Volume 134 · Issue 15 · 2021

术语非产褥期乳腺炎（NPM）是指发生于非产褥期妇女的一组原因不明的良性乳腺疾病。主要病理类型为导管周围性乳腺炎（PDM）和肉芽肿性小叶性乳腺炎（GLM）。NPM的主要临床表现为乳腺肿块和乳腺脓肿。晚期可形成相关的瘘管、鼻窦或溃疡；这些往往是持续的，无法愈合。这些疾病的自然病程约为9至12个月，并且经常复发。目前没有标准的治疗方法。为了帮助临床医生做出正确的诊断并制定适当的治疗计划，中国乳腺外科学会审查了已发表的报告并进行了专家之间的讨论，以确定将纳入NPM临床实践指南的关键问题。本小组还研究了建议评估的分级、发展和评估系统，评估了相关证据，并制定了以下NPM诊断和治疗的临床实践指南（2021版），旨在为乳腺临床医生提供参考标准。

乳腺组织夹是一种在超声（US）、乳腺X线摄影（MMG）和磁共振成像（MRI）下可见的组织标记物，可用于在US或MMG引导下精确标记乳腺病变和腋窝淋巴结（LN）。^[1]为了规范组织夹的临床应用，中国乳腺外科学会（CSBrS）确定了关键的临床问题，并在参考等级（ie、建议评估、开发和评价的分级）系统和临床实践中的可及性。

据估计，每年有超过300万人死于慢性阻塞性肺病（COPD）。COPD急性加重（AECOPD）导致肺功能不可逆下降，急诊就诊、住院和住院时间增加，死亡率增加。然而，许多恶化没有报告给医疗保健专业人员进行治疗，然而这些事件虽然通常持续时间很短，但对健康状况有显著影响。^[1]AECOPD的早期发现和干预以及减少未报告的AECOPD发作将潜在地改善预后。

冠状病毒疾病2019（新冠肺炎）的爆发引起了全球的关注，并造成了巨大的损失。2019新型冠状病毒，也称为严重急性呼吸综合征冠状病毒2（新型冠状病毒），与严重急性呼吸综合征（SARS）冠状病毒和中东呼吸综合征（MERS）冠状病毒具有显著的同源性。在随访研究中，62%的SARS和33%的MERS患者在出院后有肺纤维化（PF）的影像学证据，这些患者往往年龄较大，在重症监护室住院时间较长。^[1,2]新冠肺炎的影响也可能导致PF，损害肺功能，威胁生活质量。

It remains unclear whether the outcomes of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) during off-hours are as favorable as those treated during on-hours, especially those with a first medical contact-to-device (FMC-to-device) time within 90 min. We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time ≤90 min.

This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time ≤90 min from 19 chest pain centers in Beijing from January 2018 to December 2018. Patients were divided into on-hours group and off-hours group based on their arrival time. Baseline characteristics, clinical data, and key time intervals during treatment were collected from the Quality Control & Improvement Center of Cardiovascular Intervention of Beijing by the "Heart and Brain Green Channel" app.

Overall, the median age of the patients was 58.8 years and 19.9% (133/670) were female. Of these, 296 (44.2%) patients underwent PPCI during on-hours and 374 (55.8%) patients underwent PPCI during off-hours. Compared with the on-hours group, the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time ≤60 min (P < 0.05). During the mean follow-up period of 24 months, a total of 64 (9.6%) participants experienced a major adverse cardiovascular event (MACE), with 28 (9.1%) in the on-hours group and 36 (9.6%) in the off-hours group (P > 0.05). According to the Cox regression analyses, off-hours admission was not a predictor of 2-year MACEs (P = 0.788). Similarly, the Kaplan-Meier curves showed that the risks of a MACE, all-cause death, reinfarction, and target vessel revascularization were not significantly different between the two groups (P > 0.05).

This real-world, multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min, off-hours admission was safe, with no difference in the risk of 2-year MACEs compared with those with on-hours admission.

Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.

This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.

The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023-1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958-0.983), fatigue (HR: 1.127, 95% CI: 1.009-1.258), ascites (HR: 1.190, 95% CI: 1.057-1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140-1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291-1.769), heart rate (HR: 1.003, 95% CI: 1.001-1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993-0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008-1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220-1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223-1.690), serum sodium (HR: 0.980, 95% CI: 0.972-0.988), serum albumin (HR: 0.981, 95% CI: 0.971-0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073-1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183-1.614), diabetes (HR: 1.118, 95% CI: 1.010-1.237), stroke (HR: 1.252, 95% CI: 1.121-1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626-0.814), β-blockers (HR: 0.673, 95% CI: 0.588-0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604-0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646-0.965), spironolactone (HR: 0.814, 95% CI: 0.663-0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531-0.733), nitrates (HR: 0.715, 95% CI: 0.631-0.811), and digoxin (HR: 0.579, 95% CI: 0.465-0.721).

The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.

Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service (EMS). This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China.

A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally. Four status of awareness and annual income were identified: unaware and low-income, unaware-only, low-income-only, and aware and regular income. The outcomes were whether they intended to call EMS or not. The regional distribution of each status and their associations with not calling EMS were presented.

The status of unaware and low-income, unaware-only, and low-income-only accounted for 6.3 % (11,806/187,673), 11.9% (22,241/187,673), and 21.5% (40,289/187,673) of the total sample, respectively. Not calling EMS was significantly associated with the status of unaware and low-income (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 3.07-3.35), unaware-only (OR: 2.38, 95% CI: 2.31-2.46), and low-income-only (OR: 1.67, 95% CI: 1.63-1.71), compared with the aware and regular income status. The Midwest regions had higher percentages of people in the unaware and low-income status; the East, South, and Central had higher percentages of unaware-only status; the North and Northeast regions had a higher percentage of low-income-only status, compared with other regions.

The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.

Twin pregnancies continue to increase worldwide; however, the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons. We attempted to establish a set of fetal biometric references for Chinese twin pregnancies, stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic (SC-MCDA), spontaneously conceived dichorionic diamniotic (SC-DCDA), and assisted reproductive technology dichorionic diamniotic (ART-DCDA) twins.

From 2016 to 2019, the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women, including fetal weight, biparietal diameter, head circumference, abdominal circumference, femur length, and humerus length. The linear mixed models were used to test the difference of growth patterns between groups, and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape.

A total of 929 twin pregnant women and 2019 singleton pregnant women, met the inclusion criteria. Among twin pregnancies, 148 were SC-MCDA, 215 were SC-DCDA, and 566 were ART-DCDA twins. Overall, SC-DCDA twins grew faster than SC-MCDA twins, while slower than ART-DCDA twins (all P < 0.05), and all of the three groups showed significant differences comparing with singletons, especially during the third trimester. Hence, the customized fetal growth charts of each fetal biometric parameter were, respectively, constructed for SC-MCDA, SC-DCDA, and ART-DCDA twins.

The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode. To fill the gap, we modeled fetal biometric parameters for Chinese SC-MCDA, SC-DCDA, and ART-DCDA twin pregnancies, hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.

Prenatal evaluation of fetal lung maturity (FLM) is a challenge, and an effective non-invasive method for prenatal assessment of FLM is needed. The study aimed to establish a normal fetal lung gestational age (GA) grading model based on deep learning (DL) algorithms, validate the effectiveness of the model, and explore the potential value of DL algorithms in assessing FLM.

A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41 + 6 weeks were analyzed in this study. There were no pregnancy-related complications that affected fetal lung development, and all infants were born without neonatal respiratory diseases. The images were divided into three classes based on the gestational week: class I: 20 to 29 + 6 weeks, class II: 30 to 36 + 6 weeks, and class III: 37 to 41 + 6 weeks. There were 3323, 2142, and 1548 images in each class, respectively. First, we performed a pre-processing algorithm to remove irrelevant information from each image. Then, a convolutional neural network was designed to identify different categories of fetal lung ultrasound images. Finally, we used ten-fold cross-validation to validate the performance of our model. This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA. This was used to establish a grading model. The performance of the grading model was assessed using accuracy, sensitivity, specificity, and receiver operating characteristic curves.

A normal fetal lung GA grading model was established and validated. The sensitivity of each class in the independent test set was 91.7%, 69.8%, and 86.4%, respectively. The specificity of each class in the independent test set was 76.8%, 90.0%, and 83.1%, respectively. The total accuracy was 83.8%. The area under the curve (AUC) of each class was 0.982, 0.907, and 0.960, respectively. The micro-average AUC was 0.957, and the macro-average AUC was 0.949.

The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs, which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy. The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.

Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang. This study aims to investigate the distribution of human papillomavirus (HPV) infection and cervical cancer in rural areas of Xinjiang, China.

Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang, China in 2017 through gynecological examination, vaginal discharge smear microscopy, cytology, and HPV testing. If necessary, colposcopy and biopsy were performed on women with suspicious or abnormal screening results.

Of the 216,754 women screened, 15,518 received HPV testing. The HPV-positive rate was 6.75% (1047/15,518). Compared with the age 35-44 years group, the odds ratios (ORs) of HPV positivity in the age 45-54 years and 55-64 years groups were 1.18 (95% confidence interval [CI]: 1.02-1.37) and 1.84 (95% CI: 1.53-2.21), respectively. Compared with women with primary or lower education level, the ORs for HPV infection rates of women with high school and college education or above were 1.37 (95% CI: 1.09-1.72) and 1.62 (95% CI: 1.23-2.12), respectively. Uyghur women were less likely to have HPV infection than Han women, with an OR (95% CI) of 0.78 (0.61-0.99). The most prevalent HPV types among Xinjiang women were HPV 16 (24.00%), HPV 33 (12.70%), and HPV 52 (11.80%). The detection rate of cervical intraepithelial neoplasia (CIN)2+ was 0.14% and the early diagnosis rate of cervical cancer was 85.91%. The detection rates of vaginitis and cervicitis were 19.28% and 21.32%, respectively.

The HPV infection rate in Xinjiang is low, but the detection rate of cervical cancer and precancerous lesions is higher than the national average level. Cervical cancer is a prominent public health problem in Xinjiang, especially in southern Xinjiang.

Deep brain stimulation (DBS) has seizure-suppressing effects but the molecular mechanisms underlying its therapeutic action remain unclear. This study aimed to systematically elucidate the mechanisms underlying DBS-induced seizure suppression at a molecular level.

We established a macaque model of mesial temporal lobe epilepsy (mTLE), and continuous high-frequency hippocampus DBS (hip-DBS) was applied for 3 months. The effects of hip-DBS on hippocampus gene expression were examined using high-throughput microarray analysis followed by bioinformatics analysis. Moreover, the microarray results were validated using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analyses.

The results showed that chronic hip-DBS modulated the hippocampal gene expression. We identified 4119 differentially expressed genes and assigned these genes to 16 model profiles. Series test of cluster analysis showed that profiles 5, 3, and 2 were the predominant expression profiles. Moreover, profile 5 was mainly involved in focal adhesion and extracellular matrix-receptor interaction pathway. Nine dysregulated genes (Arhgap5, Col1a2, Itgb1, Pik3r1, Lama4, Fn1, Col3a1, Itga9, and Shc4) and three genes (Col1a2, Itgb1, and Flna) in these two pathways were further validated by qRT-PCR and Western blot analyses, respectively, which showed a concordance.

Our findings suggest that hip-DBS could markedly reverse mTLE-induced abnormal gene expression. Findings from this study establish the basis for further investigation of the underlying regulatory mechanisms of DBS for mTLE.

Endotoxin tolerance (ET) is a protective phenomenon in which pre-treatment with a tolerance dose of lipopolysaccharide (LPS) leads to dramatically elevated survival. Accumulating evidence has shown that peripheral T cells contribute to the induction of ET. However, what happens to T cell development in the thymus under ET conditions remains unclear. The purpose of this study was to analyze the alterations in thymocyte populations (double-positive [DP] and single-positive [SP] cells) under ET conditions.

Mice were intraperitoneally injected with LPS at a concentration of 5 mg/kg to establish an LPS tolerance model and were divided into two groups: a group examined 72 h after LPS injection (72-h group) and a group examined 8 days after LPS injection (8-day group). Injection of phosphate-buffered saline was used as a control (control group). Changes in thymus weight, cell counts, and morphology were detected in the three groups. Moreover, surface molecules such as CD4, CD8, CD44, CD69, and CD62L were analyzed using flow cytometry. Furthermore, proliferation, apoptosis, cytokine production, and extracellular signal-regulated kinase (ERK) pathway signaling were analyzed in thymocyte populations. The polymorphism and length of the T-cell receptor (TCR) β chain complementarity-determining region 3 (CDR3) were analyzed using capillary electrophoresis DNA laser scanning analysis (ABI 3730).

Thymus weight and cell counts were decreased in the early stage but recovered by the late stage in a murine model of LPS-induced ET. Moreover, the proportions of DP cells (control: 72.130 ± 4.074, 72-h: 10.600 ± 3.517, 8-day: 84.770 ± 2.228), CD4⁺ SP cells (control: 15.770 ± 4.419, 72-h: 44.670 ± 3.089, 8-day: 6.367 ± 0.513), and CD8⁺ SP cells (control: 7.000 ± 1.916, 72-h: 34.030 ± 3.850, 8-day: 5.133 ± 0.647) were obviously different at different stages of ET. The polymorphism and length of TCR β chain CDR3 also changed obviously, indicating the occurrence of TCR rearrangement and thymocyte diversification. Further analysis showed that the expression of surface molecules, including CD44, CD69, and CD62L, on thymocyte populations (DP and SP cells) were changed to different degrees. Finally, the proliferation, apoptosis, cytokine production, and ERK pathway signaling of thymocyte populations were changed significantly.

These data reveal that alterations in thymocyte populations might contribute to the establishment of ET.

基底细胞癌（BCC）是最常见的皮肤恶性肿瘤，在世界范围内发病率逐年上升。大多数基底细胞癌是一种惰性肿瘤，它可以生长成一个大的病灶并失去其经典表现。此外，巨型BCC近年来也引起了研究者的关注。^[1]因此，肿瘤大小较大的基底细胞癌也引起了我们的注意。皮肤镜检查是诊断和治疗基底细胞癌的有用辅助工具。^[2]关于基底细胞癌肿瘤大小和基底细胞癌皮肤镜特征的文献很少。我们观察和分析了98例基底细胞癌，发现直径≥1cm的基底细胞癌与较小的基底细胞癌的皮肤镜特征不同。

致编辑：家族性低钙性高钙血症（FHH）包括一组罕见的钙稳态遗传性疾病，其特征是终身高钙血症，通常无症状，尿钙排泄不当低。FHH是遗传异质性的。大多数病例是FHH1，由于钙敏感受体的失活突变（CASR）3号染色体上的基因。FHH2和FHH3分别是由于G蛋白亚基α 11基因和衔接子相关蛋白复合物2亚基σ 1基因中的失活突变。

致编辑：嗜酸性膀胱炎（EC）是一种罕见的疾病，其特征是膀胱壁的透壁嗜酸性炎症，伴有尿频增加、血尿、排尿困难和耻骨上疼痛。^[1]在儿童中很少报道。儿科人群中诊断的中位年龄为6.5岁。儿童期EC尚无标准治疗方法，大多数患者接受非甾体抗炎药或类固醇作为辅助治疗。^[2]大多数儿童病例是自限性的，不需要更具侵入性的治疗，但可能发生严重的并发症，并已描述了复发形式。随后，可能需要通过相关的血液和尿液测试以及成像进行长期监测。^[3,4]活检对于EC的诊断至关重要。目前，国际指南推荐膀胱镜检查和活检。膀胱镜活检是侵入性的，成本高。如果疾病局限于膀胱粘膜下层，不累及粘膜层，则进行膀胱镜活检比较棘手，因为膀胱镜活检不选择全层膀胱活检。膀胱镜活检是一种不愉快且昂贵的程序。因此，有必要开发用于EC诊断的侵入性更小、成本更低且更准确的新诊断方法。我们探讨超声（US）联合膀胱壁活检在诊断EC中的临床价值。回顾性分析2012年7月至2020年10月在青岛市妇女儿童医院确诊为EC的17例膀胱肿块模拟肿瘤患者的数据。患者的纳入标准是有膀胱可变增厚和膀胱刺激症状的儿童。排除有膀胱手术或局部用药史的儿童。本研究是根据赫尔辛基宣言并经青岛市妇女儿童医院伦理委员会批准（编号：QFELL-YJ-2021-08），所有参与者均签署了知情同意书。获得了所有参与者和/或其法定监护人的知情同意。该研究是在相关指南和法规下进行的。

致编辑：重度抑郁症是世界范围内导致残疾的最主要原因之一。抑郁症的分子病理生理学是复杂的，已经引起了广泛的关注。^[1]如今，抑郁症的神经营养假说表明，脑源性神经营养因子（BDNF）/酪氨酸激酶受体B（TrkB）受体结合激活下游信号通路，最终导致细胞存活。^[2]该过程对于参与抗抑郁药作用的神经发生和突触发生至关重要。^[3]

致编辑：非典型哮喘，如胸痛型变异性哮喘（CPVA），常导致误诊。非典型哮喘患者通常不表现为喘息和呼吸困难，并且经常被误诊为冠状动脉疾病（CAD）、胃食管反流病（GERD）和其他疾病。诊断哮喘的金标准是肺功能测试（PFT），尽管有时也使用治疗性测试。在以前的研究中已经报道了几例CPVA病例；^[1,2]然而，这种表型有时被忽视。

致编辑：71岁男性，因进行性劳力性呼吸困难入院。他有纤维化纵隔炎（FM）诱导的肺血管狭窄病史。他的右肺叶间动脉严重狭窄，植入了一个直径为6毫米的支架（6毫米× 18毫米；PALMAZ^®蓝色^TM，Cordis，上海，中国）入院前6个月，其左上肺静脉已植入9 mm直径支架（9 mm × 29 mm；Express^TM血管LD，波士顿科学公司，马尔伯勒，马萨诸塞州，美国）入院前1个月。

致编辑：原发性肺淋巴上皮瘤样癌（PPLELC）被认为是一种罕见的肺癌类型，由长期EB病毒感染引起，临床症状与大多数肺癌相似。在新冠肺炎疫情期间，我们治疗了一名看似无症状的PPLELC合并症患者，该患者因慢性鼻炎急性发作入院。胸部计算机断层扫描（CT）显示患者肺部有异常肿块。基于这个临床病例，我们提出慢性EB病毒相关性鼻炎和PPLELC之间存在正相关。此外，我们建议感染EB病毒的鼻炎患者接受持续的抗病毒治疗，并定期监测病毒浓度和CT扫描。

致编辑：膀胱癌（BCa）是最常见的泌尿系恶性肿瘤之一。2020年全球发病率为573,278例，在所有肿瘤中排名第十一位。^[1]尽管有不同批准的免疫检查点抑制剂用于BCa患者，但对这些药物的应答率仍然有限，从20%到40%不等。^[2]因此，发现新的有效免疫治疗药物来治疗BCa仍然至关重要。恶性实体瘤的肿瘤微环境被认为不仅由肿瘤细胞组成，还包括正常细胞，如基质细胞和免疫细胞，它们已被揭示在肿瘤生长和进展中起重要作用。这表明了设计靶向那些正常细胞的药物的可行性。因此，我们提出，基于新建立的预测肿瘤微环境中免疫和基质细胞浸润水平的算法，有可能鉴定对BCa具有潜在调节作用的药物。^[3]我们预计该算法将为BCa的免疫治疗提供新的见解。

致编辑：痤疮是一种慢性炎症性疾病，常见于皮脂腺丰富的地区。它更有可能产生永久性的萎缩性或肥大性疤痕，从而导致严重的心理社会后果并降低患者的生活质量。^[1]大多数人青春期后痤疮会消退，一小部分人会持续到中年。痤疮的发生是由内源性和外源性因素引起的，许多环境因素都可以诱发痤疮，如职业暴露、避孕药、饮食、某些化妆品以及女性的月经周期等。

致编辑：缺铁（ID）和ID贫血（IDA）是世界范围内常见的健康问题。世界卫生组织（2011年）估计，34%的全球人口（>20亿）受到贫血的影响，最常见的类型是ID（占总贫血的50%），主要影响育龄妇女。^[1]尽管静脉注射（IV）铁用于治疗ID和IDA已有60多年的历史，但由于过敏反应等历史问题，与在三级中心的使用相比，其在初级保健环境中的使用并不常见。较新的（非葡聚糖）IV制剂允许在15至30分钟的单次坐位中完全或接近完全替代，与口服铁剂治疗相比，具有改善的安全性、更好的耐受性、功效和有效性。它们适合在适当的环境中用于初级保健或社区实践。尽管在大多数指南中，口服铁仍然是铁替代的一线疗法，但其常见的胃部不适和便秘的副作用，以及需要定期服用数月以补充铁储备，通常会导致不依从性。由于疼痛、皮肤变色和需要多次注射，肌肉注射铁不再受欢迎。