血色病的罕见类型(2-4 型等)在全球都有报告。相比之下,最常见的类型 1 型(HFE 相关)血色病主要见于北欧血统人群。[3]Olynyk JK, Cullen DJ, Aquilia S, et al. A population-based study of the clinical expression of the hemochromatosis gene. N Engl J Med. 1999;341:718-724.http://www.ncbi.nlm.nih.gov/pubmed/10471457?tool=bestpractice.com[4]European Association For The Study Of The Liver. EASL clinical practice guidelines for HFE hemochromatosis. J Hepatol. 2010;53:3-22.http://www.journal-of-hepatology.eu/article/S0168-8278(10)00197-2/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/20471131?tool=bestpractice.com主要的 HFE 突变 (C282Y) 在美国常见:每 10 名白种人中有一名存在该基因的杂合突变,而每 200 人中有 1 人为 C282Y 纯合子。该基因C282Y纯合突变的发生率在其他人种中则要低很多。其中西班牙裔为0.27/1000,太平洋岛国为0.12/1000,黑人为0.14/1000。[5]Whitlock EP, Garlitz BA, Harris EL, et al. Screening for hereditary hemochromatosis: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2006;145:209-223.http://www.ncbi.nlm.nih.gov/pubmed/16880463?tool=bestpractice.com在全球各地区这一突变的频率可能会有所不同,而其他一些基因突变可能占优势。[6]Perez R, Toro D, Fournier J, et al. Prevalence of hemochromatosis in the Puerto Rico veteran population. P R Health Sci J. 2007;26:147-150.http://www.ncbi.nlm.nih.gov/pubmed/17722428?tool=bestpractice.com[7]Pietrangelo A. Hereditary hemochromatosis. Biochim Biophys Acta. 2006;1763:700-710.http://www.ncbi.nlm.nih.gov/pubmed/16891003?tool=bestpractice.com[8]Terzic R, Sehic A, Teran N, et al. Frequency of HFE gene mutations C282Y and H63D in Bosnia and Herzegovina. Coll Antropol. 2006;30:555-557.http://www.ncbi.nlm.nih.gov/pubmed/17058523?tool=bestpractice.com[9]Cimburova M, Putova I, Provaznikova H, et al. S65C and other mutations in the haemochromatosis gene in the Czech population. Folia Biol (Praha). 2005;51:172-176.http://fb.cuni.cz/Data/files/folia_biologica/volume_51_2005_6/FB2005A0030.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/16419611?tool=bestpractice.com[10]Leone PE, Gimenez P, Collantes JC, et al. Analysis of HFE gene mutations (C282Y, H63D, and S65C) in the Ecuadorian population. Ann Hematol. 2005;84:103-105.http://www.ncbi.nlm.nih.gov/pubmed/15517265?tool=bestpractice.com[11]Scotet V, Le Gac G, Mérour MC, et al. Impact of HFE genetic testing on clinical presentation of hereditary hemochromatosis: new epidemiological data. BMC Med Genet. 2005;6:24.http://bmcmedgenet.biomedcentral.com/articles/10.1186/1471-2350-6-24http://www.ncbi.nlm.nih.gov/pubmed/15929798?tool=bestpractice.com[12]Pardo A, Quintero E, Barrios Y, et al. Genotype and phenotypic expression of hereditary hemochromatosis in Spain [in Spanish]. Gastroenterol Hepatol 2004;27:437-443.http://www.ncbi.nlm.nih.gov/pubmed/15388046?tool=bestpractice.com[13]Sassi R, Hmida S, Kaabi H, et al. Prevalence of C282Y and H63D mutations in the haemochromatosis (HFE) gene in Tunisian population. Ann Genet. 2004;47:325-330.http://www.ncbi.nlm.nih.gov/pubmed/15581829?tool=bestpractice.com[14]Wrede CE, Hutzler S, Bollheimer LC, et al. Correlation between iron status and genetic hemochromatosis (codon C282Y) in a large German population. Isr Med Assoc J. 2004;6:30-33.http://www.ima.org.il/FilesUpload/IMAJ/0/51/25891.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/14740507?tool=bestpractice.com[15]Milman N, Pedersen P, Steig T, et al. Frequencies of the hereditary hemochromatosis allele in different populations: comparison of previous phenotypic methods and novel genotypic methods. Int J Hematol. 2003;77:48-54.http://www.ncbi.nlm.nih.gov/pubmed/12568299?tool=bestpractice.com例如,在厄瓜多尔,报告的 C282Y 频率为 0%。[10]Leone PE, Gimenez P, Collantes JC, et al. Analysis of HFE gene mutations (C282Y, H63D, and S65C) in the Ecuadorian population. Ann Hematol. 2005;84:103-105.http://www.ncbi.nlm.nih.gov/pubmed/15517265?tool=bestpractice.com在许多不同的种族中报告有 HFE 的 H63D 突变。在北美,该突变的杂合子频率约为 20%。[16]Adams PC, Reboussin DM, Barton JC, et al. Hemochromatosis and iron-overload screening in a racially diverse population. N Engl J Med. 2005;352:1769-1778.http://www.nejm.org/doi/full/10.1056/NEJMoa041534#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/15858186?tool=bestpractice.com尽管血色病是一种常染色体隐性遗传病,男性和女性纯合子的人数大致相等,但在男性中临床疾病更常见。在女性纯合子中,通过月经和妊娠丢失铁被认为会降低疾病表现,但也可能涉及其他因素。[17]Lee GR, Foerster J, Lukens J, et al. Wintrobe's clinical hematology. 1999. Philadelphia, PA: Lippincott, Williams & Wilkins; 2004.