甘氨酸螯合亚铁治疗妊娠期缺铁性贫血的临床研究

目的 探讨甘氨酸螯合亚铁治疗妊娠期缺铁性贫血的疗效及不良反应.方法 采用多中心、前瞻性、病例对照的方法,202例缺铁性贫血的孕妇按门诊就诊号分为实验组(107例)和对照组(95例).实验组给予甘氨酸螯合亚铁治疗,对照组给予多糖铁复合物治疗.治疗3个月,观察治疗前后患者的红细胞计数(RBC)、血红蛋白(Hb)、血清铁蛋白(SF)水平及不良反应的发生率.结果 治疗3个月后,实验组的RBC(3.98±0.44)高于对照组(3.72±0.55),P=0.025;实验组的Hb(117.33±9.17)高于对照组(111.56±10.88),P=0.011;实验组SF为36.17,高于对照组的25.25,P=0.030.实验组出现1例胃肠道反应,对照组出现2例便秘,两组的不良反应比较无统计学意义.结论 甘氨酸螯合亚铁可以治疗妊娠期缺铁性贫血,较多糖铁复合物更有效,并且未见增加不良反应率.     

维生素A在铁缺乏及缺铁性贫血治疗中的作用

近几年研究发现维生素A缺乏与铁缺乏具有显著的相关性,维生素A治疗缺铁性贫血和铁缺乏也取得了较好的临床效果.本文就维生素A缺乏与铁缺乏的相关性和作用机制,以及维生素A治疗缺铁性贫血的临床疗效和研究进展进行了综述,为维生素A用于儿童缺铁性贫血的防治提供依据,同时为降低我国儿童缺铁性贫血及铁缺乏的发病率提供更有效的防治措施.     

Effectiveness of treatment of iron-deficiency anemia in infants and young children with ferrous bis-glycinate chelate

Forty infants, 6 to 36 mo old, with iron-deficiency anemia (hemoglobin < 11 g/dL) were matched and assigned to two groups. One group received FeS0(4) and the other received ferrous bis-glycinate chelate at a dose of 5 mg of Fe daily per kilogram of body weight for 28 d. Both groups had significant hemoglobin increases (P < 0.001), but only the group treated with ferrous bis-glycinate chelate had significant increases (P < 0.005) in plasma ferritin. Apparent iron bioavailabilities were calculated at 26.7% for FeS0(4) and 90.9% for ferrous bis-glycinate chelate. Regression analysis indicated that absorption of both sources of iron were similarly regulated by the body according to changes in hemoglobin. We concluded that ferrous bis-glycinate chelate is the iron of choice for the treatment of infants with iron-deficiency anemia because of its high bioavailability and good regulation.     

Experience with ferrous bis-glycine chelate as an iron fortificant in milk

The objective of this study was to test whether milk is an appropriate vehicle for fortification with ferrous bis-glycine chelate and whether it has any effect on milk's organoleptic properties. In addition, the study examined the children's acceptability and tolerance of the fortifying agent. One hundred thirty-one children aged 6-14 years (79 males and 52 females) from two dormitories of the Ministry of Social Welfare in Riyadh City, Saudi Arabia participated in this study. The results of this trial showed that milk fortified with this iron chelate has unaltered organoleptic properties and is well accepted by the children. Hemoglobin and serum ferritin levels were measured before and after consuming one liter of milk fortified with 30 mg ferrous bis-glycine chelate per liter (6 mg elemental iron per liter) per day, for a period of three months. The prevalence of anemia (Hb < 12 g/dL) significantly dropped from 25.3 to 5.0%, and 23.0 to 9.6%, among boys and girls respectively. The prevalence of low serum ferritin values among boys dropped from 8.8 to 5.9% and significantly from 21.1 to 12.1% among girls. No control group was included in this study. It is concluded that ferrous bis-glycine chelate in milk does not alter milk's organoleptic properties; furthermore, it improved hemoglobin and ferritin serum levels among anemic children, suggesting milk as an appropriate vehicle for fortification with this chelate.     

琥珀酸亚铁与多糖铁复合物治疗女性贫血的临床疗效和安全性

目的对比两种不同药物方案治疗女性贫血的临床疗效和不良反应。方法回顾性分析2013年6月-2016年10月杭州市第一人民医院门诊收治的191例女性贫血患者,根据治疗药物分成琥珀酸亚铁组和多糖铁复合物组。不同方法治疗后,比较两组的临床疗效血清血红蛋白(Hb)、红细胞(RBC)变化,观察不良反应发生情况。结果琥珀酸亚铁组和多糖铁复合物组的临床总有效率分别为92.78%和82.98%,差异有统计学意义(P0.05);治疗后2周、4周,琥珀酸亚铁组血清Hb、RBC明显高于多糖铁复合物组(P0.05);琥珀酸亚铁组的胃肠道不良反应发生率明显高于多糖铁复合物组(P0.05)。结论琥珀酸亚铁提高了女性贫血临床治疗的总有效率,促进了血清Hb、RBC的恢复,但对胃肠道有一定的刺激,临床中应根据患者特点选择治疗方案。     

Nutritional strategies for controlling iron deficiency anemia

This review was elaborated in order to contribute to the planning of strategies for controlling iron deficiency anemia in developing countries. The need for intervention should be determined by the degree of iron deficiency in the individual group and knowledge of its effects on quality of life, morbidity, and mortality. The most frequent approach is to provide iron supplementation during pregnancy, lactation, and early childhood as a basic primary healthcare measure. Fortification and dietary modification are complementary approaches, and should be developed.     

Correct assessment of iron depletion and iron deficiency anemia

OBJECTIVE: Iron deficiency anemia is caused by decreased production of red blood cells (RBCs) and is characterized by a reduction in either the hematocrit (Ht) or the concentration of hemoglobin (Hb). It is detected by blood iron status measures that are below population reference standards and also below the "usual or normal" levels for an individual. In some medicine practices, usually only hemoglobin and hematocrit are routinely measured with a full blood count, without measuring the indicators of iron status. Biochemical measures that are collected on single occasion are difficult to interpret in individuals, and normal ranges of hemoglobin and hematocrit do not necessarily confirm an iron deficiency condition, because they decrease only when severe iron depletion is present and are often unreliable or misleading. Thus, iron-depleted individuals can quickly develop iron deficiency if not detected early. METHODS: Information from hematological laboratory tests records on female patients at reproductive ages were collected and analysed. RESULTS: In this study, measurement of general test for anemia in some individuals revealed normal levels of RBCs count, Hb, Ht, mean corpuscular volume (MCV), mean cell hemoglobin concentration (MCHC), and cell morphology, whereas the levels of parameters of iron depletion and iron deficiency anemia such as serum iron and ferritin showed reduced values. The results indicate that individuals who are ordered cell blood count (CBC) measures alone without examining the indicators of iron status (Group C vs Group D) may not be correctly assessed with a definitive diagnosis and categorized as normal individuals. But in fact, they are susceptible to iron depletion and could develop iron deficiency anemia. CONCLUSIONS: In evaluation of iron deficiency status it is important that total CBC test be accompanied by the other tests of iron status to pinpoint true iron deficiency. Otherwise, many cases may be missed out and misdiagnosed as normal individuals.     

妊娠期铁缺乏和缺铁性贫血对母胎影响的研究进展

妊娠期铁缺乏(Iron Deficiency,ID)和缺铁性贫血(Iron Deficiency Anemia,IDA)是近年产科研究的热点之一。本文综述了近年来国内外文献,概括妊娠期铁缺乏和缺铁性贫血的流行现状,探讨铁缺乏和缺铁性贫血对孕妇和妊娠结局的影响,以及近年来动物实验中铁缺乏和缺铁性贫血对子代的影响。     

蔗糖铁注射液治疗老年缺铁性贫血疗效观察

目的 观察蔗糖铁注射液治疗老年缺铁性贫血(IDA)的疗效和不良反应.方法 选择32例老年IDA患者,按随机数字表法分为静脉组(17例)和口服组(15例),观察两种方法对改善贫血的疗效和不良反应.结果 治疗后静脉组及口服组血红蛋白(Hb)均较治疗前升高,分别为(100.18±8.71)g/L和(85.80±6.92)g/L,两组比较差异有统计学意义(P＜0.01);治疗后血清铁亦有上升,两组分别为(23.84±5.34.)μmol/L和(14.63±3.29)μmol/L,与治疗前比较差异有统计学意义(P＜0.01).静脉组无明显不良反应发生,口服组有6例(40%)发生胃肠道反应.结论 静脉用蔗糖铁可作为老年IDA患者补铁方式,疗效优于口服铁剂,且不良反应发生率低.

Abstract：

Objective To observe the effect and adverse reactions of iron sucrose injection in treating old patients with iron deficiency anemia(IDA). Methods Thirty-two old patients with IDA were divided into injection group(17 patients)and oral group(15 patients)by random digits table. The effects of improvement on IDA and their adverse reactions were observed. Results After treatment, hemoglobin(Hb)in the injection group and oral group was(100.18±8.71)g/L and(85.80 ± 6.92)g/L(P＜0.01), and serum iron was(23.84±5.34)μmol/L and(14.63±3.29)μmol/L(P＜0.01).There were no obvious adverse reactions in injection group, whereas there were 6 cases(40%)with gastric and colon adverse reaction in oral group. Conclusions The treatment of intravenous injection of iron sucrose can be effectively used to cure old patients with IDA. It has better effect and has lower rate of adverse reaction.     

成人缺铁性贫血调查分析

目的缺铁性贫血(iron deficiency anemia,IDA)是最常见的贫血,严重影响着人类的健康。本研究通过对IDA患者的病例进行分析,总结其人口学特征、病因和实验室检查情况,为IDA预防和诊治提供参考依据。方法选取2014-04-01-2017-04-01齐齐哈尔市第一医院收治的494例成人IDA患者为调查对象,收集患者临床资料进行回顾分析,分析成人IDA患者人口学特征、病因及实验室检查结果。结果 494例成人IDA患者中,男134例(27.1%),女360例(72.9%);年龄18～45岁171例(34.6%),45～60岁188例(38.1%),60岁135例(27.3%);城镇人口居多,为299例(60.5%),农村人口为195例(39.5%)。男性以胃肠道疾病为主要病因,女性以月经多为主要病因,老年患者胃肠道恶性肿瘤比例较高。实验室检查结果显示,血小板数增多检出率为55.3%,红细胞平均体积与血小板数量呈负相关,r=-0.211,P0.001;骨髓巨核细胞增多检出率高,为89.1%,骨髓增生明显活跃的检出率随贫血程度加重呈上升趋势,P=0.002。结论成人IDA患者主要以胃肠道疾病和女性月经过多为主要病因,对于成人男性患者及非月经增多所致的女性患者,尤其针对中老年患者,胃肠镜检查对确定IDA病因十分重要。对血小板增多的IDA患者临床医生需注意鉴别。     

铁和复合微量营养素改善缺铁性贫血的实验研究

目的 :探讨铁和多种微量营养素改善缺铁性贫血的效果。方法 :用小鼠建立缺铁性贫血动物模型 ,设铁、多种微量营养素 3个补充剂量组和对照组。结果 :铁和复合微量营养素显著提高小鼠的血红蛋白、红细胞压积和血清铁水平 ,并显著降低高剂量组小鼠红细胞内游离原卟啉水平。结论 :在补铁的同时加用铜、锌等多种微量营养素能明显改善缺铁性贫血的症状     

Electrolytic iron or ferrous sulfate increase body iron in women with moderate to low iron stores

Commercial elemental iron powders (electrolytic and reduced iron), as well as heme iron supplements, were tested for efficacy in improving the iron status of women. In a randomized, double-blind trial, 51 women with moderate to low iron stores received daily for 12 wk: 1) placebo, 2) 5 mg iron as heme iron or 50 mg iron as 3) electrolytic iron, 4) reduced iron, or 5) FeSO(4). Treatments were provided in 2 capsules (heme carrier) and 3 wheat rolls (other iron sources). Differences in iron status, food nonheme iron absorption, and fecal properties were evaluated. Body iron, assessed from the serum transferrin receptor:ferritin ratio, increased significantly more in subjects administered FeSO(4) (127 +/- 29 mg; mean +/- SEM) and electrolytic (115 +/- 37 mg), but not the reduced (74 +/- 32 mg) or heme (65 +/- 26 mg) iron forms, compared with those given placebo (2 +/- 19 mg). Based on body iron determinations, retention of the added iron was estimated as 3.0, 2.7, 1.8, and 15.5%, in the 4 iron-treated groups, respectively. Iron treatments did not affect food iron absorption. The 50 mg/d iron treatments increased fecal iron and free radical-generating capacity in vitro, but did not affect fecal water cytotoxicity. In subjects administered FeSO(4), fecal water content was increased slightly but significantly more than in the placebo group. In conclusion, electrolytic iron was approximately 86% as efficacious as FeSO(4) for improving body iron, but the power of this study was insufficient to detect any efficacy of the reduced or heme iron within 12 wk. With modification, this methodology of testing higher levels of food fortification for several weeks in healthy women with low iron stores has the potential for economically assessing the efficiency of iron compounds to improve iron status.     

幽门螺旋杆菌根治治疗与缺铁性贫血的相关性研究

目的：研究幽门螺旋杆菌（HP）感染与缺铁性贫血（IDA）的相关性,探讨HP根治对IDA治疗效果的影响。方法：选择健康体检志愿者584名,对其进行IDA及HP感染构成情况分析,将其中确诊的61例IDA合并HP感染患者随机分为观察组（31例）和对照组（30例）,观察组给予铁剂联合抗HP治疗,对照组单纯给予铁剂治疗,比较两组患者治疗效果。结果：584名志愿者中IDA合并HP感染患者61例;IDA患者HP感染率为55．96％,明显高于非IDA人群的20．21％;HP感染者IDA患病率为38．85％,明显高于HP阴性者的11．24％;HP感染与IDA发病具有显著的相关性（X2=15．3403,P〈0．001）。观察组抗HP治疗药物停用4周后,HP根治29例,根治率93．55％。两组患者治疗后IDA指标均有不同程度改善,其中观察组治疗后1个月、3个月均较治疗前显著上升（t=3．974,t=4．802,t=5．221;P〈0．01）;对照组治疗后1个月仅1项指标较治疗前显著上升（,=5．383,P〈0．01）,治疗后3个月虽然各项指标较治疗前显著上升（t=4．446,t=3．741,t=8．221;P〈0．01）,但显著低于同期观察组（t=4．201,t=6．664,t=3．847;P〈0．01）。结论：HP感染与IDA密切相关,根治HP感染对改善IDA治疗效果具有重要意义。     

Social and biological determinants of iron deficiency anemia

This cross-sectional study aimed to identify the social and biological determinants of anemia in children enrolled in the Brazilian Income Transfer Program (PBF). The study evaluated 446 children (69.1% of the total enrolled) ranging from 6 to 84 months of age, of whom 262 were receiving the income transfer (60.2% of the beneficiaries) and 184 were not (87.6% of the non-beneficiaries). Testing for anemia was performed with the Hemocue portable hemoglobinometer, and the cutoff points were set at 11.0 and 11.5 g/dL, according to age bracket. The data were analyzed using Poisson hierarchical regression with robust variance for multivariate analysis. There was no difference in the anemia prevalence rates between the beneficiary and non-beneficiary groups. Risk factors for anemia were low paternal schooling, cesarean birth, consumption of untreated water, stunting, and age less than 24 months. Prevalence of anemia in the group of non-beneficiary children under two years of age was significantly higher than in the beneficiary group in the same age bracket, suggesting the importance of the PBF income transfer for preventing anemia in children.     

几种红细胞和铁参数在儿童缺铁性贫血和溶血性贫血中的比较

目的研究多种红细胞和铁参数在缺铁性贫血和溶血性贫血中的不同变化,了解它们在二者中有无鉴别意义.方法采用全自动血细胞分析仪做血常规及红细胞分析,血液荧光测定仪测定锌原卟啉,EIA法测定血清转铁蛋白受体,检测了40例缺铁性贫血患儿(Hb 62.6±20.8 g/L)和33例溶血性贫血患儿(Hb 58.5±21.6 g/L),包括15例β-地中海贫血(仅1例为轻型).结果缺铁性贫血和各种溶血性贫血的红细胞分布宽度(RDW)、锌原卟啉(ZPP)、血清转铁蛋白受体(sTfR)均增高.RDW-SD在各种溶血性贫血均显著高于缺铁性贫血,P均＜0.01;RDW-CV只在β-地中海贫血明显高于缺铁性贫血,P＜0.01,而其他溶血性贫血的RDW-CV值却和缺铁性贫血非常相似(P=0.998).缺铁性贫血的ZPP明显高于溶血性贫血,P＜0.01.sTfR在β-地中海贫血高于缺铁性贫血和其他类型溶血性贫血,P均＜0.05;不同的溶血性贫血sTfR升高的程度不同.结论虽然缺铁性贫血和溶血性贫血的红细胞分布宽度、ZPP、sTfR均增高,但程度并不一致,可根据以上变化将二者区别开来.在评价溶血性贫血的sTfR水平时,应首先考虑溶血性贫血的类型.     

几种红细胞和铁参数在儿童缺铁性贫血和溶血性贫血中的比较

目的:研究多种红细胞和铁参数在缺铁性贫血和溶血性贫血中的不同变化,了解它们在二者中有无鉴别意义。方法:采用全自动血细胞分析仪做血常规及红细胞分析,血液荧光测定仪测定锌原卟啉,EIA法测定血清转铁蛋白受体,检测了40例缺铁性贫血患儿(Hb 62.6±20.8 g/L)和33例溶血性贫血患儿(Hb 58.5±21.6 g/L),包括15例β-地中海贫血(仅1例为轻型)。结果:缺铁性贫血和各种溶血性贫血的红细胞分布宽度(RDW)、锌原卟啉(ZPP)、血清转铁蛋白受体(sTfR)均增高。RDW-SD在各种溶血性贫血均显著高于缺铁性贫血,P均<0.01;RDW-CV只在β-地中海贫血明显高于缺铁性贫血,P<0.01,而其他溶血性贫血的RDW-CV值却和缺铁性贫血非常相似(P=0.998)。缺铁性贫血的ZPP明显高于溶血性贫血,P<0.01。sTfR在β-地中海贫血高于缺铁性贫血和其他类型溶血性贫血,P均<0.05;不同的溶血性贫血sTfR升高的程度不同。结论:虽然缺铁性贫血和溶血性贫血的红细胞分布宽度、ZPP、sTfR均增高,但程度并不一致,可根据以上变化将二者区别开来。在评价溶血性贫血的sTfR水平时,应首先考虑溶血性贫血的类型。     

Differentiation of iron deficiency and the anemia of chronic disease

The predictive value positive of serum iron studies and erythrocyte indices in differentiating between iron deficiency anemia and the anemia of chronic disease (ACD) were determined in 82 hospitalized patients with an iron-binding saturation of 15 percent or less. Iron deficiency, determined by serum ferritin of 20 ng/mL or less, was present in only 31 percent of patients with a serum iron level of 10 micrograms/dL or less; 39 percent of patients with a transferrin saturation of 5 percent or less, and 54 percent of patients with a total iron-binding capacity (TIBC) of 350 micrograms/dL or greater; conversely, iron deficiency was present in only 3 percent of patients with a TIBC of 250 micrograms/dL or less. Iron deficiency was present in 83 percent of patients with a mean corpuscular volume (MCV) of 75 microns3 or less, but only 2 percent of patients with an MCV of 86 microns3 or greater. It is concluded that the MCV has strong predictive value positive (and negative) when below (or above) the values just cited, but that serum iron studies do not have sufficient predictive value to justify their use in the routine differentiation between iron deficiency anemia and the ACD in hospitalized patients when no other cause for anemia is likely.