411老师，铁蛋白升高，怎么办

keane

liver411老师，本人小三阳15年了，DNA弱阳，差不多都是在500-5000之间徘徊，有时候又是阴性，肝功能一直都是正常的，十几年以来，最近刚做了fibroscan，结果是5.2kpa。但是我肝区不适已经6年了，而且经常觉得疲劳，肌肉关节酸痛。做了很多检查，都无法找出真正的原因。最近GP帮我做了个铁蛋白（ferritin）的检查，结果是355ug/l。正常值应该是（20=300）。我的肝功能的结果是： alt 20， ast 17，ggt 13， bilirubin 15， alp 59， albumin 48。我的医生排除是肝炎引起的ferritin升高，他现在怀疑有可能是基因方面的原因。而且说ferritin level 高会造成肝损害，最后硬化。他说如果确证是基因的原因，以后可能要长期放血。请问你， 我的ferritin高的原因是乙肝引起还是基因的因素更大？肝区不适跟ferritin有关系吗？还有355ug/l的水平需要放血吗？

keane

Increased serum ferritin in chronic liver disease: a risk factor for primary hepatocellular carcinoma. (PMID:2538399)
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Hann HW,
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Kim CY,
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London WT,
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Blumberg BS
Fox Chase Cancer Center, Philadelphia, PA.
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International Journal of Cancer. Journal International du Cancer [1989, 43(3):376-9]
Type:  Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.

DOI: 10.1002/ijc.2910430304  

Abstract  Highlight Terms   Gene Ontology(2)  Diseases(3)  Genes/Proteins(1)  Species(2)  
Previous studies from this laboratory support the view that increased serum ferritin levels are associated with an increased risk of primary hepatocellular carcinoma (PHC). We have tested this hypothesis in a population of Korean patients with chronic liver disease followed for development of PHC. Serum ferritin levels were measured over time in 249 patients with liver diseases (mostly chronic) followed for 2 to 17 years in Seoul, Korea. Most of the patients were chronically infected with hepatitis B virus. During the first 8 months of follow-up, there were no cases of PHC and no deaths. During this same period, no patient had a serum ferritin level initially below 300 ng/ml and rising above 300 ng/ml, but some patients with ferritin levels above 300 ng/ml experienced decreases to below 300 ng/ml. Therefore, patients were grouped by ferritin level during the first 8 months of follow-up into 3 categories according to the above criteria. Multivariate analysis showed that consistently elevated ferritin levels (category 3) were significantly associated with the development of PHC. Men were more likely to have elevated ferritin levels than women and were at higher risk of developing PHC. Men who were chronically infected with HBV and had ferritin levels above 300 ng/ml had a 50% chance of developing PHC during the follow-up period, compared with a 20% risk of PHC for men with lower ferritin levels (categories 1 and 2). This elevated risk of PHC in men with elevated ferritin levels was confined to the first 3 years of follow-up.  

keane

令我担心的就是这篇文章，好像是说韩国的一个跟踪调查，发现铁蛋白高于300的组里面，最后有50%的人得了肝癌。如果用de-iron的方法，是不是会降低这种风险呢？

liver411

如果铁蛋白升高，需要检查HFE（遗传性血铁沉著症排除以下第六染色体上的突变。通常是检查C282Y，H63D。 大约90%血色沉著的患者C282Y呈现结合现象...。
不过大约50%的肝炎，酒精肝，非酒精性脂肪肝，丙型肝炎也会出现铁蛋白升高；另外，风湿病或某种癌症也会。所以要仔细检查清楚才能确定治疗方案。

不过你不是很象血色病，因为过量摄取铁（比如有人滥用甘利欣/甘草），用铁容器，餐具等过多，加上肝病都可能造成铁高。

对于癌变，影像定期检查为最好的工具，包括盆腔的扫描：男性前列腺，女性附件等。

hellowkeke

借帖问一下，我去年圣诞开始心跳快头晕，后来没有查出原因，吃药降心跳，但是头晕依然存在一直到现在，两个月前检查出重度脂肪肝+全身关节痛，铁蛋白480，尿酸高，节食+运动，没有吃药，因为大夫开的都是西药，其间发现胸部左右两侧疼痛，腰部两侧疼痛，胃部也疼，整个后背不舒服，不知道铁蛋白和头晕以及关节肌肉痛有没有关系，请指教。谢谢

三叠

对于目前仍在概率、假说、等阶段的研究，要持平心态。
总的来说目前所能确认的所有所谓“致癌因素”都不能单独起作用，癌症的发生在目前的认识水平上基本上应该被认为仍是原因不明确的，或者是综合因素起作用的。就如我们都知道吸烟会导致罹患肺癌的机率增加，但是这仅仅是在统计学的意义上，换句话说对于某一个吸烟的个体而言，他究竟是否将会染上肺癌没有人能够预测。

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瑞雪丰年

411老师，我今天检查是血清铁饱和度高55%，其它几项包括血铁、铁蛋白都正常。13年下半年查过都正常，饱和度25%。吃了7、8年的多种维生素（善存，含铁18mg），医生让停掉三个月复查。

我刚才看到一篇文章说除铁对乙肝治疗产生了积极的影响。也行是个例。不过我比较担心铁对肝脏和其它脏器的损伤，尤其是心脏和胰岛，最近一次查糖耐量虽然正常，但是胰岛素峰值有些延迟，有胰岛素抵抗的倾向。我在想是不是要进行除铁治疗。