ARKOP Sp. z o.o., Kolejowa 34a, 32-332 Bukowno, Poland.
Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medicine, University of Opole, Oleska 48, 45-052 Opole, Poland.
Toxicol Appl Pharmacol. 2022 Jan 1;434:115794. doi: 10.1016/j.taap.2021.115794. Epub 2021 Nov 13.
Discrepancies are present in the findings from clinical trials evaluating a physiological role of iron status in the lead-exposed population.
The purpose of this article was to summarize the current understanding of cellular mechanisms of lead toxicity and present a comprehensive review of existing clinical trials related to associations of lead poisoning and iron status. Although an association of iron metabolism pathways that are affected by lead intoxication has been studied, there are still aspects that remain to be elucidated. The existence of additional Pb uptake pathways besides DMT1 transporter-mediated is postulated to non-specifically regulate lead absorption.
Authors performed a systematic search of PubMed, EMBASE® and Web of Science databases to identify studies that reported an association between health risks of non-organic lead that are associated with iron status markers as possible effect modifier.
There were 58 studies that met the pre-defined inclusion criteria for the systematic review. There is a strong body of evidence supporting the hypothesis that alleviated blood lead level can be correlated with a reduced body iron store and increasing the risk of anemia. This association is of a high significance in cases of a young adolescent, weaker in groups of older children and often without a statistical significance in adults.
Discrepancies in the observations may result from different specificities of lead absorption pathways in children and adults, as well as the power of the statistical tests in varying population sizes. It may be assumed that the extent of iron deficits coupled together with source, timing, and severity of lead exposure, significantly influence the correlation between these factors. Some of the intervention programs of counteracting lead poisoning by iron supplementation proved to be effective and may be a promising prevention strategy for the exposed population.
评估铁状态在铅暴露人群中的生理作用的临床试验结果存在差异。
本文旨在总结铅毒性的细胞机制的现有认识，并对现有的与铅中毒和铁状态相关的临床试验进行全面综述。虽然已经研究了受铅中毒影响的铁代谢途径的关联，但仍有一些方面需要阐明。除 DMT1 转运体介导的途径外，还假设存在其他铅摄取途径，以非特异性方式调节铅吸收。
作者对 PubMed、EMBASE®和 Web of Science 数据库进行了系统检索，以确定报告铁状态标志物与非有机铅相关健康风险之间关联的研究，作为可能的效应修饰剂。
有 58 项研究符合系统评价的预先确定纳入标准。有大量证据支持这样一种假设，即减轻血铅水平可以与减少体内铁储存和增加贫血风险相关。这种关联在青少年中意义重大，在年龄较大的儿童中较弱，在成年人中通常没有统计学意义。
观察结果的差异可能是由于儿童和成人铅吸收途径的特异性不同，以及不同人群大小的统计检验的效力不同。可以假设，铁缺乏的程度与铅暴露的来源、时间和严重程度相结合，会显著影响这些因素之间的相关性。一些通过铁补充来对抗铅中毒的干预计划已被证明是有效的，并且可能是暴露人群的一种有前途的预防策略。
