Service Médecine Interne, CHU Estaing, Clermont-Ferrand, France.
Service Hématologie, Gen-Bio, Clermont-Ferrand, France.
Eur J Clin Nutr. 2022 Jun;76(6):835-840. doi: 10.1038/s41430-021-01047-5. Epub 2021 Nov 22.
To register all symptoms reported by non-anemic menstruating women, and examine the links between these symptoms and iron status parameters available including serum ferritin (SF) in primary care.
In this cross-sectional study, we collected clinical and biological data from 780 French menstruating women aged 18-50 years. The data included an anonymous questionnaire (biometric information, physical and cognitive symptoms, reduction in physical performance, current quality of life with SF-36 questionnaire) and seven biological parameters available in primary care. We excluded women with anemia (hemoglobin < 12 g/dl) or chronic disease. Correlations were studied for 554 participants in bivariate analysis (BVA) and multivariate analysis (MVA), with adjusted odds ratio (OR). Receiver operating characteristic (ROC) curves were established for significant correlations in MVA (p < 0.05).
Among these 554 non-anemic women included, 304 (54.9%) had SF level below 50 µg/l, 103 (18.6%) had SF level below 20 µg/l, and 60 (10.8%) had SF level below 15 µg/l. Iron deficiency was significantly correlated with recent hair loss for SF ≤ 15 µg/l (OR = 2.19 with p = 0.02 in MVA) and SF ≤ 20 µg/l (OR = 2.26 with p < 0.01 in MVA). SF ≤ 20 µg/l was also correlated with limitations due to emotional problems according to SF-36 questionnaire (p = 0.01 in MVA). SF ≤ 50 µg/l was significantly correlated with restless legs syndrome (OR = 2.82 with p = 0.01 in MVA). Only one ROC curve for restless legs syndrome could suggest an optimal SF cut-off point at 39 µg/l (sensitivity 73%, specificity 61%).
We identified two symptoms significantly more reported by non-anemic iron-deficient menstruating women: recent hair loss for serum ferritin (SF) ≤ 20 µg/l and restless legs syndrome for SF ≤ 50 µg/l. Non-anemic iron deficiency may also impact their quality of life, but further investigation is needed. If one of these symptoms is reported in primary care, the possibility of a symptomatic iron deficiency cannot be ruled out, and iron supplementation should be considered.
在初级保健中登记非贫血经期妇女报告的所有症状，并检查这些症状与铁状态参数之间的联系，包括血清铁蛋白（SF）。
在这项横断面研究中，我们收集了 780 名年龄在 18-50 岁之间的法国经期妇女的临床和生物学数据。数据包括匿名问卷（生物特征信息、身体和认知症状、身体机能下降、当前生活质量采用 SF-36 问卷）和初级保健中可用的 7 种生物学参数。我们排除了贫血（血红蛋白<12g/dl）或慢性病患者。在双变量分析（BVA）和多变量分析（MVA）中对 554 名参与者进行了相关性研究，并调整了优势比（OR）。对 MVA 中具有统计学意义的相关性（p<0.05）建立了接收者操作特征（ROC）曲线。
在包括的 554 名非贫血妇女中，304 名（54.9%）SF 水平低于 50μg/l，103 名（18.6%）SF 水平低于 20μg/l，60 名（10.8%）SF 水平低于 15μg/l。铁缺乏与最近脱发（SF≤15μg/l：OR=2.19，p=0.02，MVA）和 SF≤20μg/l（OR=2.26，p<0.01，MVA）显著相关。SF≤20μg/l 也与 SF-36 问卷中因情绪问题引起的身体机能受限相关（p=0.01，MVA）。SF≤50μg/l 与不宁腿综合征显著相关（OR=2.82，p=0.01，MVA）。只有一条不宁腿综合征的 ROC 曲线提示血清铁蛋白（SF）截断值为 39μg/l 时具有最佳的敏感性（73%）和特异性（61%）。
我们发现了两个非贫血缺铁经期妇女报告的更明显症状：SF≤20μg/l 时近期脱发和 SF≤50μg/l 时不宁腿综合征。非贫血缺铁也可能影响她们的生活质量，但需要进一步研究。如果这些症状之一在初级保健中报告，不能排除症状性缺铁的可能性，应考虑补铁。
