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十年铁过载疾病与血色素沉着症:来自哥伦比亚一家专业中心的临床及基因研究结果

A decade of iron overload disorders and hemochromatosis: clinical and genetic findings from a specialized center in Colombia.

作者信息

Cristancho L C Quiroga, Urbano María Alejandra, Nati-Castillo H A, Obando María Alejandra, Gómez-Gutiérrez Rigoberto, Izquierdo-Condoy Juan S

机构信息

Department of Internal Medicine, Interinstitutional Internal Medicine Group (GIMI 1), Universidad Libre, Cali, Colombia.

Departamento de Hematología, Hemato Oncólogos S.A, Cali, Colombia.

出版信息

Front Med (Lausanne). 2024 Dec 10;11:1494527. doi: 10.3389/fmed.2024.1494527. eCollection 2024.

Abstract

BACKGROUND

Iron overload disorders, including hereditary hemochromatosis (HH), are characterized by excessive iron accumulation, which can cause severe organ damage. HH is most associated with the C282Y mutation in Caucasian populations, but its prevalence and genetic profiles in Latin American populations remain underexplored.

OBJECTIVES

To describe the clinical manifestations, genetic profiles, and biochemical characteristics of patients with suspected iron overload disorders in a specialized hematology center in Cali, Colombia.

METHODS

A retrospective observational study was conducted on 70 patients diagnosed with iron overload disorders between 2014 and 2024. Data on clinical presentation, laboratory results, imaging, and genetic mutations were collected. Statistical analyses, including chi-square tests and logistic regression, were used to evaluate factors associated with HH diagnosis.

RESULTS

Male patients constituted 64.3% of the sample, with a mean age of 56.1 years at diagnosis. Fatigue (27.1%) and joint pain (17.1%) were the most common symptoms. Of the total sample, 32.9% were diagnosed with hemochromatosis. The H63D mutation was the most prevalent (52.2%), while the C282Y mutation was rare. A predominance of both slight (100.0%) and limitrophe (58.3%) iron overload was identified among patients with hemochromatosis ( = 0.036).

CONCLUSION

Colombian patients with iron overload disorders show clinical, epidemiological, and biochemical profiles consistent with global patterns, yet exhibit distinct genetic diversity. Notably, they have a low prevalence of the C282Y mutation and a higher prevalence of the H63D mutation, differing from European HH profiles. Despite elevated ferritin and transferrin saturation, no significant clinical symptoms were observed, suggesting potential delays in diagnosis. These findings highlight the need for early, region-specific diagnostic approaches to prevent complications like cirrhosis and underscore the importance of further genetic research across Latin America.

摘要

背景

铁过载疾病,包括遗传性血色素沉着症(HH),其特征是铁过度蓄积,可导致严重的器官损害。在白种人群体中,HH与C282Y突变最为相关,但在拉丁美洲人群体中其患病率和基因谱仍未得到充分研究。

目的

描述哥伦比亚卡利一家专业血液学中心疑似铁过载疾病患者的临床表现、基因谱和生化特征。

方法

对2014年至2024年间诊断为铁过载疾病的70例患者进行了一项回顾性观察研究。收集了关于临床表现、实验室检查结果、影像学和基因突变的数据。采用卡方检验和逻辑回归等统计分析方法来评估与HH诊断相关的因素。

结果

男性患者占样本的64.3%,诊断时的平均年龄为56.1岁。疲劳(27.1%)和关节疼痛(17.1%)是最常见的症状。在全部样本中,32.9%被诊断为血色素沉着症。H63D突变最为普遍(52.2%),而C282Y突变则很罕见。在血色素沉着症患者中,轻度(100.0%)和临界(58.3%)铁过载均占优势(P = 0.036)。

结论

哥伦比亚铁过载疾病患者的临床、流行病学和生化特征与全球模式一致,但呈现出独特的基因多样性。值得注意的是,他们的C282Y突变患病率较低,而H63D突变患病率较高,这与欧洲HH特征不同。尽管铁蛋白和转铁蛋白饱和度升高,但未观察到明显的临床症状,提示可能存在诊断延迟。这些发现凸显了采用早期、针对特定区域的诊断方法以预防肝硬化等并发症的必要性,并强调了在整个拉丁美洲开展进一步基因研究的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6de0/11666385/d547a714059b/fmed-11-1494527-g001.jpg

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