Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Relationship between Helicobacter pylori infection and iron-deficiency anemia in infants and children

영유아에서 Helicobacter pylori 감염과 철결핍성 빈혈과의 관계 연구

  • Son, Meong Hi (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Yeom, Jung Suk (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Park, Ji Suk (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Park, Eun Sil (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Seo, Ji Hyun (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Lim, Jae Young (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Park, Chan Hoo (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Woo, Hyang Ok (Department of Pediatrics, The Gyeongsang National University College of Medicine) ;
  • Youn, Hee Shang (Department of Pediatrics, The Gyeongsang National University College of Medicine)
  • 손명희 (경상대학교 의과대학 소아과학교실) ;
  • 염정숙 (경상대학교 의과대학 소아과학교실) ;
  • 박지숙 (경상대학교 의과대학 소아과학교실) ;
  • 박은실 (경상대학교 의과대학 소아과학교실) ;
  • 서지현 (경상대학교 의과대학 소아과학교실) ;
  • 임재영 (경상대학교 의과대학 소아과학교실) ;
  • 박찬후 (경상대학교 의과대학 소아과학교실) ;
  • 우향옥 (경상대학교 의과대학 소아과학교실) ;
  • 윤희상 (경상대학교 의과대학 소아과학교실)
  • Received : 2008.11.17
  • Accepted : 2009.01.15
  • Published : 2009.05.15
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Abstract

Purpose : To elucidate a potential association between Helicobacter pylori (HP) infection and iron-deficiency anemia (IDA) in infants and children in terms of the other factors related to iron utilization and storage although the association of ferritin was previously studied. Methods : We evaluated 135 infants (aged 6-24 months) admitted at Gyeongsang National University Hospital from 2000 to 2006. Western blot assays using the HP CagA antigen (120 kD) were conducted to identify infections. The concentrations of six parameters were measured: hemoglobin (Hb), serum ferritin, soluble serum transferrin receptors, interleukin-6, prohepcidin, and C-reactive protein. In addition, the infants were classified into IDA, anemia from inflammation (AI), unclassified anemia (UCA), and normal groups on the basis of Hb and ferritin concentrations. Results : In the IDA group (n=20), seven infants were infected with HP, with the other infants showing no evidence of infection. The mean Hb levels in the IDA group were significantly lower in HP-infected infants than those uninfected (7.1 vs. 8.2 g/dL, respectively); the mean ferritin levels were also significantly lower in the infected infants (3.2 vs. $6.8{\mu}g/L$). The other four parameters did not differ significantly among the IDA infants. No correlations were found between the six parameters and HP infection status in the other groups. Conclusion : There were no significant differences in the HP infection rates among the study groups. However, in the IDA group, the HP-infected infants had significantly lower serum ferritin and Hb levels than the HP-negative infants (P<0.05).

목 적 : 본 연구에서는 철결핍성 빈혈의 주된 호발 연령인 영유아를 대상으로 HP 감염 유무와 철결핍성 빈혈과의 상관관계를 연구하고자 하였다. 이전의 연구에서는 페리틴을 주 지표로 철결핍성 빈혈과 HP 감염과의 상관관계를 연구하였다. 철결핍성 빈혈 영유아의 대부분은 급성 상기도 감염 및 요로감염 등으로 내원하므로 급성 감염 시에 영향을 받는 페리틴 외에 철 대사의 이용이나 저장에 관련된 다른 인자들을 동시에 비교해보고자 하였다. 방 법 : 2000년부터 2006년까지 경상대학교병원에 내원한 6-24개월 영유아 135명을 대상으로 하였다. 혈청 HP CagA 항원(120kD)에 대한 western blot 을 시행하여 감염 유무를 분류하고 (Fig.1) 이들의 혈색소(g/dL), 혈청 페리틴(ug/L), sTfR, (mg/L), Interleuken (IL)-6 (pg/mL), prohepcidin (ng/mL)과 C-reactive protein (CRP) (mg/L)(이하 6인자)를 측정하였다. 또한 이들을 혈색소와 페리틴 수치에 따라 철결핍성빈혈군(IDA), 염증성빈혈군(AI), 미분류빈혈군(UCA) 그리고 정상군(Nor)으로 분류하였다. 통계량 분석은 Mann Whitney U test를 사용하였고 SPSS 14.0 버전을 사용하여 P값이 0.05미만인 경우에 통계적으로 유의한 것으로 평가하였다. 결 과 : IDA, AI, UCA 그리고 Nor 군에서 HP 감염률 비교는 통계적으로 유의한 차이가 없었다. IDA (N=20)에서 HP 감염이 있는 환아는 7명, 감염이 없는 환아는 13명이었다. 이들 두 그룹의 혈색소 평균은 각각 7.1과 8.2 g/dL로 HP 감염이 있는 환자에서 유의하게 낮았으며 페리틴은 각각 3.2, 6.8 ug/L로 HP감염이 있는 그룹에서 유의하게 낮았다. 또한 IDA외에 다른 군에서는 HP 감염 유무에 따라 6가지 인자를 각각 비교하였으나 유의한 차이는 없었다. 또한 전체 대상 환아에서 HP 감염 유무에 따라 6인자를 각각 비교하였으나 통계적으로 유의한 차이는 없었다. 결 론 : 철결핍성 빈혈이 있는 영유아(6-24개월)의 HP 감염 유병률은 대조군들과 유의한 차이가 없었다. 본 연구에서는 HP 감염이 있는 철결핍성 빈혈 군에서 sTfR 농도가 유의한 차이를 보인 청소년기 환아 에서의 연구와는 달리 sTfR은 유의한 차이를 보이지 않고 오히려 혈청 페리틴 농도와 혈색소가 의미 있게 낮게 측정되었다. 본 연구에서는 대상 환자인 철결핍성 빈혈군 환자수가 적고 환자들의 식이 등이 고려되지 않았으므로 더 많은 환자를 대상으로 연구가 시행되어야 하겠다.

Keywords

References

  1. Seo JK, Ko JS, Choi KD. Serum ferritin and Helicobacter pylori infection in children; a sero-epidemiologic study in Korea. J Gastroenterol Hepatol 2002;17:754-7 https://doi.org/10.1046/j.1440-1746.2002.02797.x
  2. Sarker SA, Davidsson L, Mahmud H, Walczyk T, Hurrell RF, Gyr N, et al. Helicobacter pylori infection, iron absorption, and gastric acid secretion in Bangladeshi children. Am J Clin Nutr 2004;80:149-53
  3. Choi JW. Does Helicobacter pylori infection relate to iron deficiency anaemia in prepubescent children under 12 years of age? Acta Paediatr 2003;92:970-2 https://doi.org/10.1080/08035250310004225
  4. Haghi-Ashtiani MT, Monajemzadeh M, Motamed F, Mahjoub F, Sharifan M, Shahsiah R, et al. Anemia in children with and without Helicobacter pylori infection. Arch Med Res 2008; 39:536-54 https://doi.org/10.1016/j.arcmed.2008.04.005
  5. Annibale B, Marignani M, Monarca B, Antonelli G, Marcheggiano A, Martino G, et al. Reversal of iron deficiency anemia after Helicobacter pylori eradication in patients with asymptomatic gastritis. Ann Intern Med 1999;131:668-72
  6. Park SA, Lee HW, Hong MH, Choi YW, Choe YH, Ahn BY. Comparative proteomic analysis of Helicobacter pylori strains associated with iron deficiency anemia. Proteomics 2006; 64:1319-28 https://doi.org/10.1002/pmic.200500293
  7. Malope BI, MacPhail AP, Alberts M, Hiss DC. The ratio of serum transferrin receptor and serum ferritin in the diagnosis of iron status. Br J Haematol 2001;115:84-9 https://doi.org/10.1046/j.1365-2141.2001.03063.x
  8. Baik SC, Kim KM, Song SM, Kim DS, Jun JS, Lee SG. Proteomic analysis of the sarcosine-insoluble outer membrane fraction of Helicobacter pylori strain 26695. J Bacteriol. 2004;186:949-55 https://doi.org/10.1128/JB.186.4.949-955.2004
  9. Youn HS, Baik SC, Cho YK, Woo HO, Ahn YO, Kim K. Comparison of Helicobacter pylori infection between Fukuoka, Japan and Chinju, Korea. Helicobacter 1998;3:9-14 https://doi.org/10.1046/j.1523-5378.1998.08011.x
  10. Roy CN, Andrews NC. Anemia of inflammation: the hepcidin link. Curr Opin Hematol 2005;12:107-11 https://doi.org/10.1097/00062752-200503000-00001
  11. Elin RJ, Wolff SM, Finch CA. Effect of induced fever on serum iron and ferritin concentations in man. Blood 1977;49:147-53
  12. Allen J, Backstrom KR, Cooper JA, Cooper MC, Detwiler TC, Essex DW, et al. Measurement of soluble transferrin receptor in serum of healthy adults. Clin Chem 1998;44:35-9 https://doi.org/10.1016/S0065-2423(07)44002-1
  13. Mast AE, Blinder MA, Gronowski AM, Chumley C, Scott MG. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem 1998;44:45-51
  14. Jansson LT, Kling S, Dallman PR. Anemia in children with acute infections seen in a primary care pediatric outpatient clinic. Pediatr Infect Dis 1986;5:424-7 https://doi.org/10.1097/00006454-198607000-00009
  15. Ryu EY, Jang SH, Yeom JS, Park ES, Seo JH, Lim JY et al. Correlation between pro-hepcidine level and iron parameter in infant patients with iron deficiency anemia and anemia- free Infants. Clin Pediatr Hematol Oncol 2007;14:145-50
  16. Youn HS, Baik SC, Cho YK, Woo HO, Ahn YO, Kim K et al. Comparison of Helicobacter pylori infection between Fukuoka, Japan and Chinju, Korea. Helicobacter 1998;3:9-14 https://doi.org/10.1046/j.1523-5378.1998.08011.x
  17. Cook JD, Skikne BS, Baynes RD. Serum transferrin receptor. Annu Rev Med 1993;44:63-74 https://doi.org/10.1146/annurev.me.44.020193.000431
  18. Holmberg L. Soluble transferrin receptor in the diagnosis of anaemia and iron deficiency in childhood. Acta Paediatr 2000;89:1152-3 https://doi.org/10.1080/080352500750027466
  19. Bhaskaram P, Madhavan Nair K, Balakrishna N, Ravinder P, Sesikeran B. Serum transferrin receptor in children with respiratory infections. Eur J Clin Nutr 2003;57:75-80 https://doi.org/10.1038/sj.ejcn.1601496
  20. Kivibidila S, Warrier RP, Ode D, Yu L, Tshefu KA. Lack of difference in iron status assessed by soluble transferrin receptor between children with cerebral malaria and those with non-cerebral malaria. J Trop Pediatr 1999;45:166-7 https://doi.org/10.1093/tropej/45.3.166
  21. Mockenhaupt FP, May J, Stark K, Falusi AG, Meyer CG, Bienzle U. Serum transferrin receptor levels are increased in asymptomatic and mild Plasmodium falciparum-infection. Haematologica 1999;84:869-73
  22. Choi JW. Serum-soluble transferrin receptor concentrations in Helicobacter pylori-associated iron-deficiency anemia. Ann Hematol 2006;85:735-7 https://doi.org/10.1007/s00277-006-0142-0
  23. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anaemia of inflammation. Blood 2003;102:783-8 https://doi.org/10.1182/blood-2003-03-0672

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