Deng Joanna, Ramelli Luca, Li Pei Ye, Eshaghpour Ali, Li Allen, Schuenemann Giovanna, Crowther Mark A
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
School of Medicine, Queen's University, Kingston, ON, Canada.
Blood Vessel Thromb Hemost. 2024 Aug 2;1(4):100023. doi: 10.1016/j.bvth.2024.100023. eCollection 2024 Dec.
Oral iron (Fe) supplementation is one of the mainstays of treatment for iron deficiency anemia (IDA). However, its therapeutic effects are limited when there is poor absorption from the gastrointestinal tract. Vitamin C is hypothesized to improve uptake when combined as an adjunct agent. We aimed to determine the difference in hematologic outcomes in patients with IDA receiving oral iron, with or without vitamin C. MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from database inception to July 2023 for studies investigating the use of oral iron supplements with vitamin C in patients with IDA. The primary outcome was the change in serum hemoglobin (Hb). Secondary outcomes include change in serum ferritin, reticulocyte percentage, and incidence of adverse events. A total of 2231 studies were retrieved; 10 randomized control trials (n = 1782), and 1 prospective cohort study (n = 148) comprising 1930 patients were included. Vitamin C supplementation was associated with a significant increase in serum Hb level (mean differences [MDs], 0.14 g/dL; 95% confidence interval [CI], 0.08-0.20; < .01; 10 studies, 1490 patients) and serum ferritin levels (MD, 3.23 μg/L; 95% CI, 1.63-4.84; < .01; 9 studies, 1682 patients) in the iron plus vitamin C group compared with the iron-only group. The addition of vitamin C to iron supplementation was associated with a small and likely clinically insignificant increase in serum Hb. The results of this study do not support routine supplementation of oral iron therapy with vitamin C in the treatment of IDA.
口服铁剂补充是缺铁性贫血（IDA）治疗的主要手段之一。然而，当胃肠道吸收不良时，其治疗效果有限。据推测，维生素C作为辅助剂联合使用时可改善铁的吸收。我们旨在确定接受口服铁剂的IDA患者在补充或不补充维生素C时血液学结果的差异。从数据库建立至2023年7月，检索了MEDLINE、Embase、科学引文索引和Cochrane对照试验中央注册库，以查找关于IDA患者使用口服铁剂与维生素C联合治疗的研究。主要结局是血清血红蛋白（Hb）的变化。次要结局包括血清铁蛋白、网织红细胞百分比的变化以及不良事件的发生率。共检索到2231项研究；纳入了10项随机对照试验（n = 1782）和1项前瞻性队列研究（n = 148），共1930例患者。与单纯铁剂组相比，铁剂加维生素C组补充维生素C与血清Hb水平显著升高相关（平均差值[MDs]，0.14 g/dL；95%置信区间[CI]，0.08 - 0.20；P <.01；10项研究，1490例患者）以及血清铁蛋白水平升高相关（MD，3.23 μg/L；95% CI，1.63 - 4.84；P <.01；9项研究，1682例患者）。在铁剂补充中添加维生素C与血清Hb的小幅升高相关，且可能在临床上无显著意义。本研究结果不支持在IDA治疗中常规补充维生素C与口服铁剂疗法联合使用。
