非贫血性铁缺乏与结直肠癌择期手术后结局的关联：一项前瞻性队列研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
铁缺乏在结直肠癌手术患者中发生率高达75%，但其在非贫血患者中是否与更差的术后结局相关尚不明确。本研究假设，在无贫血的结直肠癌手术成人患者中，铁缺乏（定义为转铁蛋白饱和度TSAT <20%）与铁充足状态相比会导致更差的术后结局。
方法
研究设计为前瞻性观察性研究，纳入澳大利亚和新西兰16家医院的无贫血（男性Hb <130 g/L，女性Hb <120 g/L）结直肠癌手术患者（≥18岁）。缺铁主要定义为转铁蛋白饱和度<20%。主要终点为术后90天存活且居家天数（DAOH90），次要终点包括术后30天DAOH、住院时长、输血需求等。通过多变量模型调整混杂因素（如手术风险、Charlson合并症指数等）。
结果
在420例患者中，170例为铁缺乏组（TSAT <20%），250例为铁充足组（TSAT ≥20%）。铁缺乏组DAOH90中位数为84.0天（IQR 80.7–85.9），铁充足组为83.1天（IQR 78.7–85.1）。调整后差异为0.9天（95%CI 0–1.8，p=0.042），铁缺乏组反而略优，但差异无临床意义（最小临床重要差异为3天）。
在无贫血的结直肠癌手术患者中，TSAT <20%定义的铁缺乏未导致更差的术后结局，且似乎与术后第90天存活天数及居家天数的增加相关。
原始文献：Miles LF, Luu S, Ong I, et al. Associations between non-anaemic iron deficiency and outcomes following elective surgery for colorectal cancer: a prospective cohort study. Anaesthesia. 2025 Jan;80(1):48-58. doi: 10.1111/anae.16444. Epub 2024 Oct 15. PMID: 39405556; PMCID: PMC11617130.
Associations between non-anaemic iron deficiency and outcomes following elective surgery for colorectal cancer: a prospective cohort study
ABSTRACT
Background: Iron deficiency is present in up to 75% of patients presenting forcolorectal cancer surgery. It is unclear whether iron deficiency without anaemia is associated with worse postoperative outcomes. We hypothesised that, in adults without anaemia undergoing surgery for colorectal cancer, iron deficiency would be associated with worse postoperative outcomes relative to an iron-replete state.
Methods: We performed a prospective, observational study, recruiting adults (aged ≥ 18 y) without anaemia who were undergoing surgery for colorectal cancer in 16 hospitals across Australia and Aotearoa/New Zealand. Anaemia was defined as a haemoglobin concentration < 130 g.l-1 for men and < 120 g.l-1 for women. Iron deficiency was defined primarily as transferrin saturation < 20%. The primary endpoint was days alive and at home on postoperative day 90. The primary endpoint analysis was adjusted for surgical risk based on recruiting institution; sex; Charlson comorbidity index; CR-POSSUM score; surgical approach; and requirement for neoadjuvant therapy.
Results: Of 420 patients, 170 were iron deficient and 250 were iron replete. The median (IQR [range]) days alive and at home in the iron-deficient group was 84.0 (80.7-85.9 [0-88.2]) days and in the iron-replete group was 83.1 (78.7-85.1 [0-88.9]) days. The unadjusted difference in medians between groups was 0.9 (95%CI 0-1.8, p = 0.047) days and the adjusted difference was 0.9 (95%CI 0-1.80, p = 0.042) days, favouring the iron-deficient group.
Conclusions: In adult patients without anaemia undergoing surgery for colorectal cancer, iron deficiency defined by transferrin saturation < 20% was not associated with worse patient outcomes and appeared to be associated with more days alive and at home on postoperative day 90.