炎症性肠病合并缺铁性贫血的诊治进展  

Advances in the diagnosis and treatment of iron deficiency anemia in inflammatory bowel disease

作　　者：陈乐燕 吴雄健 CHEN Le-yan;WU Xiong-jian(The First Clinical Medical School of Gannan Medical University;Department of Gastroenterology,The First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi 341000)

机构地区：[1]赣南医科大学第一临床医学院 [2]赣南医科大学第一附属医院消化内科,江西赣州341000

出　　处：《赣南医科大学学报》2024年第10期1064-1070,共7页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：贫血是炎症性肠病(Inflammatory bowel disease,IBD)最常见的合并表现,患病率为6%~74%,对患者生存率及生活质量有负面影响。其中缺铁性贫血(Iron deficiency anemia,IDA)是IBD患者中最常见的贫血类型。临床上评估IBD患者的铁状态一般采取血红蛋白、红细胞压积、平均血红蛋白量等常见的血生化指标,但忽略了炎症状态对其检测值的影响。因此,需要较新的铁指标,如网织红细胞含量、低色素红细胞百分比、铁调素水平等对IBD患者铁状态进行评估。口服铁剂通常是临床上用于IDA的一线治疗,但大多数患者有严重的胃肠道反应,另外,国内外多项研究表明,在IBD患者中口服铁剂可能会导致疾病本身恶化,因此,目前的指南建议IBD患者采用静脉补铁方式。本文就IDA合并IBD的病因、临床表现、改进的诊断和治疗策略进行综述。Anemia is the most common combined manifestation of inflammatory bowel disease(IBD),with a prevalence ranging from 6%to 74%.It has a negative impact on patient survival and quality of life.Of these,iron deficiency anemia(IDA)is the most common type of anemia in patients of IBD.Clinical assessment of iron status in patients with IBD generally takes common blood biochemicals such as hemoglobin,erythrocyte pressure,and mean hemoglobin volume,but ignores the effect of inflammatory status on their test values.Therefore,newer iron markers such as reticulocyte content,percentage of low pigment red blood cells,and levels of ferritin should be considered to evaluate iron status in IBD patients.Oral iron is usually the first line of treatment used clinically for IDA,but most patients have severe gastrointestinal reactions.In addition,a variety of data at home and abroad suggest that oral iron may cause worsening of the disease itself in patients with IBD.Therefore,current guidelines recommend intravenous iron.This article reviews the etiology factors of IDA in IBD,clinical manifestations,improved diagnosis and treatment strategies.

关 键 词：炎症性肠病 缺铁性贫血 铁缺乏 铁调素 口服铁 静脉补铁 

分 类 号：R574.6[医药卫生—消化系统]