铁缺乏症患者缺铁程度对口服铁剂吸收的影响

Effect of iron deficiency level on oral iron absorption

目的研究铁缺乏症患者缺铁程度对口服铁剂吸收的影响。方法纳入2018年7月至2020年6月于中国医学科学院血液病医院贫血中心门诊就诊并确诊铁缺乏症的非妊娠期女性患者37例,以13例健康查体女性为正常对照,分析缺铁性贫血(IDA)、缺铁性红细胞生成/储存铁不足(IDE/ID)患者及正常对照者Hepcidin水平并进行口服铁剂吸收试验(OIAT),比较服铁后2 h血清铁(C2)与基线血清铁(C0)差值。结果IDA、ID/IDE、正常对照组Hepcidin中位数分别为4.9(2.17~32.86)、26.98(11.02~49.71)、69.89(42.23~138.96)μg/L(P<0.001),IDA组Hepcidin低于ID/IDE组(校正后P=0.005)和正常对照组(校正后P<0.001),但ID/IDE组与正常对照组差异无统计学意义(校正后P=0.220);OIAT IDA、ID/IDE及正常对照组C2-C0平均值分别为(35.30±21.68)、(37.90±14.06)、(23.57±10.14)μmol/L,差异无统计学意义(P=0.130)。多重线性回归分析显示C0、血清铁蛋白(SF)、可溶性转铁蛋白受体(sTFR)和HGB是铁缺乏症患者Hepcidin的独立影响因素,Hepcidin=-31.842-0.642*C0+2.239*SF+1.778*sTFR+0.365*HGB-0.274*网织红细胞血红蛋白含量(RET-HB)。未发现C2-C0的独立影响因素。结论铁缺乏程度影响口服铁剂吸收,胃肠功能正常者铁缺乏越重,口服铁剂吸收越多,ID/IDE较IDA铁吸收减缓。Hepcidin较OIAT更能区分不同铁缺乏程度的口服铁吸收。

Objective To study the effect of iron deficiency level for oral iron absorption in iron deficient patients.Methods 37 non-pregnant female patients who were diagnosed with iron deficiency and 13 healthy females who completed their physical examination at the outpatient department of the Anemia Center of the Institute of Hematology&Blood Diseases Hospital from July 2018 to June 2020 were included.Hepcidin and C2-C0 of oral iron absorption test were analyzed in different iron deficiency and serum ferritin level.Results The median of Hepcidin in IDA,ID/IDE and healthy control group were 4.9(2.17-32.86),26.98(11.02-49.71)and 69.89(42.23-138.96)μg/L(P<0.001),respectively.Hepcidin level of IDA group was lower than that of ID/IDE group(adjusted P=0.005)and healthy control(adjusted P<0.001).Hepcidin level of ID/IDE group had no significant difference compared with healthy control(adjusted P=0.22).The mean of C2-C0 in IDA,ID/IDE and healthy control group were(35.30±21.68),(37.90±14.06)and(23.57±10.14)μmol/L(P=0.130),respectively.Multilinear regression analysis showed C0,SF,sTFR and HGB were independent factors for Hepcidin in iron deficient patients,with an equation of Hepcidin=-31.842-0.642*C0+2.239*SF+1.778*sTFR+0.365*HGB-0.274*RET-HB.We didn't find independent factor of C2-C0.Conclusion The degree of iron deficiency had an effect on oral iron absorption.Patients of ID/IDE group absorbed iron more slowly than patients of IDA group.Iron deficient patients with normal gastrointestinal function absorbed more iron by oral administration when they were in a more serious iron deficient stage.Hepcidin was a better parameter to distinguish iron absorption level among different iron deficient patients than C2-C0 of oral iron absorption test.