紫绀型先天性心脏病患儿血清铁及总铁结合力的变化及意义

目的检测紫绀型先天性心脏病患儿血红蛋白、平均红细胞压积、血清铁、总铁结合力及心肌组织铁分布的改变,并探讨其意义。方法入组2011年5-11月于新桥医院心外科行手术治疗的先天性心脏病患儿22例,其中男性14例,女性8例,紫绀型先天性心脏病患儿10例,非紫绀先天性心脏病患儿12例。以静脉血为标本,送本院检验科检验血红蛋白及平均红细胞压积,以亚铁嗪法检测血清铁及总铁结合力,以术中右室流出道心肌为标本,Perls-DAB法检测心肌组织中铁的分布。结果与非紫绀组患儿相比,紫绀组先心病患儿血红蛋白含量及平均红细胞压积都明显升高(P<0.05)。紫绀先天性心脏病患儿血清铁含量明显低于非紫绀患儿(23.25±4.4)μmol/L vs(31.34±4.2)μmol/L,P<0.01],并伴有总铁结合力的增加(69.59±5.8)μmol/L vs(52.67±9.2)μmol/L,P<0.01]。紫绀组患儿心肌组织中铁含量明显增加(P<0.01),广泛分布于心肌中。结论紫绀先天性心脏病患儿机体处于铁储备相对缺乏状态,而心肌组织内铁含量增加可能为心肌在缺氧环境下的代偿反应。

Changes of serum iron and total iron-binding capacity of infants with cyanotic congenital heart disease

Objective To examine the levels of hemoglobin,mean corpuscular volume,serum iron and total iron-binding capacity and the distribution of iron in myocardium of infants with cyanotic congenital heart disease,and to explore the significance.Methods A total of 22 infants with cyanotic(n=10) and acyanotic(n=12) congenital heart disease admitted in our hospital from May 2011 to November 2011 were enrolled.Venous blood was collected for the determination of hemoglobin and mean corpuscular volume,and serum iron and total iron-binding capacity were detected by ferrozine method.The right ventricular myocardium collected during operation was prepared for the detection of iron distribution in myocardium by Perls-DAB.Results Compared with the infants with acyanotic congenital heart disease,the infants with cyanotic congenital heart disease had higher levels of hemoglobin(P<0.05),mean corpuscular volume(P<0.05) and total iron-binding capacity(69.59±5.8 vs 52.67±9.2 μmol/L,P<0.01),and a lower level of serum iron(23.25±4.4 vs 31.34±4.2 μmol/L,P<0.01).The myocardial iron content was significantly higher and the myocardial iron distribution was more extensive in the infants with cyanotic congenital heart disease than in the infants with acyanotic congenital heart disease(P<0.01).Conclusion Chronic hypoxia leads to a relative deficiency of iron storage in infants with cyanotic congenital heart disease,while the increase of iron content in myocardium may be an adaptive response of the heart to chronic hypoxia.