缺铁性贫血患儿血清胃泌素水平测定及间断补铁疗效观察

研究缺铁性贫血 (IDA)儿童胃泌素水平的变化 ;观察间断补铁治疗儿童IDA的疗效。方法 :49例 IDA患儿每周口服一次铁制剂 (元素铁 2 mg/kg) ,共 1 2周。在治疗前后测查 Hb、ZPP、SF及血清胃泌素。结果 :经补铁治疗 ,Hb、SF均极显著性升高 (P<0 .0 1 ) ,ZPP则明显下降 (P<0 .0 1 ) ;IDA患儿血清胃泌素水平明显升高 ,与对照组比较差异显著 ,治疗后恢复正常。结论 :1每周一次间断补铁治疗儿童 IDA效果显著。 2 IDA患儿胃泌素的异常分泌可能与缺铁所致的胃粘膜萎缩有关     

幽门螺杆菌感染相关性缺铁性贫血的治疗

目的　探讨儿童幽门螺杆菌 (HP)感染相关性缺铁性贫血 (IDA)的治疗方法。方法　对 899例 2～ 7岁入托儿童进行外周血细胞、血清铁、血清铁蛋白 (SF)及HP抗体检测 ,并将HP抗体阳性IDA患儿分为两组。治疗组采用奥美拉唑 甲硝唑 阿莫西林治疗 2周 ,而后口服铁剂 ;对照组单纯口服铁剂治疗 ,8周后复查血红蛋白 (Hb)和SF。结果　 2 79例感染HP ,62 0例儿童未感染 ,99例患IDA ,其中HP感染性IDA患儿 58例 (2 0 .8% ) ,HP未感染IDA 41例 (6 .7% ) ,两者比较有显著差异(χ2 =39.46　P <0 .0 1 )。治疗组Hb、SF在治疗后较治疗前均有明显上升 ,而对照组治疗前后无明显变化。结论　HP感染患儿易患IDA ,IDA又易感染HP ,故HP感染相关性IDA患儿治疗需先抗HP治疗而后服用铁剂     

重型β珠蛋白生成障碍性贫血患儿生长发育指标与血清铁蛋白、血红蛋白量的关系和意义

目的 了解重型β珠蛋白生成障碍性贫血(简称β地贫)患儿生长发育指标落后情况,以及血清铁蛋白(SF)定量、每次输血前Hb量对其生长发育指标的关系和意义.方法 对59例重型β地贫(地贫组)患儿和48例同龄健康儿童(健康对照组)检测生长参数:身高[计算身高标准差分值(SDS)]、体质量[计算体质量指数(BMI)],Hb量、SF定量,青春发育分期采用Tanner分期方法 分期.应用SPSS 11.0软件进行统计学分析.结果 与对照组比较, 重型β地贫患儿组身高SDS、Hb量、SF定量水平均显著降低(t=-7.084,-25.771,11.928 Pa<0.01),而BMI无显著性差异(t=-0.326 P>0.05).青春期发育程度中,在重型β地贫组(10～14岁)21例患儿中仅2例开始发育,且均为Tanner 2期,而对照组(10～14岁)24例中全部开始正常发育,重型β地贫患儿发育显著落后.患儿身高SDS与年龄呈显著负相关(r=-0.588 P<0.01),与每次输血前Hb呈正相关(r=0.219 P<0.05),与SF无相关性(r=0.033 P>0.05).结论 重型β地贫的生长和发育指标均落后于正常同龄儿,年龄越大,落后越明显.其生长发育异常与患儿体内铁超负荷有关.患儿平时保持Hb水平相对高值,正规采用去铁胺等祛铁治疗将有助于改善患儿最终身高和发育水平.     

二价金属离子转运蛋白-1和膜铁转运蛋白-1在不同铁状态孕妇胎盘中的表达

目的 测定二价金属离子转运蛋白-1(DMT1) mRNA剪切异构体和膜铁转运蛋白-1(FPN1) mRNA在不同铁状态足月孕妇胎盘中的表达水平,探讨胎盘铁转运及调控机制.方法 选择在郑州大学第一附属医院产科分娩的无高血压、糖尿病、感染、肿瘤、肝炎的足月孕妇69例,其中14例Hb＜100 g/L及血清铁蛋白(SF)≥12 μg/L者排除,符合条件者55例.根据母血Hb、血清铁(SI)、SF将孕妇分为3组:正常组(N组)23例,Hb≥100 g/L,SF≥12 μg/L;铁缺乏组(ID组)20例,Hb≥100 g/L,SF＜12 μg/L;轻度缺铁性贫血组(IDA组)12例,90 g/L≤Hb＜100 g/L,MCV＜80 fL,MCH＜27 pg,MCHC＜320 g/L,SF＜12 μg/L,SI＜8.95 μmol/L;采用血细胞自动计数仪测定其血常规,比色法测定其SI,放射免疫分析法测定其SF.采用反转录-PCR技术检测胎盘组织DMT1 mRNA剪切异构体及FPN1 mRNA表达水平.结果 1.N组、ID组及IDA组含铁反应元件的二价金属离子转运蛋白-1(DMT1-IRE) mRNA分别为(0.568 2±0.116 9)、(0.709 0±0.138 9)、(0.912 8±0.179 8),3组间比较差异有统计学意义(F=23.955 P＜0.01),两两比较亦有统计学意义(Pa＜0.01).2.N组、ID组及IDA组不含铁反应元件的二价金属离子转运蛋白-1(DMT1-nonIRE mRNA)分别为(0.738 0±0.224 0)、(0.806 1±0.212 8)、(0.766 7±0.210 8),3组间比较差异无统计学意义(F=0.562 P＞0.05);3.N组、ID组及IDA组FPN1 mRNA分别为(0.462 5±0.077 6)、(0.507 1±0.074 4)、(0.551 8±0.104 1),3组间比较差异有统计学意义(F=4.767 P＜0.05),其中IDA组与N组比较差异有统计学意义(P＜0.01),而ID组与N组、ID组与IDA组比较差异均无统计学意义(Pa>0.05).结论 ID及IDA孕妇可通过上调胎盘DMT1-IRE mRNA、FPN1 mRNA的转录最大限度的增加了母体血浆铁至胎儿的转运,以保证胎儿铁供给的相对恒定.     

叶酸及维生素B12在强化促红细胞生成素促进早产儿造血中作用的研究

目的 观察叶酸,维生素B12对促红细胞生成素 铁剂改善早产儿贫血的强化作用.方法 将56名早产儿分为两组,两组患儿均使用人基因重组促红细胞生成素(Rh-EPO)(1000U/kg)和硫酸亚铁(Fe每日3～5mg/ks),治疗组(29例)在此基础上加用叶酸[230μg/(kg·d).维生素B12(每周37μkg),对照组(27例)只供给奶粉、叶酸[30μg/kg·d)]维生素B12(每周7μg/kg),4周后测定血红蛋白(Hb),血球压积(HCT),红细胞计数(RBC),平均红细胞体积(MCV),平均红细胞血红蛋白含量(MCHC),血小板(BPC),铁蛋白(Ferritin)的变化.结果 治疗组在Hb,HCT,RBC与对照组相比,均有提高且差异有统计学意义(P<0.01),MCV较对照组减小(P<0.01),MCHC和BPC铁蛋白在两组间差异无统计学意义(P>0.05).结论 叶酸,维生素B12具有加强促红细胞生成素促进早产儿造血的功能.     

血清可溶性转铁蛋白受体对缺铁性贫血的诊断价值

目的探讨血清可溶性转铁蛋白受体(sTfR)对儿童缺铁性贫血(IDA)的诊断价值。方法小细胞低色素性贫血患儿63例根据临床诊断标准分为IDA和非缺铁性贫血(n-IDA)组,测定sTfR及血清铁蛋白(SF)、血清铁(SI)等铁代谢指标,并分别行t检验和ROC曲线分析。结果IDA组sTfR均值高于正常值,与n-IDA组比较具有极显著差异(P<0.001),而IDA组SF和SI均值在正常参考值范围;尽管SF与SI特异度较高,但其敏感度和ROC曲线下面积明显较sTfR低。结论血清sTfR可较准确反映铁贮存状况,是诊断IDA的有效客观指标,在儿童铁缺乏疾病的鉴别诊断中具有重要价值。     

血清铁蛋白在缺铁性贫血并感染中的诊断价值

目的 研究血清铁蛋白(SF)在并感染的缺铁性贫血(IDA)患儿中的诊断价值。方法 采用酶联免疫吸附试验,检测60例感染性疾病IDA患儿SF,其中38例骨髓铁染色显示铁缺乏患儿为A组[Hb(62.9±21.3)g／L],22例未做骨穿检查患儿为B组[Hb(83.3±16.4)g／L];同时检测20例患同类感染性疾病Hb正常患儿为对照组。结果 对照组SF为(170±150)μg／L,A组和B组分别为(40±32)μg／L、(53±37)μg/L,A、B组均明显低于对照组(P均<0.01)。在有骨髓铁染色作为金标准A组中,若分别以SF<14μg／L、<60μg／L、<100μg／L作为诊断界点,诊断缺铁敏感度分别为15.8％、73.7％、92.1％,约登指数分别为0.26、0.52、0.57,以SF<100μg／L为诊断界值准确性最好;在B组中若以同样几个界点作为判断缺铁标准,其敏感度分别为18.2％、63.6％、95.5％,约登指数为0.18、0.43、0.61,与A组相似。结论 在并感染性疾病的贫血患儿中,建议可将SF<100μg／L作为判断IDA的依据。     

促红细胞生成素治疗早产儿贫血的临床研究

目的 观察重组人类促红细胞生成素(rh-EPO)防治早产儿贫血的疗效。方法 将46例早产儿按入 院顺序随机分为治疗组和对照组各23例,治疗组用rh-EPO每周600 IU／kg,隔天1次,皮下注射共6周,加常规治 疗(维生素E 25 mg／d,维生素C 0.2 g／d,元素铁每天6 mg／kg),必要时输血,对照组仅用常规治疗。结果 治疗后 治疗组网织红细胞计数(Ret)较对照组明显升高(P<0.01);两组早产儿出生后血红蛋白(Hb)均逐渐下降,但治疗 组下降缓慢,治疗结束后两组差异非常显著(P<0.001);血清铁水平在治疗期间治疗组明显低于对照组(P <0.01);治疗结束后差异缩小(P<0.05);治疗组输血率(13.04％)较对照组(52.17％)明显减少(P<0.01)。结论 rh-EPO能有效防治早产儿贫血,无明显副作用。     

重型β地中海贫血铁过载患儿心脏与肝脏磁共振T2*检测及其相关因素分析

目的探讨重型β地中海贫血(β-TM)患儿心脏、肝脏铁过载状况,以及与临床监测指标之间的关系。方法 2010年6月,根据自愿的原则,从规律输血治疗的80例≥7岁的β-TM患儿中,选择51例,进行心脏磁共振T2*(心脏T2*)及肝脏磁共振T2*(肝脏T2*)检测。检测结果与年龄、血清铁蛋白(SF)、心脏左室射血分数(LVEF)、输血年限、去铁年限、输血前血红蛋白(Hb)进行比较。结果 51例患儿中11例(21.6%)发生心肌铁过载,其中轻度3例,中度3例,重度5例;肝脏铁过载43例(84.3%),其中轻度14例,中度17例,重度12例。心脏T2*与SF、LVEF、肝脏T2*之间无相关性,SF与肝脏T2*呈正相关(r=0.558,P<0.01)。心肌铁过载患儿输血年限大于心肌铁正常患儿(P<0.05),而肝脏铁过载发生率差异无统计学意义(P>0.05)。11例心肌铁过载患儿中,2例LVEF降低。结论β-TM患儿SF值可反映机体肝脏铁过载的情况,但不能预测心肌铁过载;随着输血年限的增加,心肌铁过载风险亦加大;心肌铁过载与肝脏铁过载之间存在着不一致性,肝脏铁过载不能成为提示心肌铁过载的依据。心肌铁过载患儿LVEF可以在...     

不同基因型地中海贫血患儿铁代谢和红细胞系造血状况研究

目的：探讨不同基因型地中海贫血（地贫）患儿体内铁代谢和红细胞系造血状况。方法：对158例确诊地贫患儿进行血清铁蛋白（SF）、血清转铁蛋白受体（sTfR）、促红细胞生成素（EPO）检测,比较不同基因型地贫患儿之间的差异,并分析其与血红蛋白水平的相关性。结果：158例地贫患儿中,轻型α地贫52例（32.9％）,血红蛋白H病（HbH病）27例（17.1％）,轻型β地贫59例（37.4％）,重型β地贫13例（8.2％）,α复合β地贫7例（4.4％）。HbH病及重型β地贫患儿的SF水平较其他各组明显升高,差异有统计学意义（P＜0.01）;重型β地贫患儿sTfR水平较其他各组升高,差异有统计学意义（P<0.05）。重型β地贫患儿EPO水平较其他各组明显升高,差异有统计学意义（P＜0.01）;HbH病和重型β地贫患儿Hb水平和EPO水平呈负相关,分别为γ=-0.656（P＜0.01）和γ=-0.641（P＜0.05）。结论：不同基因型地贫患儿体内铁代谢和红细胞系造血状况不同,联合SF、sTfR和EPO检测可反映造血状况,指导临床治疗。［中国当代儿科杂志,2010,12（8）：602-604］     

Salivary iron status in children with iron deficiency and iron overload.

Forty anaemic (iron deficiency anaemia-27, thalassemia major-8, and aplastic anaemia-5) and 10 non-anaemic children (serving as controls) aged from 8 months to 10 years were selected for the study. The salivary iron was significantly higher in iron deficient and iron overload conditions compared to controls. The mean salivary:serum iron ratio was same in control and iron overload cases, while it was twice as high in iron deficient anaemic children. The correlation between salivary iron and serum iron was significant (r = 0.7392, P less than 0.001) in these cases. The iron deficient anaemic children with hypoalbuminaemia had significantly reduced serum and salivary protein (P less than 0.001), but iron concentrations in serum and saliva remained unaltered. The salivary protein level had significant correlations with serum albumin and serum protein (P less than 0.001). Thus, the iron in saliva is maintained at a higher level and more so in iron deficiency anaemia; it correlates well with serum iron (r = 0.6853, P less than 0.001) in iron deficient anaemic children also and is not affected by co-existing hypoproteinaemic situation.     

Dietary iron intake and iron status in adolescents

The aim of this study was to evaluate the dietary iron intake of 15-year-old adolescents from two different regions of Sweden, in relation to their iron status. The study comprised 185 boys and 209 girls, randomly selected from the official population register. The iron intake was calculated from a 7-day record, and varied between 7 and 35 and 6 and 27 mg per day for boys and girls, respectively. The daily median intakes in boys and girls were 18.7 and 14.2 mg, respectively. S-ferritin, s-iron, and s-transferrin saturation, measured in all the subjects, did not differ significantly between the two regions. However, the mean serum ferritin concentration was significantly higher in the boys (36.4μgl^-1) than in the girls (29.4μgl^-1)( p < 0.001). Low s-ferritin levels, defined as s-ferritin < 12 μgl^-1 were found in seven boys (3.7%) and in 29 girls (13.9%). None of the adolescents had iron deficiency anaemia, defined as Hb< 110gl^-1 in combination with s-ferritin < 12μgl^-1. Regression and correlation analyses did not show any significant correlation between dietary iron intake and s-ferritin, or between s-ferritin and haemoglobin (Hb), MCH and MCHC. A significant correlation was found, however, between s-ferritin and transferrin saturation ( p < 0.005) in both sexes. When the adolescents who still had s-ferritin < 12μgl^-1 at a second blood examination were given a 6 weeks trial with oral iron therapy, all of them showed an increase both in s-ferritin and in blood Hb. The 95% confidence intervals of s-ferritin for 15-year-old Swedish boys and girls were defined as 11-90 and 7 85 μ.gl^-1, respectively.     

Intravenous iron sucrose for children with iron deficiency failing to respond to oral iron therapy

Background

For decades, parenteral iron has been used in patients with iron deficiency unresponsive to oral iron therapy and in hemodialysis‐dependent patients receiving erythropoietin. Newer intravenous (IV) iron formulations such as iron sucrose have replaced high‐molecular weight iron (HMW) dextran in dialysis patients; however, the use of parenteral iron in children without renal disease has not been well defined.

Procedure

Pharmacy records were reviewed on children (≤18 years of age) who received IV iron sucrose at Children's Medical Center Dallas between January 1, 2004 and June 30, 2009. Patients who received iron sucrose for chronic renal disease were excluded from analysis.

Results

Thirty‐eight children received iron sucrose for non‐renal indications, 13 with iron deficiency refractory to oral iron therapy, 13 with iron malabsorption or dependence on parenteral nutrition, 7 for chronic gastrointestinal blood loss, and 5 for miscellaneous indications. Among these 38 children, who received a total of 510 doses of IV iron sucrose, there were only six adverse reactions. Patients in all categories had a good response to the iron sucrose, with a median hemoglobin rise of 1.9–3.1 g/dl depending on the indication.

Conclusions

Parenteral iron is a safe and effective means to treat iron deficiency in children who cannot receive or do not respond to oral iron due to intolerance, poor adherence, or iron malabsorption. Pediatr Blood Cancer 2011;56:615–619. © 2010 Wiley‐Liss, Inc.     

Malabsorption of iron in children with iron deficiency.

Inability to absorb oral iron is believed to be an extremely rare cause of therapeutic failure in the treatment of iron deficiency anemia. Six patients who had failed to respond to oral iron therapy were studied by a simple oral absorption test and contrasted with 25 patients with untreated iron deficiency anemia and 10 normal subjects. All six of the patients who were therapeutic failures demonstrated impaired iron absorption in the absence of other clinical evidence of gastrointestinal disease. In the 25 newly diagnosed patients with iron deficiency. 24 demonstrated elevated iron absorptions while 10 ironreplete normal subjects had minimal elevations in their serum iron values following the administration of the test dose of 1 mg of elemental iron per kilogram. When the therapeutic failures were treated with parenteral iron, all had a therapeutic response. In addition, after treatment the impaired absorption of iron improved transiently. All children who absorbed iron readily responded to oral iron therapy.     

Reversal of iron deficiency anemia-induced peripheral neuropathy by iron treatment in children with iron deficiency anemia

The effects of iron deficiency anemia (IDA) on nerve conduction and efficiency of iron therapy were investigated by peripheral nerve-electrophysiological measurements. Eighteen children (10 boys, eight girls; mean age 31 +/- 1.3 months) with IDA and 12 healthy children (six boys, six girls; mean age 29 +/- 1.3 months) were enrolled into the study. Nerve conduction velocity was measured in the median and posterior tibial nerve. After nerve conduction values were determined in the patients and controls, 6 mg/kg/24 h ferrous sulphate was given orally to the patients for 3 months and nerve conduction velocity tests were performed again. Median/motor and sensory nerve conduction velocity and tibial/motor nerve distal-amplitute values of children with IDA were lower than for the control group (p < 0.05, p < 0.01 and p < 0.001 respectively). With iron supplementation these values increased to the normal levels and even higher than control levels for some parameters. In correlation studies between whole blood parameters and nerve conduction velocity results, there was a correlation between median/sensory nerve conduction velocity values and serum iron levels. Additionally there was a correlation between some nerve conduction velocity values and age. In conclusion, the evidence from this preliminary study suggests that peripheral neuropathy may develop in children with IDA. Peripheral neuropathy symptoms in these patients may be improved by iron therapy.     

Acute iron ingestion

OBJECTIVE: Intoxication is one of the most common causes of admissions to emergency department in pediatric age group. Incidence of iron poisoning gradually increased because of wide spread use of iron containing drugs. METHOD: In this report, we present five cases of iron ingestion who were admitted to our emergency department within a year. RESULT: Whole bowel irrigation in addition to gastric lavage with an iron dose of over 50 mg/kg as well as deferoxamine treatment for patients in whom clinical and laboratory indications are present. CONCLUSION: The prompt recognition and treatment of children with acute iron poisoning is the single and the most critical point for decreasing the morbidity and mortality associated with iron containing products.