[Recommendations of EASL clinical practice guidelines on haemochromatosis]

Zhonghua Gan Zang Bing Za Zhi. 2022 Sep 20;30(9):934-938. doi: 10.3760/cma.j.cn501113-20220717-00384.
[Article in Chinese]

Abstract

Haemochromatosis is characterised by elevated transferrin saturation (TSAT) and progressive iron loading that mainly affects the liver. Early diagnosis and treatment by phlebotomy can prevent cirrhosis, hepatocellular carcinoma, diabetes, arthropathy and other complications. In patients homozygous for p.Cys282Tyr in HFE, provisional iron overload based on serum iron parameters (TSAT >45% and ferritin >200 μg/L in females and TSAT >50% and ferritin >300 μg/L in males and postmenopausal women) is sufficient to diagnose haemochromatosis. In patients with high TSAT and elevated ferritin but other HFE genotypes, diagnosis requires the presence of hepatic iron overload on MRI or liver biopsy. The stage of liver fibrosis and other end-organ damage should be carefully assessed at diagnosis because they determine disease management. Patients with advanced fibrosis should be included in a screening programme for hepatocellular carcinoma. Treatment targets for phlebotomy are ferritin <50 μg/L during the induction phase and <100 μg/L during the maintenance phase.

血色病以转铁蛋白饱和度(TSAT)升高,进行性铁超载并主要影响肝脏为特征。早期诊断和放血治疗可预防肝硬化、肝细胞癌、糖尿病、关节病及其他并发症。对于遗传性血色病基因(HFE)p.Cys282Tyr纯合子变异的患者,女性TSAT>45%和铁蛋白>200 μg/L,男性和绝经后女性TSAT>50%和铁蛋白>300 μg/L可以疑似诊断血色病;对于其他HFE基因型的患者,除有TSAT升高和铁蛋白升高证据外,还需要在磁共振成像或肝活检中明确肝脏铁超载才可以诊断。诊断时应仔细评估肝脏纤维化状态和其他器官损害的程度,这决定了疾病的治疗及管理策略。晚期肝纤维化患者应定期进行肝癌筛查。放血治疗的追求目标是诱导期铁蛋白<50 μg/L,维持期铁蛋白<100 μg/L。.

Publication types

  • English Abstract

MeSH terms

  • Carcinoma, Hepatocellular* / complications
  • Female
  • Ferritins
  • Fibrosis
  • Hemochromatosis Protein / genetics
  • Hemochromatosis* / diagnosis
  • Hemochromatosis* / therapy
  • Humans
  • Iron
  • Iron Overload* / diagnosis
  • Iron Overload* / genetics
  • Liver Cirrhosis / complications
  • Liver Neoplasms* / complications
  • Male
  • Transferrins

Substances

  • Hemochromatosis Protein
  • Ferritins
  • Iron
  • Transferrins