiency with the severity of COPD warrant research in this direction. This was an observational, cross-sectional study on patients with COPD to compare disease severity, functional status and quality of life in non-anemic patients with COPD between two groups - iron deficient and non-iron deficient. Stable non-anemic COPD with no cause of bleeding were evaluated for serum iron levels, ferritin levels, TIBC, 6MWD, SGRQ, spirometry, and CAT questionnaire. The study patients were divided into iron replete (IR) and iron deficient (ID) groups. A total of 79 patients were studied, out of which 72 were men and seven were women. The mean age was 61.5±8.42 years. Of these, 36 (45.5%; 95% CI, 34.3-56.8%) had iron deficiency. Mean 6-minute-walk distance was significantly shorter in ID (354.28±82.4 meters vs 432.5±47.21 meters; p=0.001). A number of exacerbations in a year were more in ID group (p=0.003), and more patients in ID had at least two exacerbations of COPD within a year (p=0.001). However, the resting pO2, SaO2, and SpO2 levels did not differ significantly between the two groups (p=0.15 and p=0.52, respectively). Also, there was no significant difference in the distribution of patients of a different class of airflow limitations between the two groups. Non-anemic iron deficiency (NAID) is an ignored, yet easily correctable comorbidity in COPD. Patients with iron deficiency have a more severe grade of COPD, had lesser exercise capacity and more exacerbations in a year as compared to non-iron deficient patients. So, foraying into the avenue of iron supplementation, which has shown promising results in improving functional capacity in heart failure and pulmonary hypertension, may well lead to revolutionary changes in the treatment of COPD.
非贫血性缺铁在心力衰竭中已有研究，但在慢性阻塞性肺疾病（COPD）方面的研究尚少。缺铁与COPD严重程度之间关联的潜在临床意义值得在这一方向开展研究。这是一项针对COPD患者的观察性横断面研究，旨在比较缺铁和不缺铁的两组非贫血性COPD患者的疾病严重程度、功能状态和生活质量。对无出血原因的稳定非贫血性COPD患者进行血清铁水平、铁蛋白水平、总铁结合力（TIBC）、6分钟步行距离（6MWD）、圣乔治呼吸问卷（SGRQ）、肺量计检查和COPD评估测试（CAT）问卷评估。研究患者被分为铁充足（IR）组和缺铁（ID）组。共研究了79例患者，其中72例为男性，7例为女性。平均年龄为61.5±8.42岁。其中36例（45.5%；95%置信区间，34.3 - 56.8%）存在缺铁。ID组的平均6分钟步行距离显著缩短（354.28±82.4米 vs 432.5±47.21米；p = 0.001）。ID组一年中的急性加重次数更多（p = 0.003），且ID组中更多患者在一年内至少有两次COPD急性加重（p = 0.001）。然而，两组之间的静息动脉血氧分压（pO2）、动脉血氧饱和度（SaO2）和脉搏血氧饱和度（SpO2）水平无显著差异（分别为p = 0.15和p = 0.52）。此外，两组之间不同气流受限分级患者的分布也无显著差异。非贫血性缺铁（NAID）是COPD中一种被忽视但易于纠正的合并症。与不缺铁的患者相比，缺铁患者的COPD分级更严重，运动能力更差，一年中的急性加重次数更多。因此，探索铁补充途径，这在改善心力衰竭和肺动脉高压患者的功能能力方面已显示出有前景的结果，可能会给COPD治疗带来革命性变化。
