NRAMP1基因INT4和3’UTR位点多态性与肺结核易感性的研究

目的 探讨人类自然抵抗相关巨噬细胞蛋白1（NRAMP1）基因INT4和3＇UTR位点多态性与中国北方汉族成人肺结核发病的关系.方法 采用1：1配对的病例对照研究设计,用聚合酶链反应-限制性片段长度多态性分析方法检测NRAMP1基因中INT4和3＇UTR两个多态性位点,对与肺结核相关的危险因素进行问卷调查,进行单因素和多因素条件logistic回归分析,同时对基因型与肺结核病变的性质和程度进行研究.结果 对124对研究对象进行了INT4和3＇UTR两个多态性位点的基因分型,3＇UTR TGTG＋/del基因型病例组频率显著高于对照组,粗OR值（95%CI）为2.923（1.557～5.487）.病例组和对照组INT4各基因型频率比较差异均无统计学意义.对17个环境危险因素进行了单因素分析,在多因素分析中调整卡痕、体重指数、人均居住面积、家族史4个因素后,3＇UTR TGTG＋/del基因型仍与肺结核显著相关,调整OR值（95%CI）为2.955（1.369～6.381）.在INT4不同基因型中,病例组和对照组肺结核病变性质差异具有统计学意义（x2=9.634,P＜0.05）.结论 NRAMP1基因3＇UTR位点多态性可能是中国北方汉族成人肺结核的易感因素,而INT4多态性可能与肺结核的病变性质有关系.     

自然抗性相关巨噬细胞蛋白1基因多态性与肺结核易感性的研究

目的　探讨自然抗性相关巨噬细胞蛋白 1基因 (NRAMP1)多态性与中国汉族人群肺结核发病的关系。方法　采用以医院为基础的病例对照研究设计 ,用聚合酶链反应 限制性片段长度多态性分析 (PCR RFLP)法检测NRAMP1基因中INT4、D5 4 3N及 3′UTR 3个多态性位点的基因型 ,并对结核病相关危险因素进行问卷调查 ,应用SPSS软件进行单因素和多因素非条件logistic回归分析。2 0 0 1年 4月至 2 0 0 2年 6月选择 110例肺结核病例 ,平均年龄为 (2 8± 13)岁 ;对照组为 180名健康体检者 ,平均年龄为 (2 7± 9)岁。对NRAMP1基因各多态性位点进行单因素分析。结果　病例组D5 4 3NG/A及 3′UTRTGTG +/del基因型频率显著高于对照组 ,OR值 (95 %CI)分别为 2 2 2 (1 0 3～ 4 78)和 1 93(1 14～ 3 2 6 )。病例组和对照INT4各基因型频率比较差异无显著性。多因素分析调整暴露史和疫苗接种史 2个因素后 ,D5 4 3NG/A及 3′UTRTGTG +/del基因型仍与结核病显著相关 ,调整OR值 (95 %CI)分别为 3 0 4 (1 12～ 8 2 7)和 2 36 (1 2 0～ 4 6 4 ) ,而病例和对照组INT4位点多态性比较差异未见显著性。结论　NRAMP1基因D5 4 3N及 3′UTR位点多态性可能是汉族人群肺结核的易感因素。     

Sex differences in prevalence of anaemia and iron deficiency in infancy in a large multi-country trial in South-East Asia

To evaluate effects of Fe supplementation and sex on the prevalence of anaemia and Fe status in infants in South-East Asia, biochemical data from four parallel, randomized, double-blind trials with Fe and/or Zn supplementation in infants (n 2452) in Indonesia, Thailand and Vietnam was pooled. At recruitment (5 months of age), Hb concentrations were slightly but significantly lower in boy infants compared with girl infants (108.7 g/l v. 111.4 g/l, P = 0.04). At 11 months of age, boy infants not receiving Fe had significantly lower Hb (106.2 g/l v. 111.0 g/l, P < 0.001) and lower serum ferritin concentrations (14.3 microg/l v. 21.1 g/l, P < 0.001) than girl infants not receiving Fe. Consequently, boy infants had a relative risk of 1.6 (95% CI 1.3, 2.1) to be anaemic, and of 3.3 (95% CI 2.1, 5.0) for having Fe deficiency anaemia compared with girl infants. Fe supplementation significantly increased Hb concentrations in both boys and girls. There was no sex difference in Fe status in infants receiving Fe for 6 months. This study shows that the markedly higher risk for anaemia and Fe deficiency indicates higher Fe requirements in boy than in girl infants. In South-East Asia, standard infant feeding practices do not provide sufficient Fe to meet requirements of infants, especially boys. Current daily recommended intake for Fe in infancy is the same for boy and girl infants however. Our findings suggest that in especially the second half of infancy, Fe requirements for boy infants are approximately 0.9 mg/d higher than for girl infants.     

Poor micronutrient status of active pulmonary tuberculosis patients in Indonesia

Malnutrition is observed frequently in patients with pulmonary tuberculosis (TB), but their nutritional status, especially of micronutrients, is still poorly documented. The objective of this study was to investigate the nutritional status of patients with active TB compared with that of healthy controls in Jakarta, Indonesia. In a case-control study, 41 out-patients aged 15-55 y with untreated active pulmonary TB were compared with 41 healthy controls selected from neighbors of the patients and matched for age and sex. Cases had clinical and radiographic abnormalities consistent with pulmonary TB and at least two sputum specimens showing acid-fast bacilli. Anthropometric and micronutrient status data were collected. Compared with the controls, TB patients had significantly lower body mass index, skinfold thicknesses (triceps, biceps, subscapular, suprailiac), mid-upper arm circumference, proportion of fat, and concentrations of serum albumin, blood hemoglobin, plasma retinol and plasma zinc, whereas plasma zinc protoporphyrin concentration, as a measure of free erythrocyte protoporphyrin concentration, was greater. When patients and controls were subdivided on the basis of nutritional status, concentrations of serum albumin, blood hemoglobin, and zinc and retinol in plasma were lower in malnourished TB patients than in well-nourished healthy controls, well-nourished TB patients and malnourished healthy controls. In conclusion, the nutritional status of patients with active pulmonary TB was poor compared with healthy subjects, i.e., significantly more patients were anemic and more had low plasma concentrations of retinol and zinc. Low concentrations of hemoglobin, and of retinol and zinc in plasma were more pronounced in malnourished TB patients.     

NRAMP1和SP110基因多态性与蒙古族结核病易患的关系

目的 探讨NRAMP1基因rs17235409A/G、NRAMP1基因rs17235416TGTG/(-)和Sp110基因rs3948464C/T位点（以下简称NRAMP1rs17235409、NRAMP1rs17235416、SP110rs3948464）基因多态性与蒙古族结核病易患的关系。方法 采用病例-对照研究,收集蒙古族132例结核病患者和108例健康体检者静脉血,应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)的方法检测3个位点基因分型,运用卡方检验、广义多因子降维法(Generalized Multifactor Dimensionality Reduction,GMDR)分析NRAMP1和Sp110基因多态性及交互作用与结核病易患的关系。 结果 (1)病例组和对照组NRAMP1rs17235409位点GG型,GA型,AA型和NRAMP1rs17235416位点TGTG/TGTG型,TGTG/(-)型,(-)/(-)型基因频率分别为66.67%,30.30%,3.03% vs 86.11%,12.96%,0.93%和60.61%,33.33%,6.06% vs 80.55%,18.52%,0.93%,2个位点基因型与等位基因型在两组的构成均存在差异(〖XC五号.EPS;P〗=12.178,〖XC五号.EPS;P〗=12.462;〖XC五号.EPS;P〗=11.935,〖XC五号.EPS;P〗=13.193,均P＜0.05)。(2)Sp110rs3948464位点CC型和CT型在病例组和对照组的基因频率分别为90.15%,9.85% 和71.30%,28.70%,2组间基因型与等位基因型构成存在差异 (〖XC五号.EPS;P〗=14.105;〖XC五号.EPS;P〗=12.681,均P＜0.05)。(3)GMDR法分析结果显示,NRAMP1rs3948464和NRAMP1rs17235409位点之间存在交互作用(P＜0.05)。结论 NRAMP1rs17235409,NRAMP1rs17235416和Sp110rs3948464位点基因多态性与蒙古族结核病易患有关,NRAMP1rs17235409,NRAMP1rs17235416两位点基因多态性存在交互作用。     

Effect of iron supplementation on mild to moderate anaemia in pulmonary tuberculosis

Anaemia is a common complication of pulmonary tuberculosis. The precise mechanism of anaemia in pulmonary tuberculosis is not clearly known, but anaemia of inflammation as well as of Fe deficiency has been implicated. Both are common in developing countries. It is extremely difficult to distinguish anaemia of Fe deficiency from anaemia of inflammation with the haematological indices used routinely. Therefore, Fe preparations are usually prescribed for all anaemic patients irrespective of the aetiology. This approach has been questioned. The present study aimed to assess the effect of Fe supplementation on anaemic patients with pulmonary tuberculosis. Adult male patients 15-60 years of age with pulmonary tuberculosis and a blood haemoglobin concentration 80-110 g/l were included in the study; healthy adult males matched for age and socio-economic status were taken as controls. Blood haemoglobin concentration, total erythrocyte count (TEC), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin and serum Fe, total Fe-binding capacity and ferritin were estimated before treatment and 1, 2 and 6 months after treatment. The patients were divided randomly into three groups and during the initial 2 months of treatment were provided with one of three supplementary regimens consisting of placebo, Fe alone or Fe with other haematinics. Significant improvements in haematological indices and Fe status were noticed in all three groups. Blood haemoglobin concentration, MCV and PCV were significantly higher at 1 month in both Fe-supplemented groups than the placebo group. This difference, however, disappeared at 2 and 6 months with similar values in all three groups. The increase of other haematological indices was similar in all groups. Serum Fe and Fe saturation of transferrin were significantly higher in both Fe-supplemented groups than the placebo group up to 2 months; this effect, however, disappeared at 6 months. There was a consistent increase in TEC and decrease in ferritin values up to 6 months in all groups. Radiological and clinical improvement was similar in all three groups. These observations suggest that Fe supplementation in mild to moderate anaemia associated with pulmonary tuberculosis accelerated the normal resumption of haematopoiesis in the initial phases by increasing Fe saturation of transferrin. However, consistent improvement of haematological status was dependent only on the improvement of the disease process.     

Effectiveness of weekly vitamin A (10,000 IU) and iron (60 mg) supplementation for adolescent boys and girls through schools in rural and urban East Java, Indonesia

OBJECTIVE: High prevalences of vitamin A deficiency and anaemia among adolescents warrant interventions. This study evaluated the effectiveness of school-based supplementation to reduce anaemia and improve vitamin A status. DESIGN: School-based, grade-randomized, intervention. SUBJECTS AND SETTING: In all, 1757 girls and 1859 boys, aged 12-15 y, in 24 Junior High Schools. INTERVENTIONS: Weekly supplementation for 14 weeks with 60 mg iron and 250 microg folate (Fe group; n=978), 10 000 IU vitamin A (VA group; n=970) or both (VAFe group; n=1042) to subjects in 15 schools, compared to subjects in nine other schools not receiving supplements (control; n=626). RESULTS: The baseline anaemia prevalence (Hb <120 g/l) in girls was 20% (prepubertal) and 26% (pubertal), and in boys 24% (pre-pubertal) and 11% (pubertal). Serum retinol concentrations were low (<1.05 micromol/l) in 41% of boys and 45% of girls. The interventions did not increase haemoglobin concentrations. Serum retinol concentration of boys, but not girls, in the VA group increased (0.33 vs 0.07 micromol/l in controls; P<0.01). The risk factors for low serum retinol concentration were lower baseline serum retinol concentration (OR 0.02-0.03) with, for girls, nightblindness at baseline (OR 5.88), and for boys, not receiving vitamin A (OR control: 1.00; VA: 0.37; Fe: 0.77; VAFe: 0.34) and maternal illiteracy (OR mother never attended school 1.00, mother received any formal education 0.17-0.33). CONCLUSIONS: Supplementation with vitamin A increased serum retinol concentration of boys. Iron supplementation did not change Hb. This appeared to be due to poor compliance, and partly related to side effects.     

NRAMP1基因3'UTR多态性与大理地区彝族肺结核易感相关性研究

目的 探讨NRAMP1基因3'UTR位点多态性与大理彝族肺结核病易感相关性及抗结核疗效的联系。方法 采用PCR - RFLP方法检测102例彝族肺结核病人及108例彝族健康人群的NRAMP1基因3'UTR位点的基因型,分析其与彝族人群患肺结核病的易感相关性,且对病人进行抗结核治疗1月后随访及不良反应观察,分析NRAMP1基因多态性与病人抗结核疗效的关系。结果 病例组中NRAMP1基因3'UTR位点AA基因型频率为20.59%,对照组中为5.55%,组间分布差异有统计学意义,χ2 = 14.135,P＜0.001。具有AA基因型的彝族患者肺结核的OR值为6.250,95% CI为2.404～16.247。抗结核治疗后,各基因型患者间胃肠道反应、肝损害及关节损害不良反应的发生率不同,突变型（GA + AA）患者比野生型（GG型）患者更易发生胃肠道反应、肝损伤、关节损害3种不良反应（P＜0.05）。需临床处理的较重不良反应在突变型（GA + AA）患者及野生型（GG型）患者中无统计学差异（P＞0.05）。结论 NRAMP1基因3'UTR位点多态性与大理彝族人群肺结核的易感性相关,可能是大理地区彝族人群肺结核易感的影响因素。A等位基因可能是大理彝族人群肺结核病发病危险因素（OR = 2.069,95% CI = 1.389～3.082 ）。患者抗结核治疗后发生的不良反应情况与NRAMP1基因3'UTR位点多态性存在相关性。     

MBL基因H/L、P/Q位点多态性与新疆维吾尔族结核病的相关性研究

目的探讨MBL基因H/L、P/Q位点的多态性是否与新疆维吾尔族人群结核病发病相关。方法通过使用引物序列特异性PCR（PCR-SSP）的方法分别对226例新疆维吾尔族活动性肺结核患者及231例有结核分枝杆菌接触史的新疆维吾尔族健康者研究MBL基因的H/L、P/Q多态性位点与新疆维吾尔族人群结核病易感性的关系。结果新疆维吾尔族结核病例组中MBL-H/L突变基因型频率与新疆维吾尔族健康对照组突变基因型频率分别为25.66%、18.18%,差异无统计学意义（OR=1.600,95%CI：1.020～2.511,P=0.040,Pc=0.052〉0.05）。新疆维吾尔族结核病例组中MBL-P/Q突变基因型频率与新疆维吾尔族健康对照组突变基因型频率分别为10.62%、10.82%,差异无统计学意义（OR=0.979,95%CI：0.541~1.797,P=0.050,Pc=0.994〉0.05）。MBL-AB等位基因型与MBL-HL等位基因在病例组的相交系数为0.018,P值为0.006〈0.05。新疆维吾尔族人群MBL-A/B,H/L,P/Q之间测出4个单倍体型：HPA,LPA,LPB,LQA。结论新疆维吾尔族人群中MBL基因H/L、P/Q多态性与结核病易感性无明显相关性。新疆维吾尔族人群MBL-A/B,H/L,P/Q等位基因型之间存在连锁不平衡,MBL-A/B等位基因型与MBL-H/L等位基因有正向交互作用。     

Low folic acid status and its association with anaemia in urban adolescent girls and women of childbearing age in Sri Lanka

Folic acid deficiency is implicated in the aetiology of nutritional anaemia and adverse pregnancy outcomes for the fetus. Data on folic acid status among adolescent girls and non-pregnant, non-lactating young women are limited. We assessed folic acid status in a random sample of 552 subjects (277 adolescent girls aged 15-18.9 years and 275 women aged 19-30 years) living in Colombo, Sri Lanka. The association of low folic acid status with anaemia was evaluated. Socio-economic, food intake and anthropometric data were obtained. Hb, serum folic acid, vitamin B12 and ferritin and plasma homocysteine concentrations were measured. Forty-three per cent of subjects studied had low serum folic acid concentrations (<3 ng/ml) and 47 % had low Fe stores (serum ferritin <20 microg/l). Overall prevalence of anaemia was 12.9 %, and 43.9 % of anaemic subjects had both low folic acid status and depleted Fe stores (serum ferritin <12 microg/l). Both low folate status and depleted Fe stores were significantly associated with anaemia (odds ratio = 2.32; 95 % CI 1.34, 4.01 and odds ratio = 5.98; 95 % CI 3.36, 10.63, respectively). Serum folic acid concentration was associated (r = 0.108, P = 0.015) with folate intake as indicated by a computed folate index. Folate index was associated inversely with household size and positively with economic status and education level. In this study population low folic acid status, besides depleted Fe stores, was associated with anaemia. The high prevalence of low folic acid status observed highlights the need for nutrition education to improve intakes of folate, Fe and other micronutrients among adolescent girls and young women.     

Vitamin D and tuberculosis

Tuberculosis is highly prevalent worldwide, accounting for nearly two million deaths annually. Vitamin D influences the immune response to tuberculosis, and vitamin D deficiency has been associated with increased tuberculosis risk in different populations. Genetic variability may influence host susceptibility to developing active tuberculosis and treatment response. Studies examining the association between genetic polymorphisms, particularly the gene coding for the vitamin D receptor (VDR), and TB susceptibility and treatment response are inconclusive. However, sufficient evidence is available to warrant larger epidemiologic studies that should aim to identify possible interactions between VDR polymorphisms and vitamin D status.     

Postnatal anaemia: neglected problems and missed opportunities in Uganda

Anaemia is a neglected disorder that affects a huge proportion of women, particularly in developing countries. In a cross-sectional study among 349 mothers attending child clinics in Tororo District, eastern Uganda, who had delivered within 12 months prior to the study, the magnitude and prevalence of anaemia, important risk factors for anaemia and the usefulness of clinical examination and patient history as a screening tool were determined. Approximately two-thirds (64.4%) of the women were anaemic, with 55 (15.8%) suffering from moderate to severe anaemia (Hb < 10.0 g/dl) and 169 (48.6%) with mild anaemia (10.0-11.9 g/dl). Five (1.4%) women suffered from severe anaemia (Hb < 7.0 g/dl). Only iron supplementation and excessive bleeding during or after delivery emerged as risk factors using multinominal regression modelling. Lack of iron supplementation was a factor for mild anaemia (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.5-4.2), but not for moderate to severe anaemia. Excessive bleeding was a risk factor for moderate to severe anaemia (OR 2.3; 95% CI 1.1-4.7), but not for mild anaemia. The sensitivity of using clinical signs to detect anaemia (hb < 12.0 g/dl) was relatively high (0.74; 95% CI 0.7-0.8), but with a low specificity (0.4; 95% CI 0.3-0.6). Although anaemia in postnatal women is widespread, the health care system had missed the opportunities to effectively address it, such as through the implementation of the WHO policy recommendation for iron and folic acid supplementation, improvement of obstetric services and, despite its imperfection, screening for anaemia using clinical signs.     

Nutritional status of schoolchildren in rural Iran

The present study compared the nutritional status of schoolchildren from recently settled, ethnic minority tribespeople with those from a Persian village in southern Iran. Height and weight were measured and blood was collected from school children at three time points over 1.5 years. Supplemental Fe was provided to children with low Hb after the first screening. Twenty-one per cent of the children were wasted, 57 % were stunted and 23 % were anaemic. No statistically significant difference in the prevalence of wasting, stunting and anaemia was found between gender or ethnic groups. Children over the age of 12 years had a higher prevalence of wasting than children aged below 12 years. In a sub-sample of forty-one children the average BMI-for-age decreased. Fe supplementation increased Hb levels to normal in most children, but did not increase Fe level in a few children. Dietary deficiency of micronutrients, especially Zn and Fe, probably accounts for the high prevalence of stunting and anaemia in these children. Infection with Helicobacter pylori is another possible explanation for the Fe-deficiency anaemia. Further investigation is in progress to determine the cause(s) of the observed deficiencies.     

Heinz body anaemia in lambs with deficiencies of copper or selenium

1. The progression of Heinz body anaemia was studied in groups of lambs of low- and high-copper status, produced through breeding or Cu supplementation, when they were transferred from improved pasture to rape (Brassica napus L.) in autumn. Some lambs had previously received selenium by injection. The Cu and Se supplements markedly increased superoxide dismutase (EC 1.15.1.1; SOD) and glutathione peroxidase (EC 1.11.1.9; GSHPx) activities respectively in the erythrocytes, and both supplements had elicited growth responses at pasture. 2. At the time of transfer to rape, lambs not treated with Cu had lower whole-blood haemoglobin (Hb) concentrations and a higher percentage of erythrocytes containing Heinz bodies (6.6 v. 3.7%, P less than 0.01) than Cu-treated lambs: the corresponding effects of Se treatment were similar in direction but lower in magnitude (P less than 0.05). 3. After grazing rape for 2 weeks the mean Hb concentration had fallen by 30 g/l while Heinz body count had increased from 5 to 25%. However, counts were negatively correlated with the initial values and were unaffected by the Cu and Se treatments which maintained high plasma Cu concentrations and SOD and GSHPx activities. 4. The results provide the first evidence that Cu deficiency can induce Heinz body formation and the anaemia in grazing Cu-deficient lambs may be partly haemolytic in origin. The concomitant Se deficiency added marginally to the problem but neither the separate nor combined deficiencies increased the susceptibility of lambs to brassica anaemia.     

Zinc-induced anemia in young japanese quail ameliorated by supplemental copper and iron

Studies were conducted to examine whether anemia induced in newly hatched Japanese quail by moderate dietary Zn supplements could be corrected by supplemental Fe, Cu, or Mg by 14 d of age. Low hemoglobin (Hb) was partially alleviated by increased levels of Fe or Cu, but normal Hb was obtained only with Fe plus Cu. Fe and Cu concentrations in the liver were decreased at 7 d, prior to the development of anemia by 13 d. Additional Mg had no effect on low Hb caused by Zn. Copper supplementation partially alleviated the growth depression and entirely prevented the lack of feather pigmentation that resulted from Zn toxicosis. Neither Fe nor Mg affected either of these parameters. These data indicate that both Fe and Cu status of an individual may be compromised by dietary Zn supplementation.     

NRAMP1基因和人类对结核分枝杆菌的易感性

NRAMP1基因,又称SLC11A1基因,位于2号染色体长臂35区(2q35),包括15个外显子及内含子4中交替出现的1个外显子,长13 604 bp.NRAMP1的常见多态性基因有D543N、3′UTR、INT4和5′(GT)n等,和结核易感性相关.NRAMP1蛋白由巨噬细胞表达,是一种H+/二价阳离子的反向转运体,对巨噬细胞的功能有多效性.此文对NRAMP1基因及其和MTB的易感相关性的研究结果进行综述.     

MBL2 gene polymorphisms and susceptibility to tuberculosis in a northeastern Brazilian population

The innate immune system represents the first line of host defense against pathogens. Genetics factors regulating the immune responses play a role in the susceptibility to infectious diseases, such as tuberculosis (TB). We analyzed MBL2 promoter and exon 1 functional single nucleotide polymorphisms (SNPs) in a group of 155 TB patients and 148 healthy controls in order to evaluate their influence on the onset of infection and TB development. There was no association between MBL2 −550 HL promoter polymorphisms and susceptibility to develop TB, but heterozygous −221 Y/X genotype was significantly more frequent in pulmonary TB patients than controls. Moreover, MBL2 exon 1 O allele, was significantly associated with susceptibility to TB development in general (p = 0.023, OR = 1.61, 95% CI 1.05–2.49) and pulmonary TB (p = 0.0008, OR = 2.16, 95% CI 1.35–3.46); C allele at codon 57, as well as A/C genotype, were significantly more frequent in TB patients than in controls. Our results indicate that MBL2 polymorphisms, especially at codon 57, could be considered as risk factors for TB development.     

The silent burden of anaemia in Tanzanian children: a community-based study

OBJECTIVE: To document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old, thereby assisting in the development of effective strategies for controlling anaemia. METHODS: Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed. FINDINGS: Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6-11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1-5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was not associated with risk of anaemia. CONCLUSION: Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria.     

人类NRAMP1基因单核苷酸多态与接尘工人肺结核易感性

目的 探讨人类自然抵抗相关巨噬细胞蛋白1（NRAMP1）基因多态性与接尘工人肺结核易感性的关系.方法 采用1：2病例对照设计,按年龄相差小于5岁,工种、吸烟、饮酒率、总粉尘接触量和矽肺患病同比例匹配,选择61例男性肺结核患者为病例组（矽肺50例、非矽肺11例）,122例男性无肺结核者为对照组（矽肺100例、非矽肺22例）.应用聚合酶链反应-限制性片段长度多态性分析（PCR-RFLP）技术检测NRAMP1 INT4和D543N位点的多态性.结果 NRAMP1 INT4多态位点野生纯合子（G/G）、杂合子（G/C）和突变纯合子（C/C）在病例组的分布频率分别为63.9%、34.4%、1.6%,与对照组比较,差异有统计学意义（P＜0.05）,NRAMP1 INT4 C等位基因携带者患肺结核的危险性升高（OR=2.73,95% CI：1.32～5.64）,D543N位点多态与接尘工人肺结核易感性之间无关联（P＞0.05）.结论 NRAMP1基因第4内含子G＞C单核苷酸可能是接尘工人肺结核的易感因素.     

Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan.

BACKGROUND: A high prevalence of 50-65% iron-deficiency anaemia in mothers and infants in Jordan was reported by the United Nations Relief and Works Agency (UNRWA) in 1990. Iron-deficiency in infancy has been shown to delay cognitive and psychomotor development with long-term consequences. While socioeconomic deprivation and inadequate nutrition are known underlying factors, it is unclear whether iron endowment at birth is compromised when mothers are anaemic, further jeopardizing iron status during infancy. A prospective case-control study of infants from birth to one year was conducted in a lower middle-class urban setting in Amman, Jordan. The study objective was to examine the relationship between maternal anaemia and iron-deficiency anaemia during infancy. METHOD: A sample of 107 anaemic (Hb < 11 g/dl) and 125 non-anaemic mothers was selected at 37 weeks' gestation and matched for age and parity, and infant data at birth obtained. The infants were reviewed at 3, 6, 9 and 12 months, to assess growth, current nutrition, infection rates and iron status. The main outcome measure was the incidence of iron-deficiency anaemia in the two groups of infants, defined in the study as Hb < 11 g/dl and either plasma ferritin < 12 mcg/l or zinc protoporphyrin > 35 mcg/dl. RESULTS: Iron endowment in cord blood samples appeared similar between the two groups. The incidence of iron-deficiency anaemia was very high in these infants, at 72% by research criteria, (51% if Hb < 10.5 g/dl), but significantly higher in the infants born to anaemic mothers at all stages of the year, with overall incidence of 81% (n = 91), compared to 65% in controls (n = 112). This was not explained by differences in environmental risk factors. Anaemic mothers had not recovered adequate iron status at 6 months' postpartum, with implications for future pregnancy iron demands. CONCLUSIONS: Anaemia during pregnancy compromises the health of mothers in traditional cultures, where women tend to have several children close together after marriage, with an inadequate interval to replenish nutritional stores. Their infants also appear to be at increased risk of developing iron-deficiency anaemia, undetected at birth.