超高海拔地区成人铁代谢水平调查

孙舒瑶; 王溯源; 尹蓉; 李曼; 伊雯; 蒲雪; 刘春蓉; 邬云红; 张成慧

doi:10.16766/j.cnki.issn.1674-4152.004062

超高海拔地区成人铁代谢水平调查

doi: 10.16766/j.cnki.issn.1674-4152.004062

孙舒瑶¹,
王溯源¹,
尹蓉²,
李曼³,
伊雯⁴,
蒲雪⁵,
刘春蓉⁶,
邬云红¹,
张成慧^1, ,

1.
西藏自治区人民政府驻成都办事处医院内分泌科，四川成都 610041
2.
西藏自治区人民政府驻成都办事处医院肾内科，四川成都 610041
3.
西藏自治区人民政府驻成都办事处医院放射诊断科，四川成都 610041
4.
西藏自治区人民政府驻成都办事处医院手术室，四川成都 610041
5.
西藏自治区人民政府驻成都办事处医院心内科，四川成都 610041
6.
西藏自治区人民政府驻成都办事处医院重症医学科，四川成都 610041

基金项目:

西藏科技厅自然科学基金项目 XZ202201ZR0037G

详细信息

通讯作者:
张成慧，E-mail：zchscu0616@163.com

中图分类号: R589.9
计量
- 文章访问数: 10
- HTML全文浏览量: 9
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-10
- 网络出版日期: 2025-09-04

Investigation of iron metabolism level in adults in ultra-high altitude area

1.
Department of Endocrinology and Metabolism, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan 610041, China

摘要

摘要: 目的高原低氧环境会影响人体内铁的代谢，本文拟探讨长驻超高海拔地区(海拔3 500~5 500 m)人群的铁代谢水平。方法于2021年3—9月对长期居住在安多县(平均海拔4 800 m)的成年居民进行资料收集，排除有酗酒、肝硬化、急慢性感染、血液系统疾病的患者。记录一般资料，完成血常规、铁代谢指标以及生化指标的检测。根据铁蛋白水平将研究对象分为2组，正常组和铁过载组(铁蛋白≥1 000 ng/mL)。采用回归分析筛查影响铁蛋白的因素。结果共纳入361名受试者，其中女性130名，男性231名。铁过载患者28人(7.8%)，全部为男性，其中23人为藏族。与正常组比较，铁过载组的年龄、BMI、高原居住时间、平均血红蛋白浓度(MCHC)、谷丙转氨酶、谷草转氨酶、γ-谷氨酰基转移酶(GGT)、促红细胞生成素(EPO)、超敏C反应蛋白均更高。LASSO回归分析显示，年龄、高原暴露时间、BMI、ALT、GGT、EPO、MCHC均为铁蛋白水平的影响因素。多元线性回归分析显示，超高海拔地区成人铁蛋白水平主要相关因素包括性别(β'= -218.094，95% CI：-301.763~-134.425)、年龄(高原暴露时间，β' =13.203，95% CI：5.850~20.557)、MCHC(β' =4.602，95% CI：1.130~8.080)、ALT(β'=1.910，95% CI：0.038~3.782)、EPO(β'=9.908，95% CI：5.027~14.790)。结论超高海拔地区成人铁蛋白升高可能与低氧适应有关，而过高的铁蛋白水平即铁过载是否对健康产生不利影响，需要进一步研究。
- 铁代谢 /
- 铁过载 /
- 超高海拔 /
- 促红细胞生成素 /
- 铁调素
Abstract: Objective The low oxygen concentration at high altitudes can affect iron metabolism in the human body. The purpose of this study was to explore the iron metabolism in plateau populations living at ultra-high altitude areas (from 3 500 to 5 500 m). Methods Adult volunteers living in Amdo County (4 800 m above sea level) were recruited, and they provided blood samples for analyses. Patients with alcoholism, cirrhosis, acute or chronic infection, and hematological diseases were excluded. General information was recorded, and the detection of blood routine, iron metabolism indicators, and biochemical indicators were completed. Participants were divided into two groups according to serum ferritin levels: the normal group and the iron overload group (serum ferritin ≥ 1 000 ng/mL). Regression analysis was used to screen for causes affecting ferritin. Results A total of 361 participants were included, 130 of whom were female, 231 of whom were male. Twenty-eight participants (7.8%) were diagnosed with iron overload, all were male, 23 of whom were Tibetan. Compared with the normal group, age, BMI, altitude residence time, mean corpuscular hemoglobin concentration (MCHC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), erythropoietin (EPO) and C-reactive protein (CRP) in the iron overload group were higher than those in the normal group. LASSO regression analysis suggested that age, high altitude exposure time, BMI, ALT, GGT, EPO, and MCHC were influencing factors of the level of serum ferritin. Multiple linear regression analysis showed that the influencing factors of ferritin levels were gender (β'=-218.094, 95% CI: -301.763 to -134.425), age (altitude exposure time, β'=13.203, 95% CI: 5.850-20.557), MCHC (β'=4.602, 95% CI: 1.130-8.080), ALT (β'=1.910, 95% CI: 0.038-3.782), and EPO (β'=9.908, 95% CI: 5.027-14.790). Conclusion Elevated ferritin levels in adults living at ultra-high altitudes may be related to hypoxic adaptation. Whether high ferritin levels have adverse health effects needs further study.
- Iron metabolism /
- Iron overload /
- Ultra-high altitude /
- Erythropoietin /
- Hepcidin

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表 1 铁过载组与非铁过载组研究对象一般资料比较

Table 1. Comparison of general data of research subjects between the iron overload group and the non-iron overload group

项目	总人群(n=361)	正常组(n=333)	铁过载组(n=28)	统计量	P值
性别[例(%)]				15.430^a	< 0.001
男性	231(64.0)	203(61.0)	28(100.0)
女性	130(36.0)	130(39.0)	0
民族[例(%)]				6.872^a	0.009
汉族	156(43.2)	151(44.9)	5(20.0)
藏族	205(56.8)	182(55.1)	23(80.0)
年龄(x±s，岁)	32.58±6.27	32.05±5.98	38.89±6.32	-5.793^b	< 0.001
高原暴露时间(x±s, 年)	21.40±13.78	20.50±13.57	33.77±10.52	-5.589^b	< 0.001
BMI(x±s)	24.32±3.75	24.08±3.72	27.43±2.74	-4.419^b	< 0.001
血红蛋白(x±s, g/L)	187.18±27.39	186.87±27.93	190.89±19.78	-0.996^b	0.326
血细胞比容(x±s, %)	55.42±7.95	55.41±8.11	55.49±5.82	-0.047^b	0.962
MCHC(x±s, g/L)	337.58±10.87	337.02±10.90	344.11±8.08	-3.360^b	0.001
ALT[M(P₂₅, P₇₅), U/L]	30.00(20.00, 47.00)	29.00(19.00, 44.75)	52.00(38.75, 72.25)	-4.955^c	< 0.001
AST(x±s, IU/L)	25.84±10.43	25.08±9.72	34.68±14.03	-3.548^b	< 0.001
GGT[M(P₂₅, P₇₅), U/L]	29.00(18.25, 47.00]	28.00(18.00, 43.00)	56.50(45.50, 86.00)	-5.667^c	< 0.001
血清铁蛋白[M(P₂₅, P₇₅), ng/mL]	167.36(56.59, 424.27)	138.43(51.55, 333.22)	1 410.29(1 082.10, 1 924.34)	-8.790^c	< 0.001
转铁蛋白(x±s, g/L)	2.95±0.43	2.99±0.42	2.51±0.33	5.988^b	< 0.001
血清铁(x±s, μmol/L)	24.37±10.92	24.23±11.01	25.93±9.75	-0.788^b	0.431
总铁结合力(x±s, μmol/L)	57.05±8.74	57.71±8.62	49.17±5.80	5.143^b	< 0.001
TS(x±s, %)	44.20±20.93	43.40±20.72	53.68±21.49	-2.514^b	0.012
EPO[M(P₂₅, P₇₅), ng/mL]	6.08(3.36, 9.31)	5.96(3.05, 9.16)	7.70(5.30, 10.96)	-2.094^c	0.036
CRP[M(P₂₅, P₇₅), mg/L]	1.10(0.50, 3.20)	1.00(0.50, 3.20)	1.90(1.00, 4.58)	-2.590^c	0.010
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 铁蛋白水平影响因素的LASSO回归分析

Table 2. LASSO regression analysis of influencing factors of ferritin levels

变量	B	SE	95% CI	t值	P值
性别(女性)^a	-395.756	41.121	-476.353~-315.158	-9.624	< 0.001
年龄	24.247	3.302	17.774~30.719	7.343	< 0.001
高原暴露时间	9.272	1.529	6.275~12.269	6.064	< 0.001
BMI	34.666	5.504	23.878~45.455	6.298	< 0.001
MCHC	10.482	1.968	6.624~14.339	5.326	< 0.001
ALT	7.739	0.796	6.178~9.300	9.717	< 0.001
GGT	5.807	0.646	4.540~7.074	8.983	< 0.001
EPO	7.219	2.354	2.605~11.833	3.066	0.002
注：因变量为铁蛋白水平，自变量为性别(男性=0，女性=1)、年龄、高原暴露时间、BMI、MCHC、ALT、GGT、EPO(连续性变量，均以实际值赋值)；^a以男性为参照。

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表 3 铁蛋白水平影响因素的多元线性回归分析

Table 3. Multiple linear regression analysis of influencing factors of ferritin levels

变量	β	SE	β'	95% CI	t值	P值
性别(女性)^a	-0.264	42.514	-218.094	-301.763~-134.425	-5.130	< 0.001
年龄	0.201	3.737	13.203	5.850~20.557	3.534	< 0.001
高原暴露时间	0.100	1.681	2.844	-0.465~6.153	1.692	0.092
BMI	0.088	5.151	9.244	-0.892~19.381	1.795	0.074
MCHC	0.125	1.766	4.602	1.130~8.080	2.606	0.010
ALT	0.120	0.951	1.910	0.038~3.782	2.008	0.046
GGT	0.107	0.801	1.429	-0.147~3.006	1.784	0.075
EPO	0.184	2.480	9.908	5.027~14.790	3.995	< 0.001
注：因变量为铁蛋白水平，自变量为性别(男性=0，女性=1)、年龄、高原暴露时间、BMI、MCHC、ALT、GGT、EPO(连续性变量，均以实际值赋值)；^a以男性为参照。

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