Jensen P D, Heickandorff L, Helweg-Larsen H M, Jensen F T, Christensen T, Ellegaard J
Department of Medicine, Aarbus University Hospital, Denmark.
Eur J Haematol. 1996 Aug;57(2):157-64. doi: 10.1111/j.1600-0609.1996.tb01354.x.
Patients with severe iron overload may develop hepatic fibrosis due to iron toxicity. Unfortunately, the follow-up of the fibrogenic activity during treatment by histological examination of tissue biopsies carries potential side effects, and may therefore not be justified ethically. Recently, the serum concentration of procollagen type III peptide (S-PIIINP) has been shown to be a valid serum marker of the activity of collagen metabolism in conditions with hepatic fibrosis unrelated to iron overload. In order to evaluate the potential usefulness of this test in patients with fibrosis due to iron overload, we investigated the relationship between the PIIINP serum concentration and the size of iron overload in 18 patients with hereditary haemochromatosis (HH) and in 14 patients with transfusional iron overload. A close correlation was found between S-ferritin and S-PIIINP (r = 0.73, p < 0.0001). Follow-up of 6 patients during iron depletion treatment revealed a normalization of the serum aminotransferase concentration before normalization of S-PIIINP was found. This may indicate that excess iron directly induces an increase in fibrogenesis rather than the increased fibrogenesis is secondary to hepatocellular injury caused by iron excess. Thus, serial measurements S-PIIINP may be useful in follow-up of the fibrogenic process due to iron overload.
严重铁过载患者可能因铁毒性而发生肝纤维化。不幸的是，通过组织活检的组织学检查来随访治疗期间的纤维化活性存在潜在副作用，因此在伦理上可能不合理。最近，III型前胶原肽血清浓度（S-PIIINP）已被证明是在与铁过载无关的肝纤维化情况下胶原代谢活性的有效血清标志物。为了评估该检测在铁过载所致纤维化患者中的潜在用途，我们研究了18例遗传性血色素沉着症（HH）患者和14例输血性铁过载患者的PIIINP血清浓度与铁过载程度之间的关系。发现血清铁蛋白与S-PIIINP之间存在密切相关性（r = 0.73，p < 0.0001）。对6例患者进行铁耗竭治疗期间的随访发现，血清转氨酶浓度在S-PIIINP恢复正常之前就已恢复正常。这可能表明过量铁直接诱导纤维化增加，而非纤维化增加继发于铁过量引起的肝细胞损伤。因此，连续测量S-PIIINP可能有助于随访铁过载所致的纤维化过程。
