中国血液净化

›› 2011, Vol. 10 ›› Issue (7): 372-376.doi: 10.3969/j.issn.1671-4091.2011.06.00

• 临床研究 • 上一篇    下一篇

终末期肾脏病患者血清中铁调素的水平变化及其与铁代谢的关系

张 妍 周晓玲 陈孟华   

  1. 宁夏医科大学附属医院肾脏内科
  • 收稿日期:2011-03-01 修回日期:1900-01-01 出版日期:2011-07-12 发布日期:2011-07-12
  • 通讯作者: 陈孟华

Relationship between serum hepcidin level and iron metabolism in patients with end-stage renal disease

ZHANG Yan, ZHOU Xiao-ling, CHEN Meng-hua   

  1. Department of Nephrology, the Affiliated Hospital of Ningxia Medical University, Yinchuan 750004, China
  • Received:2011-03-01 Revised:1900-01-01 Online:2011-07-12 Published:2011-07-12

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摘要：

目的 研究维持性血液透析(maintenance hemodialysis,MHD)患者、非透析终末期肾脏病(end-stage renal disease,ESRD)患者血清中铁调素的水平及与其铁代谢的关系。 方法 选择MHD患者30例、非透析ESRD患者30例及健康体检者30例。酶联免疫吸附法检测血清铁调素、总铁结合力(total iron binding capacity,TIBC)，同时测定血清铁、铁蛋白(ferritin,Fer)、血清转铁蛋白(transferrin,TRF)，比较组间差异。 结果 MHD患者和非透析ESRD患者血清铁调素水平显著高于正常人群，差异有统计学意义(P＜0.01)；MHD患者血清铁调素水平高于非透析ESRD患者，差异有统计学意义(P＜0.05)。相关分析显示，血清铁调素与血清肌酐、血清铁、高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、全段甲状旁腺激素、Fer呈正相关(r分别为0.969、0.95、0.515、0.290、0.286，均P＜0.01)；与血红蛋白(hemoglobin,Hb)、红细胞计数(red blood cell,RBC)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、血细胞比容、TRF、TIBC、白蛋白、总蛋白呈负相关(r分别为-0.543、-0.540、-0.534、-0.466、-0.362、-0.285、-0.248、-0.224，P＜0.05)。多元逐步回归分析显示，非透析ESRD患者中RBC、 Hb、hs-CRP、Fer、 TRF、TIBC与铁调素水平密切相关；MHD患者中RBC、Hb、eGFR、 Fer、TIBC与铁调素水平密切相关。在非透析ESRD患者中，血清铁调素的受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线下面积为86.3%，其敏感性和特异性分别为76.7%和99.1%；在MHD患者中，血清铁调素的ROC曲线下面积为84.6%，其敏感性和特异性分别为73.0%和99.8%。 结论 ESRD患者血清铁调素水平明显增加，铁调素参与铁代谢、红细胞生成的调控，可能为反映铁储备状态的一种新型血清标志物。

关键词: 铁调素, 维持性血液透析, 终末期肾脏病, 铁代谢

Abstract:

Objective To investigate the relationship between serum hepcidin level and iron metabolism in end-stage renal disease (ESRD) patients with maintenance hemodialysis (MHD) and those without dialysis. Methods A total of 30 ESRD patients with MHD, 30 ESRD patients without dialysis, and 30 healthy people as the controls were enrolled in this study. Serum hepcidin and total iron-binding capacity (TIBC) were measured by ELISA. Serum Fe, ferritin (FER) and transferrin (TRF) were measured by routine methods. Data were compared among the groups. Results (a) Serum hepcidin was significantly higher in ESRD patients on MHD and those without dialysis than in healthy control group (P＜0.01). (b) Serum hepcidin was higher in ESRD patients on MHD than in those without dialysis (P＜0.05). (c) Pearson correlation analyses revealed that serum hepcidin was positively correlated with Scr (r=0.969), Fe (r=0.95), hs-CRP (r=0.515), iPTH (r=0.290), and FER (r=0.286) (P＜0.05), and was negatively correlated with HGB (r=-0.543), RBC (r=-0.540), eGFR (r=-0.534), HCT (r=-0.466), TRF (r=-0.362), TIBC (r=-0.285), ALB (r=-0.248), and TP (r=-0.224) (P＜0.05). (d) Multiple regression analyses showed that RBC, HGB, hs-CRP, FER, TRF, and TIBC were closely associated with serum hepcidin level in ESRD patients without dialysis, and RBC, HGB, eGFR, FER, and TIBC were closely associated with serum hepcidin level in ESRD patients on MHD. (e) In ESRD patients without dialysis, the area of serum hepcidin under the ROC curve is 86.3%, and the sensitivity and specificity are 76.7% and 99.1%, respectively. In ESRD patients on MHD, the area of serum hepcidin under the ROC curve is 84.6%, and the sensitivity and specificity are 73.0% and 99.8%, respectively. Conclusions Serum hepcidin level increases in ESRD patients. Serum hepcidin may contribute to the abnormal iron metabolism and erythropoiesis, and may be a novel serum marker to iron status.

Key words: Maintenance hemodialysis, End-stage renal disease, Iron metabolism