Iron and its relation to immunity and infectious disease
Iron and its relation to immunity and infectious disease
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DOI：
10.1093/jn/131.2.616s
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发表时间：
2001-02-01
影响因子：
4.2
通讯作者：
Oppenheimer, SJ
中科院分区：
文献类型：
--
作者：
Oppenheimer, SJ
铁和感染的相互作用的持续未解决的争论表明，需要对临床发病率结果进行定量评价。铁缺乏与免疫功能的可逆性异常有关，但在观察性研究中很难证明这些异常的严重程度和相关性。铁治疗与感染的急性加重有关，特别是疟疾。口服铁与临床疟疾发病率增加（9项研究中的5项）和其他传染病发病率增加（8项研究中的4项）相关。在大多数情况下，使用治疗剂量的口服铁。在疟疾流行地区的研究没有显示出益处。在规划干预措施时，必须了解当地贫血病因的流行情况，包括缺铁、季节性疟疾流行、保护性血红蛋白病和年龄特异性免疫。必须在口服铁剂的剂量和干预的时机与年龄和疟疾传播之间取得平衡。抗疟干预很重要。没有口服铁补充剂的研究清楚地表明在非疟疾流行地区的有害影响。在非疟疾流行地区的两项非常早期的研究中，牛奶强化降低了呼吸道疾病的发病率，但这在后来的三项强化研究中没有得到证实，而且仅通过母乳喂养可以实现更好的发病率。一项在印度尼西亚非疟疾流行区进行的研究表明，贫血学童口服补铁剂后，感染结果减少。没有系统的研究报告口服铁补充剂和非疟疾流行地区母乳喂养的婴儿感染性发病率。
The continuing unresolved debate over the interaction of iron and infection indicates a need for quantitative review of clinical morbidity outcomes. Iron deficiency is associated with reversible abnormalities of immune function, but it is difficult to demonstrate the severity and relevance of these in observational studies. Iron treatment has been associated with acute exacerbations of infection, in particular, malaria. Oral iron has been associated with increased rates of clinical malaria (5 of 9 studies) and increased morbidity from other infectious disease (4 of 8 studies). in most instances, therapeutic doses of oral iron were used. No studies in malarial regions showed benefits. Knowledge of local prevalence of causes of anemia including iron deficiency, seasonal malarial endemicity, protective hemoglobinopathies and age-specific immunity is essential in planning interventions. A balance must be struck in dose of oral iron and the timing of intervention with respect to age and malaria transmission. Antimalarial intervention is important. No studies of oral iron supplementation clearly show deleterious effects in nonmalarious areas. Milk fortification reduced morbidity due to respiratory disease in two very early studies in nonmalarious regions, but this was not confirmed in three later fortification studies, and better morbidity rates could be achieved by breast-feeding alone. One study in a nonmalarious area of Indonesia showed reduced infectious outcome after oral iron supplementation of anemic schoolchildren. No systematic studies report oral iron supplementation and infectious morbidity in breast-fed infants in nonmalarious regions.