重度β-地中海贫血患儿脾脏切除术前后铁负荷的变化

Changes of iron overload in children with severe beta-thalassaemia pre-and post-splenectomy

目的探讨重度β-地中海贫血患儿脾脏切除术前后铁负荷状况的变化。方法回顾性分析2003年1月至2012年12月18例重度β-地中海贫血患儿行脾切除术前、后的年输血量及血清铁蛋白水平。结果重度β-地中海贫血患儿脾切除术后第1年和第2年的平均年输血量为(101.94±30.73)ml/kg和(96.50±34.00)ml/kg,均分别低于脾切除术前2年(241.89±73.66)ml/kg和前1年(289.22±102.30)ml/kg的年输血量,差异均有统计学意义(P<0.05)。脾切除术后6、12、18和24个月患儿的血清铁蛋白(SF)水平分别为(2 410.00±731.77)μg/L、(2 742.78±813.74)μg/L、(2 870.56±740.94)μg/L和(2 886.67±795.34)μg/L,均低于脾切除术前SF水平[(4 975.00±1 245.85)μg/L],差异均有统计学意义(P<0.05)。结论行脾切除术后β-地中海贫血患儿血清铁蛋白水平较前降低,但仍远高于正常值,需持续监测及去铁治疗。

Objective To explore the changes of iron overload in children with severe 13-thalassemia pre- and post-sple- nectomy. Method The annual amount of blood transfused and serum ferritin （SF） levels of 18 children with severe 13-thalasse- mia before and after splenectomy from January 2003 to December 2012 were retrospectively analyzed. Result The annual amount of blood transfused in children with severe 13-thalassemia at one year and two years after splenectomy were （101.94± 30.73） ml/kg and （96.50 ±34.00） ml/kg respectively, significantly lower than the amount of two years before splenectomy （241.89±73.66） ml/kg and one year before splenectomy （289.22＋ 102.30） ml/kg （P〈0.05）. The SF levels at 6, 12, 18 and 24 months after splenectomy were （2 410.00＋731.77） p.g/L, （2 742.78±813.74） ug/L, （2 870.56±740.94） ig/L and （2 886.67± 795.34） ug/L, significantly lower than that （4 975.00±1 245.85） ig/L of before splenectomy （P〈0.05）. Conclusions The serum ferritin level after splenectomy significantly decreases compared with that of before splenectomy, but still remarkably higher than that of normal controls. Monitoring of serum ferritin level and iron-chelating therapy are needed.