Sartain Stephanie, Al-Ezairej Maryam, McDonnell Martin, Westoby Catherine, Katarachia Vasiliki, Wootton Stephen A, Cummings J R Fraser
Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
PLoS One. 2025 Jan 13;20(1):e0304293. doi: 10.1371/journal.pone.0304293. eCollection 2025.
It is unclear what impact iron deficiency has on fatigue in people with inflammatory bowel disease (IBD). This systematic review examined the evidence of whether iron deficiency, with or without anaemia, was associated with fatigue in IBD. Fatigue is a common symptom in patients with IBD that can be difficult to manage and treat. A greater understanding of the role and contribution of iron deficiency to fatigue may help improve the management of this condition.
The databases searched were MEDLINE, OVID, CINAHL and Web of Science. Inclusion criteria were studies measuring iron status for iron deficiency (ID) and patient-reported outcome measures (PROMs) for fatigue in patients with IBD of any level of disease activity. Assessment of bias was conducted using the Newcastle Ottawa Scale. Studies were grouped for syntheses according to whether exposure was iron deficiency without anaemia (IDWA) or ID regardless of haemoglobin level.
Two hundred and eighty-five individual database results were identified and screened; 32 complete records were reviewed, from which seven studies with 1425 individuals were deemed eligible for inclusion in the results synthesis. Considerable variation in the methods and statistical analysis used to investigate the relationship between ID and fatigue prevented any quantitative synthesis. Studies varied by population disease activity levels, approaches used to define ID and PROMs used to measure fatigue. Three studies directly compared fatigue scores in IDWA to those not iron deficient, two of which showed patients with IDWA had significantly lower fatigue scores. Four studies used ID irrespective of anaemia as the exposure and reported mixed results on fatigue, with only one study reporting a higher prevalence of fatigue in the ID group.
There was marked heterogeneity between studies in this review. Two studies found evidence of a slight increase in fatigue levels in patients with IDWA. Though this does not explain all fatigue in patients with IBD, iron replacement should be considered to improve fatigue in iron-deficient patients.
尚不清楚缺铁对炎症性肠病（IBD）患者疲劳的影响。本系统评价研究了缺铁（无论有无贫血）与IBD患者疲劳相关的证据。疲劳是IBD患者的常见症状，可能难以管理和治疗。更好地理解缺铁对疲劳的作用和影响可能有助于改善这种情况的管理。
检索的数据库包括MEDLINE、OVID、CINAHL和科学网。纳入标准为测量缺铁（ID）铁状态以及疾病活动程度不同的IBD患者疲劳的患者报告结局指标（PROMs）的研究。使用纽卡斯尔渥太华量表进行偏倚评估。根据暴露因素是无贫血缺铁（IDWA）还是无论血红蛋白水平如何的缺铁，将研究分组进行综合分析。
共识别并筛选了285个独立数据库结果；审查了32份完整记录，从中7项研究共1425名个体被认为符合纳入结果综合分析的条件。用于研究ID与疲劳之间关系的方法和统计分析存在很大差异，无法进行任何定量综合分析。研究因人群疾病活动水平、定义ID的方法以及用于测量疲劳的PROMs不同而有所差异。三项研究直接比较了IDWA患者与非缺铁患者的疲劳评分，其中两项研究显示IDWA患者的疲劳评分显著更低。四项研究将无论有无贫血的ID作为暴露因素，并报告了关于疲劳的混合结果，只有一项研究报告ID组疲劳患病率更高。
本综述中的研究之间存在明显异质性。两项研究发现有证据表明IDWA患者的疲劳水平略有增加。虽然这并不能解释IBD患者的所有疲劳，但应考虑补充铁剂以改善缺铁患者的疲劳症状。
