成人输血依赖型β地中海贫血中铁负荷与CD4之间的相关性

Correlations between Iron Load and CD4 in Adult Transfusion-Dependent Beta Thalassemia.

作者信息

Atmakusuma Tubagus Djumhana, Girson Ralph, Koesnoe Sukamto

机构信息

Division of Hematology-Medical Oncology, Department of Internal Medicine Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Kota Depok, Indonesia.

Division of Allergy-Immunology, Department of Internal Medicine. Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Kota Depok, Indonesia.

出版信息

Anemia. 2021 Jun 17;2021:5549503. doi: 10.1155/2021/5549503. eCollection 2021.

DOI:10.1155/2021/5549503

PMID:34239727

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8233081/

Abstract

BACKGROUND

Thalassemia is a hereditary disease, and severe anemia is the main phenotype of major thalassemia. Furthermore, the most important method in the management of this disease is red blood cell transfusion. Regular transfusions administered 1 or 2 times every month improve prognosis and survival. However, there is higher risk of infections and iron overload, especially in transfusion-dependent thalassemia (TDT). Infections are the second leading cause of death in adult TDT, after heart failure. Higher risk of infection is also influenced by multiple blood transfusions which causes alteration in immune response due to alloimmunization, transfusion-related infections, and iron overload. Meanwhile, iron overload in TDT alters both innate and specific immune responses. Furthermore, previous studies have shown the correlation between ferritin with CD4, but this has not been carried out in Indonesia. Therefore, this study aims to determine the correlations between iron overload (serum ferritin and transferrin saturation) and specific immune cells (CD4).

METHODS

This is a cross-sectional study, and a total number of 64 subjects were examined consecutively. Chest X-ray and blood sera were obtained. The total number of subjects was 64. The seromarkers HBsAg, anti-HCV, and anti-HIV were tested using the ELISA method. Serum ferritin and transferrin saturation was tested using ECLIA, and lymphocyte subsets were analyzed using flowcytometry. Meanwhile, the correlation between variables was determined using Spearman's test.

RESULTS

The results showed that 4.9% subjects were HBsAg positive, 10.7% were anti-HCV positive, and none were anti-HIV positive. There were 4 subjects with lung tuberculosis based on the 41 chest X-ray. Meanwhile, there was a weak negative and insignificant correlation between serum ferritin with CD4 (=0.75; = -0.04) and a weak positive and insignificant correlation between transferrin saturation with CD4 (=0.133; 0.19).

CONCLUSION

There were no correlations between iron overload (ferritin) and cellular immunity (CD4) in adult transfusion-dependent thalassemia.

摘要

背景

地中海贫血是一种遗传性疾病，重度贫血是重型地中海贫血的主要表型。此外，该病治疗的最重要方法是红细胞输血。每月进行1或2次定期输血可改善预后和生存率。然而，感染和铁过载的风险较高，尤其是在依赖输血的地中海贫血（TDT）患者中。感染是成年TDT患者仅次于心力衰竭的第二大死亡原因。多次输血导致的感染风险增加，这是由于同种免疫、输血相关感染和铁过载引起的免疫反应改变所致。同时，TDT中的铁过载会改变先天性和特异性免疫反应。此外，先前的研究表明铁蛋白与CD4之间存在相关性，但在印度尼西亚尚未开展此类研究。因此，本研究旨在确定铁过载（血清铁蛋白和转铁蛋白饱和度）与特异性免疫细胞（CD4）之间的相关性。

方法

这是一项横断面研究，连续检查了64名受试者。获取胸部X线片和血样。受试者总数为64名。采用酶联免疫吸附测定（ELISA）法检测血清标志物乙肝表面抗原（HBsAg）、抗丙型肝炎病毒（抗-HCV）和抗人类免疫缺陷病毒（抗-HIV）。采用电化学发光免疫分析（ECLIA）法检测血清铁蛋白和转铁蛋白饱和度，采用流式细胞术分析淋巴细胞亚群。同时，使用Spearman检验确定变量之间的相关性。

结果

结果显示，4.9%的受试者HBsAg呈阳性，10.7%的受试者抗-HCV呈阳性，无一例抗-HIV呈阳性。根据41份胸部X线片，有4名受试者患有肺结核。同时，血清铁蛋白与CD4之间存在微弱的负相关且无统计学意义（=0.75； = -0.04），转铁蛋白饱和度与CD4之间存在微弱的正相关且无统计学意义（=0.133； 0.19）。