中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (06): 458-461.doi: 10.3969/j.issn.1671-4091.2014.06.010

• 临床研究 • 上一篇    下一篇

维持性血透患者贫血治疗中铁调素的变化和影响因素

刘玉夏1,朱丽芹2,刘娜1,方路1,李晓珺1,严海东1,庄守纲1   

  1. 1. 同济大学附属东方医院肾内科
    2. 同济大学附属东方医院护理部
  • 收稿日期:2013-09-18 修回日期:2013-11-22 出版日期:2014-06-12 发布日期:2014-06-12
  • 通讯作者: 刘娜，庄守纲 naliubrown@hotmail.com, gangzhuang@hotmail.com E-mail:gangzhuang@hotmail.com
  • 基金资助:

    国家自然基金项目(81200492，81270778，81170638)，上海市浦江人才项目(13PJ1406900), 同济大学附属东方医院起航基金(DFQH-M12)，同济大学临床教学示范病区(2012)，浦东新区卫生系统重点学科建设资助(PWZxk 2014-06)

Changes in hepcidin during treatment of anemia in patients on maintenance hemodialysis

  • Received:2013-09-18 Revised:2013-11-22 Online:2014-06-12 Published:2014-06-12

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摘要： 【摘要】 目的 探讨铁调素在维持性血液透析(Maintenance hemodialysis , MHD)患者贫血治疗中对铁稳态的调节作用，及与铁剂补充、促红细胞生成素（EPO）应用的相互影响，探求恢复机体铁稳态的治疗方法。 方法 选取同济大学附属东方医院肾内科血液净化中心的32例MHD患者，HD时间6月以上，血红蛋白低于110g/L，给予常规补铁及EPO治疗，应用ELISA方法测定患者血清铁调素水平，分析其与铁代谢指标血清铁，血清铁蛋白（Serum ferritin，SF）与转铁蛋白饱和度（Transferrin saturation，TSAT）以及红细胞生成、铁剂补充和EPO应用的相关性及相互作用。结果 MHD患者血清铁调素水平显著高于正常对照组（324±124.2 vs 72.4±12.3，p<0.001），相关性分析显示铁调素与血清铁、SF及TSAT正相关（r分别为0.68，0.62，0.7，p值分别为0.005，0.004，0.001），与网织红细胞计数呈负相关(r=-0.63，p=0.015)。常规血透可有效清除铁调素，但于2周后血透前血清铁调素水平几乎可恢复至原水平。在贫血治疗中，EPO应用而非静脉补铁可显著降低铁调素水平，改善贫血的同时促进了铁的利用。结论 MHD患者铁调素显著升高，参与了铁代谢紊乱的发病和红细胞生成的调控；及时有效的清除铁调素和足量EPO应用可改善红细胞生成及铁的循环利用，恢复机体铁稳态，防止铁超载对机体的进一步损伤。

关键词: 铁调素, 维持性血液透析, 铁稳态, 贫血, 治疗

Abstract: ABSTRACT Objective: The current study was to investigate the change of hepcidin in the treatment of anemia and its interaction with iron supplement and Erythropoietin (EPO) agents in patients on maintenance hemodialysis (MHD), and to explore the therapy for iron homeostasis. Methods: 32 MHD patients for more than 6 months were enrolled in the study. Their hemoglobin level was lower than 110g/l. We gave them iron supplement and EPO treatment. Serum hepcidin was measured by ELISA. Iron metabolism index such as serum Fe, serum ferritin (SF) and transferrin saturation (TSAT) were measured by routine assays. The relationships between hepcidin with iron metabolism index, erythropoiesis, iron supplement or EPO agents were analyzed. Results: Serum hepcidin levels were significantly higher in patients on MHD than that in healthy control group（324±124.2VS72.4±12.3，p<0.001. It is also positively correlated with serum Fe (r=0.68,p=0.005), SF(r=0.62,p=0.004),TSAT(r=0.7,p=0.001), and negatively with reticulocyte count (r=-0.63,p=0.015). Regular hemodialysis can effectively remove hepcidin, and restore serum level to the original level in 2 weeks before hemodialysis. Treatment with EPO agents rather than iron supplement could decrease serum hepcidin levels.Conclusions: Serum hepcidin levels increasedin patients on MHD. Serum hepcidin may contribute to the abnormal iron metabolism and erythropoiesis. Timely and effectively removingf hepcidin from the body and treating with EPO can improve erythropoiesis and iron recycle, restore iron homeostasis, and prevent the further damage caused by iron overload.

Key words: Hepcidin, Maintenance hemodialysis, Iron homeostasis, Anemia, Treatment