中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (11): 785-789.doi: 10.3969/j.issn.1671-4091.2022.11.001

• 临床研究 •    下一篇

铁调素在血液透析患者相对红细胞增多的发生机制中的作用

胡 楠    吕蓓妮    陈育青   

  1. 100034 北京，北京大学第一医院肾内科，北京大学肾脏病研究所，卫生部肾脏疾病重点实验室，慢性肾脏病防治教育部重点实验室(北京大学)，中国医学科学院免疫介导肾病诊治创新单元
  • 收稿日期:2022-06-01 修回日期:2022-06-20 出版日期:2022-11-11 发布日期:2022-11-12
  • 通讯作者: 陈育青 E-mail:cyq@bjmu.edu.cn

Low Hepcidin level associated with relative erythrocytosis in chronic hemodialysis patients

  1. enal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
  • Received:2022-06-01 Revised:2022-06-20 Online:2022-11-11 Published:2022-11-12
  • Contact: 100034 北京，1北京大学第一医院肾内科，北京大学肾脏病研究所，卫生部肾脏疾病重点实验室，慢性肾脏病防治教育部重点实验室(北京大学)，中国医学科学院免疫介导肾病诊治创新单元 E-mail:cyq@bjmu.edu.cn

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摘要： 目的 探索血液透析患者中相对红细胞增多的原因。 方法  纳入规律血液透析患者，根据基线血红蛋白浓度及是否接受红细胞生成刺激剂(erythropoietin stimulating agent，ESA)治疗分2组。横断面收集临床信息，比较2组贫血，铁代谢及甲状旁腺功能亢进程度。对比检测铁调素，铁代谢指标，红细胞生成素水平以及炎症因子水平。随访84个月。 结果 纳入的161例患者中，14例(8.7%)符合相对红细胞增多即无ESA治疗组，其血红蛋白浓度高于ESA治疗组(t=6.108，P＜0.001)；铁调素水平低于ESA治疗组(t=-4.857，P＜0.001)，且铁调素水平与血液透析患者的血红蛋白浓度呈负相关(r =-0.491， P =0.007)，与铁蛋白水平呈正相关(r =0.684，P＜0.001)，与可溶性转铁蛋白受体呈负相关(r =-0.406， P =0.029。血清铁调素与超敏C反应蛋白(r =-0.098，P =0.614)，白细胞介素-6(r =-0.140，P =0.469)以及肿瘤坏死因子-α(r=-0.091，P =0.639)水平无相关性。 结论 血液透析患者中少部分患者不需要接受ESA或铁剂治疗，可能与较低的铁调素水平有关。而铁调素水平越高，组织可利用铁越少，而红细胞生成水平越低。

关键词: 血液透析, 相对红细胞增多, 铁调素, 炎症

Abstract: Objective  To explore the mechanism of relative erythrocytosis in hemodialysis patients. Methods   Patients on chronic hemodialysis were divided into subgroups according  to the baseline hemoglobin levels and whether they treated with erythropoiesis stimulating agent (ESA). Clinical characteristics and laboratory data was collected at baseline. The degree of anemia, hyperparathyroidism, and iron metabolism were compared between the two groups. All patients were followed up for 84 months.  Results   In total, 161 patients were enrolled. Fourteen (8.7%) were diagnosed as relative erythrocytosis, with significantly higher level of hemoglobin compared to ESA treated group [(130.8±13.3) vs. (110.3±11.8)g/L, t=6.108, P＜0.001]. The level of hepcidin was significantly lower in patients without ESA treatment [(5.33±5.21) vs. (20.07±10.17)×104 pg/ml, t=-4.857, P＜0.001). And in both of groups, there was a negative correlation between hepcidin level and hemoglobin concentration (r=-0.491, P=0.007). The level of hepcidin positively correlated with ferritin (r=0.684, P＜0.001) and negatively correlated with the level of soluble transferrin receptor (sTfR,    r=-0.406, P=0.029). There was no association between hepcidin and proinflammatory cytokines.  Conclusion   A small portion of hemodialysis patients may maintain reasonable activity of erythropoiesis with no need of treatment with ESA or supplement of iron. They show a relatively lower level of circulating hepcidin than patients treated with ESA. And the higher the level of hepcidin, the less iron available for the tissue, and the lower activity of erythropoiesis.

Key words: Hemodialysis, Relative erythrocytosis, Hepcidin, Inflammation

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