铁超载的估计及其非线性相关性

P. Chowdhury, M. Saha, S. Karpurkayastha, D. Chowdhury, R. Jena
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引用次数: 2

摘要

就单基因疾病而言,地中海贫血和血红蛋白病的病例数量最多,输血和铁螯合仍然是治疗的主要方法。根据输血的需要,地中海贫血分为两类:1)输血依赖型,2)非输血依赖型。非输血依赖型地中海贫血患者,与以往的看法相反,患有铁超载。如果这种铁是通过血清铁蛋白水平来估计的,它与肝铁和/或心脏铁没有线性相关。在我们的研究中注意到,高达300 ng/ml的血清铁蛋白水平与高达3mg /g DLT的肝铁负荷几乎呈线性相关,在平均值的+0.5 SD范围内。少数患者血清铁蛋白水平相对于相应的肝铁含量(MRI测量)大于+1.0 SD,部分患者甚至≥2.5 SD。除了血清铁蛋白(也是急性炎症的标志物)外,还评估了CRP。可见,在这些患者中,CRP也较高。研究人员对他们进行了乙肝、丙肝检查,并对他们进行了肺结核检查。在350例患者中,18例(5.14%)患者血清铁蛋白水平≥1.0 SD,结核阳性08例,丙型肝炎阳性05例,乙型肝炎阳性01例。在18例(77.77%)被筛选为超出SD范围的患者中,有14例(77.77%)患者除了原发疾病外,还存在一些感染性病理,由于观察到这种差异而被检测出来。他们正在接受适合诊断的治疗。综上所述,在血清铁蛋白水平与相应的肝铁呈线性相关的范围内,其值为> - 1.0 SD的平均值,应进行临床检查,排除肝炎、肺结核等感染的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Estimation of Iron Overload-Implications of its Non-linear Correlation
Thalassaemias and haemoglobinopathies contribute the highest number of cases, as far as single gene disorders are concerned, where blood transfusion and iron chelation remain the mainstays of therapy. Depending upon the requirement of transfusion, thalassaemias have been classified into two categories: 1) Transfusion dependent, 2) Non-transfusion dependent. Non-transfusion dependent thalassaemia patients, contrary to previous belief, suffer from iron overload. If this iron is estimated by the level of ferritin in serum, it does not linearly correlate to hepatic and/or cardiac iron. It was noted during our study that serum ferritin levels up to 300 ng/ml correlated with hepatic iron load of up to 3 mg/g of DLT almost linearly, within +0.5 SD of mean. There were a few patients in whom the serum ferritin level compared to the corresponding hepatic iron content (as measured by MRI) was more than +1.0 SD, and in some patients it was even ≥ 2.5 SD. In addition to serum ferritin, which is also a marker of acute inflammation, CRP was also estimated. It was seen that in these patients, CRP was also high. They were investigated for Hepatitis B, C and work ups were done for Tuberculosis. Out of the 350 such patients who were examined, 18 patients (5.14%) had their level of serum ferritin ≥ 1.0 SD, 08 tested positive for Tuberculosis, and 05 tested Positive for Hepatitis C and 01 for Hepatitis B. 14 patients out of the 18 (77.77%), who were screened to be out of the limits of SD had some infectious pathology in addition to their primary disorder, which was detected due to this observed discrepancy. They are undergoing treatment as appropriate for the diagnosis. In conclusion, in the range where the level of serum ferritin is linearly correlated to the corresponding hepatic iron, the value was >1.0 SD of mean, clinical investigations should be done to exclude possibilities of infections like Hepatitis and Tuberculosis.
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