不同补铁方式改善铁缺乏儿童Hb的荟萃分析

王波,詹思延,夏惜惜,等.乙二胺四乙酸铁钠改善铁缺乏人群血红蛋白水平的系统综述[J].中华流行病学杂志,2008,29(1):65-70.

Higgins J P T,Green S.Cochrane handbook for systematic reviews of interventions Version 4.2.6(updated September 2006)[Z].UK:John Wiley & Sons Ltd,2006.

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血清铁蛋白诊断铁缺乏临界值研究的Meta分析

目的探讨血清铁蛋白(SF)诊断铁缺乏的适宜临界值。方法通过计算机检索及手工查阅收集以骨髓铁染色为金标准,探讨SF诊断铁缺乏临界值的国内外相关文献,按照纳入与排除标准筛选文献并提取数据,将纳入研究依据阈值效应异质性检验结果按SF临界值12～20、25和30、36～60μg/L分组,根据异质性检验结果选择相应的效应模型对各组进行加权定量合并,计算各组的综合诊断效能参数及其95%CI,绘制综合受试者工作特征(SROC)曲线并计算曲线下面积和Q*指数,并进行敏感性分析。结果 14篇纳入文献分为三组进行合并效应值分析发现,SF临界值12～20μg/L组的汇总灵敏度最低(0.767,95%CI 0.705～0.821),但汇总特异度最高(0.959,95%CI 0.934～0.976),25和30μg/L组的汇总灵敏度最高(0.877,95%CI 0.799～0.933),汇总特异度为(0.944,95%CI 0.888～0.977),36～60μg/L组的汇总灵敏度(0.836,95%CI 0.797～0.870)和特异度(0.876,95%CI 0.846～0.901)都较低。综合诊断效能指标诊断比值比属SF 25、30μg/L组最高(101.42,95%CI 36.137～284.64),SROC曲线下面积最大(0.9497±0.039),Q*指数也最接近1(0.8901±0.052)。分别剔除样本量<50的文献和中文文献后,各项诊断效能参数仍以SF 25和30μg/L组为最佳,与剔除研究前的结论一致。结论 SF检测以25或30μg/L为临界值判断铁缺乏时其准确性和综合效能较高。     

铁缺乏的治疗：每日补铁远优于每周补铁

每周补铁治疗缺铁性贫血是基于对大鼠铁代谢的研究，其理由是肠粘膜上皮有阻滞作用。本文主要讨论三个问题：口服补铁期间是否有粘膜阻滞以致妨碍铁的吸收？每周补的能否满足妊娠妇女对大量铁剂的需要？如没有粘膜阻滞作用，为何每日补铁与每周补铁的结果，其血红蛋白的变化并没有区别？分析之后认为，粘膜阻滞并不存在，而且每周补铁可能会严重损害孕妇和胎儿；每日补铁无优于每周补铁。     

乙二胺四乙酸铁钠改善铁缺乏人群血清铁蛋白水平的系统综述

作 者：

王波    詹思延    夏愔愔    李立明    WANG Bo    ZHAN Si-yan    XIA Yin-yin    LI Li-ming  

作者单位：

流行病学教育部重点实验室,北京大学医学部公共卫生学院流行病与卫生统计学系,100083 

期 刊：

中华预防医学杂志   ISTICPKU  

Journal：

CHINESE JOURNAL OF PREVENTIVE MEDICINE  

年，卷(期)：

2008, 42(6) 

分类号：

R3 

关键词：

铁    铁蛋白类    系统综述    Meta分析   

Keywords：

Iron    Ferritim    Review literature    Meta-analysis   

机标分类号：

TS2 TS3 

机标关键词：

乙二胺四乙酸铁钠铁缺乏人群血清铁蛋白蛋白水平系统综述systematic review文献检索随机对照试验评价电子数据库测量可靠性相关期刊手工检索领域专家可信区间会议摘要灰色文献防止污染可比性 

基金项目：

 

DOI：

 

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36. Sun J.Hoang J.Li WX Effects of wheat flour fortified with different iron fortificants on iron status and anemia prevalence in iron deficient anemic students in Northern China 2007
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43. Simpson JM.Klar N.Donner A Accounting for cluster randomization:a review of primary prevention trials,1990 through 1993 1995
44. Divine GW.Brown JT.Frazier LM Unit of analysis error in studies about physicians' patient care behavior 1992
45. Donner A.Brown KS.Brasher P A methodological review of nontherapentic intervention trials employing cluster randomization,1979-1989 1990
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铁耗竭无贫血妇女血清转铁蛋白受体对补铁的反应

在本项随机双盲试验中，３７名年龄有１９岁－３５岁之间的铁耗竭无贫血妇女受试者，分别接受８周的补铁或安慰剂治疗。在治疗前，治疗中和治疗后分别测定铁水平。     

不同地区学龄前儿童血清铁蛋白分布的研究

本文在我国五个不同饮食习惯的地区调查1458名学龄前儿童的血清铁蛋白(SF)水平,发现不同地区学龄前儿童SF水平的年龄分布趋势是一致的,出生一年左右SF水平基本是最低的,随着年龄的增加,SF的水平也随之增加并逐步达较稳定的水平;但是不同地区之间SF水平差别是明显的,以食海鱼为主的地区SF水平最高。五个地区约50.1%的学龄前儿童的SF水平低于20.0ng/ml的标准,说明这些地区学龄前儿童缺铁情况是严重的。     

儿童维生素D缺乏对血清铁蛋白的影响

目的 了解东莞市儿童维生素D(VD)缺乏现状,研究VD缺乏对血清铁蛋白的影响。方法 选取2016年11月－2018年4月间在东莞市儿童医院体检的6个月~14岁儿童,检测血清铁蛋白及VD浓度,采用SPSS24.0进行统计分析。结果 VD降低的比例为34.73%,而婴幼儿组、学龄前组和学龄组的VD降低的比例分别为19.75%、65.45%和77.78%,储存铁减少的比例为22.42%。VD正常组血清铁蛋白浓度高于VD不足组及VD缺乏组(F=6.21,P=0.002)。年龄增大(OR=0.312,95%CI:0.233~0.419,P＜0.001)为储存铁减少的保护因素,VD不足(OR=1.377,95%CI:1.109~1.710,P＝0.004)为储存铁减少的危险因素。结论 本院健康体检儿童VD缺乏的比例较高,且随着年龄增大而升高,VD缺乏为血清铁蛋白降低的危险因素之一。临床工作中有必要延长VD制剂补充的年限,同时,在铁缺乏或者补充铁剂疗效欠佳的病例,建议同时检测VD浓度。     

淀粉铁、蔗糖铁对铁缺乏大鼠的补铁效应

淀粉铁和蔗糖铁是糖和铁的络合物,本实验以相当于5～6mgFe/kg bw/d的淀粉铁或蔗糖铁连续灌胃大鼠24天。并以硫酸亚铁和普通饲料为对照,实验结果表明,淀粉铁组,蔗糖铁组,硫酸亚铁组和普通饲科组的血清铁含量(SIμg/dl)分别为111.08±22.3、118.64±26.80、136.80±54.36、83.44±22.60;血清铁蛋白含量(SFng/ml)分别为12.69±3.19、14.52±1.98、16.91±2.02、7.51±2.09;血红蛋白含量(Hbg/dl)分别为10.71±0.61、10.96±0.45、11.01±0.84、8.46±1.27,淀粉铁、蔗糖铁可被大鼠机体吸收并利用。     

饮酒对冠心病患者血清铁和铁蛋白水平的影响

体内铁贮量高与冠心病的关系是一个争议颇多的课题。有研究显示，饮用葡萄酒可降低冠心病发病率，并提出抑制铁吸收可能是饮酒预防冠心病的机理之一。进一步的研究分析显示，葡萄酒酒精摄入量与血清铁、铁蛋白及γ-谷氯酸基转移酶（GGT）呈正相关，且驳斥了葡萄酒酒精因减少铁贮量而降低冠心病发病率的假说。     

应用血清铁蛋白与运铁蛋白受体比值评价儿童铁营养状况

目的利用运铁蛋白受体、血清运铁蛋白受体与血清铁蛋白比值评价儿童铁补充干预效果。方法选择某幼儿园3~6岁健康儿童,按班随机分为3组,A组为每日补充组(一周补充5次微量营养素补充剂)、B组为间歇性补充组(每周补充一次微量营养素补充剂)、C组为空白对照组。从3组儿童中,每组随机抽取30名儿童,测定干预前后血清铁蛋白(SF)和运铁蛋白受体(sTfR)含量,并计算运铁蛋白受体含量与血清铁蛋白含量比值(RF)和机体铁含量(BFe)。结果干预前,三组儿童的sTfR、SF、RF、BFe含量差异无统计学意义(P>0.05)。干预后,A、B组儿童的sTfR、RF显著降低,BFe含量显著升高,而C组儿童的sTfR、RF、BFe无明显变化(P>0.05);干预后,A组、B组儿童的sTfR、RF显著低于C组(P<0.05),BFe含量显著高于C组(P<0.05);A组与B组之间sTfR、BFe含量及RF比值差异无统计学意义(P>0.05)。结论血清运铁蛋白受体含量与血清铁蛋白比值以及计算出的机体铁含量能够很好地用于评价儿童铁干预效果。     

补铁对人体血清转铁蛋白受体水平的影响

目的研究补铁过程血清转铁蛋白受体(sTfR)值的时相动态变化趋势,为sTfR是否可作为观察补铁效果的指标提供依据.方法 2002年4～10月,从河北省廊坊市和北京顺义区初筛942名18～45岁育龄妇女,检测其铁生化指标,依现行铁状况评价标准,筛检红细胞生成缺铁(IDE)和缺铁性贫血(IDA)妇女,经知情同意后,共有59名妇女完成了自始至终的补铁效果动态观察.采用L-苏糖酸亚铁胶囊(7 mg元素铁/粒),IDE妇女隔日服4粒,IDA妇女每日服4粒,补铁12周,分别测定补铁过程中0、3、6、9和12周的铁生化指标和sTfR值,观察sTfR时相动态变化.结果 IDE和IDA育龄妇女sTfR含量分别为(26.62±10.57)nmol/L和(41.25±21.96)nmol/L,均显著高于健康者的水平;在补铁过程中,sTfR呈现以下变化特点在IDE期,sTfR在补铁后3周内趋于平稳,3周后渐进性降低,至12周时接近和达到健康者的水平,检测值为(17.86±5.57)nmol/L;在IDA期,补铁后3周内sTfR迅速下降,3周后缓慢下降,至第9周趋于平稳,至12周时接近和达到健康者的水平,检测值为(19.54±5.94)nmol/L;sTfR/血清铁蛋白在补铁过程中的变化趋势与sTfR基本平行;补铁过程中sTfR与血红蛋白、血清铁蛋白呈负相关,与锌卟啉呈正相关.结论在补铁过程,sTfR随机体铁状况的恢复而逐渐下降至正常水平,sTfR可作为观察补铁效果的特异指标.     

Response of hemoglobin, serum ferritin, and serum transferrin receptor during iron supplementation in pregnancy: a prospective study

OBJECTIVE: We evaluated the effect of iron supplementation on biochemical indicators of iron status, namely hemoglobin (Hb), serum ferritin (SF), and serum transferrin receptor (sTfR), during pregnancy. METHODS: A prospective study was conducted in 73 pregnant women who received daily supplements of 60 mg of iron and 500 microg of folic acid for 100 d from 19 wk of gestation. The indicators of iron status (Hb, SF, and sTfR) at 19, 27, and 35 wk of gestation were analyzed. The response of iron status indicators to iron supplementation was assessed in the cohort and in pregnant women who were anemic (n = 35) and non-anemic (n = 38) at 19 wk. RESULTS: All three indicators of iron status during supplementation (27 and 35 wk) were similar to the presupplementation status. The sTfR as an indicator correlated negatively with presupplementation Hb levels (r = -0.417). Based on sTfR level in iron-adequate pregnant women, a cutoff value of at least 12.0 mg/L was derived to define iron deficiency in pregnancy. When the response was tested in anemic pregnant women, iron supplementation improved mean Hb (P < 0.05) at the end of 35 wk (96 +/- 8.8 to 110 +/- 20.2 g/L) of gestation, with no change in SF. Conversely, non-anemic pregnant women showed a significant increase in SF and a decrease in Hb (122 +/- 11.6 to 112 +/- 15.2 g/L) at 35 wk of gestation. A significant effect of iron intake on sTfR was seen only among iron-deficient anemic women. CONCLUSIONS: These observations suggest that, during pregnancy, sTfR responds to iron supplementation when there is iron-deficiency anemia and therefore can be used as an indicator.     

Effects of haemoglobin and serum ferritin on cognitive function in school children

The association between iron deficiency anaemia and cognitive function impairment has been widely reported in young children, but whether the impairment is a result of iron deficiency per se or a combination of iron deficiency and anaemia, and how these conditions interact, is still questionable. Four hundred and twenty-seven school children from two schools in socioeconomically deprived communities were selected in southern Thailand. Iron status was determined by haemoglobin and serum ferritin concentrations. Cognitive function in this study was measured by IQ test and school performance, including Thai language and mathematics scores, using z-scores based on distributions within the same grade and school. Data on demography and socioeconomic status were collected by questionnaire answered by the parents. Linear regression models were used to investigate the effect of anaemia and iron deficiency, reflected by haemoglobin and serum ferritin concentration, on cognitive function and school performance. We found that cognitive function increased with increased haemoglobin concentration in children with iron deficiency, but did not change with haemoglobin concentration in children with normal serum ferritin level. Children with iron deficiency anaemia had consistently the poorest cognitive function (IQ, 74.6 points; Thai language score, 0.3 SD below average; and mathematics score, 0.5 SD below average). Children with non-anaemic iron deficiency but with high haemoglobin levels had significantly high cognitive function (IQ, 86.5 points; Thai language score, 0.8 SD above average; and mathematics score, 1.1 SD above average). This study found a dose-response relationship between haemoglobin and cognitive function in children with iron deficiency, whereas no similar evidence was found in iron sufficient children.     

补充维生素A与铁对改善学龄前儿童贫血和免疫功能的影响

目的为观察学龄前儿童亚临床维生素A(VA)缺乏状态缺铁时,机体免疫功能的变化以及VA与铁同时补充对改善儿童铁营养状况和免疫功能的影响.方法检测北京农村270名3～7岁儿童血清VA含量和血红蛋白(Hb)、血清铁(SI)、运铁蛋白饱和度(TS)及血清铁蛋白(SF)后,将其分为正常、低 VA、低铁和低VA低铁4组,每组选40人,检测血清免疫球蛋白IgA、IgG、IgM 与白细胞介素-2(IL-2).然后将低VA低铁组儿童随机分为补铁组 (每日口服相当于30 mg元素铁的硫酸亚铁,连续8周)和补VA+铁组(口服VA胶丸12 500 IU /次,2次/周,连续8周;口服铁量同补铁组,连续8周),分别进行干预.干预后重复检测血清VA、血液铁生化指标和以上免疫指标,进行两组间比较,并与干预前比较. 结果低VA低铁组儿童血清IgM为(1 260±310) mg/L显著高于正常组的(1 0 7 0±170) mg/L.对其实施VA+铁联合干预后,血清TS为(26.5±8.6)%,明显高于补铁前的(16.2±1.6)%和单纯补铁组的(22.3±3.8)%;IL-2在VA与铁同时补充后为(2 78.9±117.7) ng/L,显著高于补充前的(161.6±90.3) ng/L和单纯补铁组的(189 .5 ±89.3)ng/L的水平;其他铁生化指标和免疫指标无明显变化.结论对存在亚临床VA缺乏状态的缺铁儿童实施一定剂量的VA+铁联合干预,对改善机体铁营养状况和免疫功能有明显作用.     

铁缺乏儿童血清转铁蛋白受体的变化及对铁干预的反应

目的观察血清转铁蛋白受体(sTfR)在铁状况正常和不同程度缺铁儿童体内的水平和铁干预后的变化,评价sTfR在筛检人群铁缺乏和补铁效果中的价值.方法初筛北京房山区6～14岁儿童1006名,检测其铁生化指标,从中筛选铁正常、贮存铁减少(ID)、红细胞生成缺铁(IDE)和缺铁性贫血(IDA)儿童239名,采用双抗体夹心ELISA法测定sTfR含量,计算sTfR/log血清铁蛋白(SF).对铁缺乏儿童给予口服乙二胺四乙酸钠铁胶囊(60mg元素铁/粒),每次1粒,ID与IDE儿童,每周1次,IDA儿童每周3次,连续9周.补铁后重复测定铁生化指标与sTfR,比较补铁前后sTfR的变化.结果ID、IDE、IDA期儿童sTfR含量分别为(20.03±2.33)nmol/L、(24.52±1.07)nmol/L和(33.28±6.09)nmol/L,sTfR/logSF值分别为18.15±5.31、20.98±8.88和29.08±8.57,均显著高于正常对照组的sTfR(18.74±3.06)nmol/L与sTfR/logSF值9.89±1.74.sTfR与红细胞游离原卟啉(FEP)、血红蛋白(Hb)显著相关.正常儿童sTfR为12.5～23.5nmol/L.补铁后,ID、IDE与IDA期儿童sTfR含量为(16.37±3.10)nmol/L,明显低于补铁前水平,但在IDE与IDA期没有变化;ID期儿童sTfR/logSF值分别为11.42±3.12、16.54±4.70和23.59±9.93,与补铁前相比均显著降低.结论sTfR为鉴定铁缺乏IDE与IDA期的特异指标,sTfR/logSF为观察补铁效果的敏感指标.     

学龄前儿童血清铁水平及影响因素分析

目的 调查深圳市学龄前儿童血清铁营养素状况及其影响因素，为制定保护儿童健康措施提供科学依据。方法 采用分阶段整群随机抽样方法，抽取深圳市3所托幼机构的300名学龄前儿童作为调查对象，进行问卷调查和血清铁检测。用SPSS10．0统计分析软件进行描述性分析和单因素、多因素非条件Logistic逐步回归分析。结果 (1)深圳市学龄前儿童血清铁的平均水平中位数为12．60μmol／L，最小值为4．20μmol／L，最大值为49．00μmol／l。。男女性别间有显著性差异(t=2．369，P=0．018)，男性高于女性；不同年龄间差异无显著性意义(F=1．090。P=0．353)。(2)血清铁含量低于正常水平的占37．54％，男女性别间无显著性差异(χ2=0．4586，P=0．498)。(3)影响血清铁营养状况有6个主要因素，其中添加铁剂、添加鱼肝油、母乳喂养方式和母亲文化程度高是保护因素；近半年曾患贫血和近2月曾患呼吸道疾病是危险因素。结论 深圳市学龄前儿童中存在不同程度的血清铁缺乏状况，血清铁缺乏与多种因素有关。     

深圳市宝安区学龄前儿童血液铁含量的调查

目的:探讨深圳市宝安区学龄前儿童血液铁的含量,为学龄前儿童预防铁缺乏的合理保健,提供科学依据。方法:采用BH5100型多通道原子吸收光谱分析仪及专用配套试剂,严格按照仪器和试剂说明书操作。结果:小于2岁和大于7岁年龄组与其它各组比较P<0.01,差异非常显著。但随年龄递增血液铁的含量呈增加趋势。结论:年龄越小,学龄前儿童血液铁含量越低,小于2岁尤为显著。这应引起相关行政部门及妇幼保健院的足够重视。