Stoltzfus R J, Albonico M, Chwaya H M, Savioli L, Tielsch J, Schulze K, Yip R
Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA.
Am J Trop Med Hyg. 1996 Oct;55(4):399-404. doi: 10.4269/ajtmh.1996.55.399.
Iron deficiency remains the most prevalent form of human malnutrition, and current interventions to control it have not decreased the global prevalence. Hookworm control activities are becoming more widely implemented, but the importance of these efforts to prevent anemia in populations is not well-defined. We studied the relationships among hookworm infection, intestinal blood loss, and iron status of 203 Zanzibari school children. Helminth infection intensity was quantified by fecal egg counts, and iron deficiency anemia was defined by low hemoglobin and serum ferritin concentrations. Intestinal blood loss was quantified by measuring fecal heme and heme breakdown products as porphyrin, a noninvasive method that has not been used previously to assess hookworm blood loss. Intestinal blood loss was strongly and linearly related to hookworm egg counts. The degree of degradation of fecal heme indicated that blood loss occurred in the upper gastrointestinal tract, compatible with the behavior of hookworms. Trichuris trichiura and Ascaris lumbricoides infections were also common, but did not contribute significantly to intestinal blood loss in this population. The prevalence of iron deficiency anemia increased steadily as hookworm infection intensity and intestinal blood loss increased. In the context of a poor diet, as exists in Zanzibar and many tropical countries, hookworm-related blood loss contributes dramatically to anemia. In such contexts, hookworm control is a feasible and essential component of anemia control. Determination of fecal heme is relatively simple and noninvasive and may be a useful tool for measuring the impact of hookworm control activities.
缺铁仍然是人类营养不良最普遍的形式，目前控制缺铁的干预措施并未降低全球患病率。钩虫控制活动正在更广泛地开展，但这些努力对预防人群贫血的重要性尚未明确界定。我们研究了203名桑给巴尔学龄儿童的钩虫感染、肠道失血与铁状态之间的关系。通过粪便虫卵计数对蠕虫感染强度进行量化，缺铁性贫血通过低血红蛋白和血清铁蛋白浓度来定义。通过测量粪便血红素和作为卟啉的血红素分解产物来量化肠道失血，这是一种以前未用于评估钩虫失血的非侵入性方法。肠道失血与钩虫卵计数呈强烈的线性关系。粪便血红素的降解程度表明失血发生在上消化道，这与钩虫的行为相符。鞭虫和蛔虫感染也很常见，但对该人群的肠道失血没有显著影响。随着钩虫感染强度和肠道失血的增加，缺铁性贫血的患病率稳步上升。在桑给巴尔和许多热带国家存在的不良饮食背景下，与钩虫相关的失血对贫血有显著影响。在这种情况下，控制钩虫是控制贫血的可行且必不可少的组成部分。测定粪便血红素相对简单且非侵入性，可能是衡量钩虫控制活动影响的有用工具。
