再生障碍性贫血患者铁过载情况及影响因素分析

目的 探讨再生障碍性贫血(aplastic anemia,AA)患者铁过载情况及铁过载的影响因素。 方法 选择宁波市第一医院、宁波市第二医院、安徽医科大学附属阜阳医院血液科2014年3月-2018年3月初诊的成人AA患者200例。收集患者临床资料,采用放射免疫法测定血清铁蛋白(ferritin,SF)水平,采用亚铁嗪比色法测定总铁结合力(total iron binding force,TIBC)和血清铁(serum iron,SI)水平,采用免疫比浊法测定血清可溶性转铁蛋白受体(soluble transferrin receptor,sTfR)和转铁蛋白(transferrin,Tf)水平,计算转铁蛋白饱和度(transferrin saturation,TS)。 结果 200例AA患者SF为1 253.25(519.06,1 757.17)μg/L,SI为33.31(21.60,56.66)μmol/L,TS为62.02%(30.88%,74.60%),Tf为1.87(1.60,2.71)g/L,sTfR为0.93(0.54,2.10)mg/L,200例AA患者中发生铁过载29例,铁过载发生率为14.5%。男性、重型AA、输血>8 U、合并感染者铁过载的比例高于无铁过载者(P<0.05),年龄、病因、病程与AA铁过载无关(P>0.05)。Logistic回归分析结果显示:男性、输血>8 U、合并感染为AA铁过载发生的独立危险因素(P<0.05)。 结论 AA患者铁过载发生率高,男性、输血>8 U、合并感染为AA患者铁过载发生的独立危险因素。 

Iron overload condition and its influencing factors in patients with aplastic anemia

Objective To investigate the iron overload and its influencing factors in patients with aplastic anemia (AA). Methods A total of 200 adult AA patients were selected in Department of Hematology of the First Hospital of Ningbo, the Second Hospital of Ningbo City and the Fuyang Hospital Affiliated to Anhui Medical University from March, 2014 to March, 2018. The clinical data of patients were collected. The serum ferritin (SF) levels were measured by radioimmunoassay. The levels of total iron binding force (TIBC) and serum iron (SI) were determined by the colorimetric method of ferrozine. The levels of soluble transferrin receptor (sTfR) and transferrin (Tf) were determined by immunoturbidimetry. The transferrin saturation (TS) was calculated. Results In 200 patients with AA, the SF was 1 253.25(519.06, 1 757.17) μg/L, SI was 33.31 (21.60, 56.66) μmol/L, TS was 62.02%(30.88%, 74.60%), the Tf was 1.87 (1.60, 2.71)g/L, and the sTfR was 0.93 (0.54, 2.10)mg/L. In 200 patients with AA, iron overload occurred in 29 patients, with an overload rate of 14.5%. The proportion of iron overload in males, heavy AA, blood transfusion >8 U and coinfection were higher than that of without iron overload (P<0.05). The age, etiology and course of disease were not associated with iron overload in AA (P>0.05). Logistic regression analysis showed that men, blood transfusion >8 U and coinfection were independent risk factors for iron overload in AA (P<0.05). Conclusion The incidence of iron overload in AA patients is high. Males, blood transfusion >8 U and coinfection are independent risk factors for iron overload in AA patients.