中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (01): 30-34.doi: 10.3969/j.issn.1671-4091.2017.01.008

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血浆铁调素水平及其影响因素分析

李萍1,陈孜瑾1,蒋钻红1, 俞海瑾1,马晓波1,陈晓农1   

  1. 1. 上海交通大学医学院附属瑞金医院肾脏内科
  • 收稿日期:2016-06-13 修回日期:2016-08-30 出版日期:2017-01-12 发布日期:2017-01-12
  • 通讯作者: 陈晓农 xiaonong@medmail.com.cn E-mail:xiaonong@medmail.com.cn
  • 基金资助:

    上海市自然科学基金(14ZR1425400)；上海市科委医学引领项目(114119b2700)；上海市卫生计划生育委员会课题(20154Y0015)

Plasma hepcidin level and its related factors in maintenance hemodialysis patients

  • Received:2016-06-13 Revised:2016-08-30 Online:2017-01-12 Published:2017-01-12

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摘要： 目的检测维持性血液透析(maintenance hemodialysis, MHD)患者血浆铁调素(hepcidin)水平，分析其与贫血相关指标和血管钙化的相关性，探讨其在MHD 患者中的应用价值。方法纳入2011年1 月至2011 年12 月期间于上海交通大学医学院附属瑞金医院血液透析中心长期MHD 患者，记录患者入组时一般资料及生化指标。收集患者透析前血浆标本，应用酶联免疫吸附法测定血浆hepcidin 水平，分析hepcidin 与贫血相关指标、红细胞生成刺激剂(erythropoiesis stimulating agent, ESA)、铁代谢指标、C 反应蛋白(C-reactive protein,CRP)之间的相关性，探讨hepcidin 的危险因素及其与血管钙化之间的关系。结果216 例MHD 患者中位hepcidin 水平2952.66(1131.38，6076.72)pg/ml。Hepcidin 水平与红细胞计数(r=-0.203,P=0.003)、血红蛋白(r=-0.165,P=0.015)、红细胞比容(r=-0.182, P= 0.007)、总铁结合力(r=-0.467,P＜0.001)、转铁蛋白(r=-0.362,P＜0.001)呈显著负相关，与平均血红蛋白量(r=0.163,P=0.017)、平均血红蛋白浓度(r= 0.156, P= 0.022)、转铁蛋白饱和度(r=0.193,P=0.004)、铁蛋白(r=0.681,P＜0.001)、CRP(r=0.301,P＜0.001)、每周ESA 剂量(r=0.146, P=0.032)呈显著正相关；逐步多元线性回归显示体质量指数(body mass index,BMI)(β=1.360,95%CI 0.437～2.283,P=0.004)、铁蛋白(β=0.061,95% CI 0.046～0.077,P＜0.001)、CRP(β=3.532,95% CI 0.887～6.177,P=0.009)是影响hepcidin 水平的独立危险因素，总铁结合力(β=-0.729, 95% CI -1.170～-0.288,P=0.001)是保护因素。Hepcidin 水平与腹主动脉钙化(aorta abdominalis calcification,AAC)受累节段(r=0.189,P=0.028)、腹主动脉钙评分(r=0.178,P=0.039)显著正相关。结论MHD 患者hepcidin 水平与贫血、铁代谢指标显著相关，且与炎症指标、AAC 也显著相关，提示hepcidin 可能参与了MHD 患者微炎症状态和血管钙化的病理学机制。

关键词: 血液透析, 肾性贫血, hepcidin, 微炎症状态, 血管钙化

Abstract: Objective To investigate plasma hepcidin level, the potential factors relating to hepcidin level, and its association with anemia and vascular calcification in maintenance hemodialysis (MHD) patients. Methods The MHD patients treated in Shanghai Ruijin Hospital from Jan. 1st, 2011 to Dec. 31st, 2011 were
enrolled in this study. Clinical characteristics and biochemical indices at baseline were collected. Blood samples at baseline were collected to determine plasma hepcidin level using ELISA method. The relationship between hepcidin level and anemia parameters and abdominal aortic calcification (AAC) was analyzed. Results A total of 216 MHD patients were enrolled in this study. The median plasma hepcidin level was 2,952.66 (1,131.38～6,076.72) pg/ml. Spearman analysis showed that significant negative correlations were observed between hepcidin level and red blood cell (r=-0.203, P=0.003), hemoglobin (r=-0.165, P=0.015), hematocrit (r=-0.182, P=0.007), total iron binding capacity (r=-0.467, P＜0.001) and transferrin (r=-0.362, P＜0.001); significant positive correlations were found between hepcidin level and mean corpuscular hemoglobin (r= 0.163, P=0.017), mean corpuscular hemoglobin concentration (r=0.156, P=0.022), transferrin saturation (rr= 0.193, P=0.004), ferritin (r=0.681, P＜ 0.001), C- reactive protein(CRP) (r=0.301, P＜0.001), and weekly ESA dose (r=0.146, P=0.032). Stepwise multivariate regression analysis showed that BMI (β=1.360, 95% CI 0.437～2.283, P=0.004), ferritin (β =0.061, 95% CI 0.046～0.077, P＜0.001), and CRP (β =3.532, 95% CI 0.887～6.177, P=0.009) were the independent risk factors for the increase of hepcidin level, and total iron binding capacity (β=-0.729, 95%CI -1.170～-0.288, P=0.001) was the independent inhibition factor for the increase of hepcidin level. Hepcidin level was positively correlated with AAC. Conclusion Plasma hepcidin level was related to anemia and iron metabolism parameters, inflammation factors and AAC, implying that hepcidin may participate in the pathogenesis of micro-inflammation state and vascular calcification.

Key words: Hemodialysis, Renal anemia, Hepcidin, Micro-inflammation state, Vascular calcification