Bonkovsky H L, Banner B F, Lambrecht R W, Rubin R B
Department of Medicine, University of Massachusetts Medical Center, Worcester 01655, USA.
Semin Liver Dis. 1996 Feb;16(1):65-82. doi: 10.1055/s-2007-1007220.
There is growing evidence that normal or only mildly increased amounts of iron in the liver can be damaging, particularly when they are combined with other hepatotoxic factors such as alcohol, porphyrogenic drugs, or chronic viral hepatitis. Iron enhances the pathogenicity of microorganisms, adversely affects the function of macrophages and lymphocytes, and enhances fibrogenic pathways, all of which may increase hepatic injury due to iron itself or to iron and other factors. Iron may also be a co-carcinogen or promoter of hepatocellular carcinoma, even in patients without HC or cirrhosis. Based on this and other evidence, we hope that the era of indiscriminate iron supplementation will come to an end. Bloodletting, a therapy much in vogue 2 centuries ago, is deservedly enjoying a renaissance, based on our current understanding of the toxic effects of iron and the benefits of its depletion.
越来越多的证据表明，肝脏中正常或仅轻度增加的铁含量可能具有损害作用，特别是当它们与其他肝毒性因素（如酒精、致卟啉药物或慢性病毒性肝炎）结合时。铁会增强微生物的致病性，对巨噬细胞和淋巴细胞的功能产生不利影响，并增强纤维化途径，所有这些都可能因铁本身或铁与其他因素而增加肝损伤。即使在没有血色病（HC）或肝硬化的患者中，铁也可能是肝细胞癌的协同致癌物或促进剂。基于这一证据和其他证据，我们希望不加区分地补充铁的时代将结束。放血疗法在2个世纪前曾非常流行，基于我们目前对铁的毒性作用及其消耗的益处的理解，它理应正在复兴。
