Geisinger Obesity Institute, Danville, Pennsylvania.
Geisinger Obesity Institute, Danville, Pennsylvania.
Surg Obes Relat Dis. 2020 Dec;16(12):2074-2081. doi: 10.1016/j.soard.2020.08.018. Epub 2020 Aug 27.
The near universal presence of chronic low-grade systemic inflammation among patients with severe obesity disrupts iron homeostasis and underlies the association between obesity and iron deficiency. Immune activation and inflammation result in a reduction in circulating iron and diminished iron bioavailability for erythropoiesis. Inflammation also alters blood levels of commonly measured markers of iron nutrition status, which makes the diagnosis of iron deficiency difficult and has led to new recommendations regarding laboratory markers for the diagnosis. Recent evidence using these newly recommended laboratory markers, which include levels of ferritin, C-reactive protein, and transferrin saturation, suggests that the actual prevalence of iron deficiency among candidates for metabolic surgery may be double or triple the prevalence identified by low levels of ferritin alone. Thus large numbers of surgical candidates have iron deficiency that has been heretofore largely unrecognized and inadequately treated. The assessment of iron status using the currently recommended markers in the presence of chronic inflammatory diseases and repletion of depleted stores for surgical candidates with deficiency during the preoperative period present an important opportunity for mitigating this condition in postoperative patients.
在严重肥胖症患者中，慢性低度全身炎症几乎普遍存在，破坏了铁平衡，并导致肥胖与缺铁之间存在关联。免疫激活和炎症导致循环铁减少，红细胞生成的铁生物利用度降低。炎症还会改变通常用于衡量铁营养状况的标志物的血液水平，这使得缺铁的诊断变得困难，并导致了关于诊断的实验室标志物的新建议。最近的证据使用了这些新推荐的实验室标志物，包括铁蛋白、C 反应蛋白和转铁蛋白饱和度，表明接受代谢手术的候选人中缺铁的实际患病率可能是仅通过低铁蛋白水平确定的患病率的两倍或三倍。因此，大量手术候选人存在缺铁，而这种缺铁在很大程度上尚未被认识到，也未得到充分治疗。在存在慢性炎症性疾病的情况下，使用目前推荐的标志物评估铁状态，并在术前期间为有缺铁的手术候选人补充耗尽的储存量，这为减轻术后患者的这种情况提供了一个重要机会。
