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Revaluation of clinical and histological criteria for diagnosis of dysmetabolic iron overload syndrome

World Journal of Gastroenterology 2008年第30期14卷 4745-4752页

作者： Alessia Riva Paola Trombini Raffaella Mariani Alessandra Salvioni Sabina Coletti Silvia Bonfadini Valentina Paolini Matteo Pozzi Rita Facchetti Giorgio Bovo Alberto Piperno Department of Clinical Medicine University of Milano-Bicocca San Gerardo Hospital Department of Clinical and Preventive Medicine University of Milano-Bicocca Department of Clinical Pathology San Gerardo Hospital University of Milano-Bicocca

AIM： To re-evaluate the diagnostic criteria of insulin resistance hepatic iron overload based on clinical, biochemical and histopathological findings. METHODS： We studied 81 patients with hepatic iron overload not explained by known genetic and acquired causes. The metabolic syndrome （MS） was defined according to ATPⅢ criteria. iron overload was assessed by liver biopsy. Liver histology was evaluated by Ishak＇s score and iron accumulation by Deugnier＇s score; steatosis was diagnosed when present in ≥ 5% of hepatooltes. RESULTS： According to transferrin saturation levels, we observed significant differences in the amount of hepatic iron overload and iron distribution, as well as the number of metabolic abnormalities. Using Receiving Operating Curve analysis, we found that the presence of two components of the MS differentiated two groups with a statistically significant different hepatic iron overload （P 〈 0.0001）. Patients with ≥2 metabolic alterations and steatosis had lower amount of hepatic iron, lower transferrin saturation and higher sinusoidal iron than patients with 〈 2 MS components and absence of steatosis. CONCLUSION： In our patients, the presence of ≥ 2 alterations of the MS and hepatic steatosis was associated with a moderate form of iron overload with a prevalent sinusoidal distribution and a normal transferrin saturation, suggesting the existence of a peculiar pathogenetic mechanism of iron accumulation. These patients may have the typical dysmetabolic iron overload syndrome. By contrast, patients with transferrin saturation ≥ 60% had more severe iron overload, few or no metabolic abnormalities and a hemochromatosis-like pattern of iron overload.

关键词： iron overload hepatic iron distribution Transferrin saturation Metabolic syndrome hepatic steatosis

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