儿童炎症性肠病相关贫血的诊治研究进展

doi:10.3969/j.issn.1674-8115.2025.09.015

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (9): 1232-1238.doi: 10.3969/j.issn.1674-8115.2025.09.015

儿童炎症性肠病相关贫血的诊治研究进展

王治琪¹, 王莹¹^,²^,³()

^1.上海交通大学医学院附属新华医院儿消化营养科，上海 200092
^2.上海市儿科医学研究所，上海 200092
^3.上海市小儿消化与营养重点实验室，上海 200092

收稿日期:2025-05-05 接受日期:2025-09-01 出版日期:2025-09-28 发布日期:2025-09-30
通讯作者: 王　莹，主任医师，博士；电子信箱：wangying02@xinhuamed.com.cn。
基金资助:
国家重点研发计划(2023YFC2706505);国家自然科学基金(82370525);上海市自然科学基金(22ZR1441100);上海市科技创新行动计划(22Y31900600);上海市“医苑新星”青年医学人才培养资助计划(20234Z0004);上海交通大学医学院“双百人”项目(2024009)

Advances in the diagnosis and treatment of inflammatory bowel disease-associated anemia in children

WANG Zhiqi¹, WANG Ying¹^,²^,³()

^1.Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
^2.Shanghai Institute for Pediatric Research, Shanghai 200092, China
^3.Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China

Received:2025-05-05 Accepted:2025-09-01 Online:2025-09-28 Published:2025-09-30
Contact: WANG Ying, E-mail: wangying02@xinhuamed.com.cn.
Supported by:
National Key R&D Program of China(2023YFC2706505);National Natural Science Foundation of China(82370525);Natural Science Foundation of Shanghai(22ZR1441100);Shanghai Science and Technology Innovation Action Plan(22Y31900600);Shanghai Rising Stars of Medical Talent Youth Development Program(20234Z0004);“Two-Hundred Talents” Program of Shanghai Jiao Tong University School of Medicine(2024009)

摘要/Abstract

摘要：

炎症性肠病（inflammatory bowel disease，IBD）是一类病因不明的非特异性慢性胃肠道炎症性疾病。IBD患者常合并多种肠外症状及并发症，贫血是常见的肠外表现之一，且在儿童中的发病率及患病率高于成人。儿童IBD患者的贫血不仅会引起头晕、头痛、疲劳等非特异性症状，还会影响生长发育，与患儿生活质量密切相关。IBD相关性贫血的病因包括缺铁、慢性病、维生素缺乏、溶血、骨髓抑制等，其中缺铁最为常见。近年来，除传统的血红蛋白、红细胞压积、平均红细胞血红蛋白浓度等常见指标外，还出现了很多用于评估贫血和缺铁的新指标，如可溶性转铁蛋白受体、可溶性转铁蛋白受体/铁蛋白指数、网织红细胞血红蛋白含量等。在儿童IBD相关性贫血的治疗中，临床上通常采用口服补铁，静脉补铁尚不普遍。尽管贫血会对IBD患儿产生诸多负面影响，但目前对贫血的诊断和治疗仍不及时。该文综述儿童IBD相关性贫血的发病机制、诊断和治疗研究进展，旨在提高临床对儿童IBD合并贫血的认识和关注度，为进一步改善患儿的治疗效果和提高其生活质量提供依据。

关键词: 炎症性肠病, 贫血, 儿童

Abstract:

Inflammatory bowel disease (IBD) is a group of non-specific chronic gastrointestinal inflammatory disorders of unknown etiology. Patients with IBD often have a variety of extraintestinal symptoms and complications. Anemia is one of the most common extraintestinal manifestations, and its incidence and prevalence in children are higher than in adults. Anemia in children with IBD not only causes non-specific symptoms such as dizziness, headache, and fatigue, but also impacts growth and development, and is closely related to the quality of life. The etiologies of IBD-associated anemia include iron deficiency, anemia of chronic disease, vitamin deficiency, hemolysis, and myelosuppression, among which iron deficiency is the most common. In recent years, in addition to conventional indicators such as hemoglobin, hematocrit, and mean corpuscular hemoglobin, many new indicators for evaluating anemia and iron deficiency have emerged, including soluble transferrin receptor (sTfR), the ratio of sTfR to log ferritin (sTfR-F) index, and reticulocyte hemoglobin content (CHr). In the treatment of IBD-associated anemia in children, oral iron supplementation is the most commonly used therapy in clinical practice, while intravenous iron therapy is not widely used. Although anemia has many negative effects on children with IBD, its diagnosis and treatment are often delayed. This article reviews the pathogenesis, diagnosis, and treatment of IBD-associated anemia in children, in order to improve clinical awareness and attention, and provide a basis for further improving the treatment effect and quality of life.

Key words: inflammatory bowel disease (IBD), anemia, child

中图分类号:

R725.7

王治琪, 王莹. 儿童炎症性肠病相关贫血的诊治研究进展[J]. 上海交通大学学报（医学版）, 2025, 45(9): 1232-1238.

WANG Zhiqi, WANG Ying. Advances in the diagnosis and treatment of inflammatory bowel disease-associated anemia in children[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(9): 1232-1238.

图/表 1

参考文献 56

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Biomarker	Clinical significance	Cut-off for iron deficiency	Advantage	Limitation
Serum ferritin	Iron storage	<5 years: serum ferritin<12 μg·L^-1; ≥5 years: serum ferritin<15 μg·L^-1	Direct measure of stored iron	Affected by inflammation
TSAT	Iron utilization efficiency	<16%	Less influenced by inflammation	Cannot distinguish IDA from ACD
sTfR	Erythroid marrow iron demand	>8 mg·L^-1	Unaffected by inflammation	Lack of standardized assays
sTfR-F index	Integrated iron status	CRP<5 mg·L^-1: sTfR-F>1.5; CRP≥5 mg·L^-1: sTfR-F>0.8	High specificity	No universal reference ranges
CHr	Iron availability	<31 pg	More sensitive	Affected by inflammation

Biomarker	Clinical significance	Cut-off for iron deficiency	Advantage	Limitation
Serum ferritin	Iron storage	<5 years: serum ferritin<12 μg·L^-1; ≥5 years: serum ferritin<15 μg·L^-1	Direct measure of stored iron	Affected by inflammation
TSAT	Iron utilization efficiency	<16%	Less influenced by inflammation	Cannot distinguish IDA from ACD
sTfR	Erythroid marrow iron demand	>8 mg·L^-1	Unaffected by inflammation	Lack of standardized assays
sTfR-F index	Integrated iron status	CRP<5 mg·L^-1: sTfR-F>1.5; CRP≥5 mg·L^-1: sTfR-F>0.8	High specificity	No universal reference ranges
CHr	Iron availability	<31 pg	More sensitive	Affected by inflammation

儿童炎症性肠病相关贫血的诊治研究进展

Advances in the diagnosis and treatment of inflammatory bowel disease-associated anemia in children

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