维持性血液透析患者贫血治疗中铁调素的变化和影响因素  

Changes of hepcidin during anemia treatment in patients on maintenance hemodialysis

作　　者：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] 

机构地区：[1]同济大学附属东方医院肾内科,上海200120 [2]同济大学附属东方医院护理部,上海200120

出　　处：《中国血液净化》2014年第6期458-461,共4页Chinese Journal of Blood Purification

基　　金：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)

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、红细胞生成素(erythropoietin,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 ng/L比72.4±12.3 ng/L,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)。常规血液透析可有效清除铁调素,但于2周后血液透析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。Objective This study was to investigate the changes of hepcidin during anemia treatment and its interaction with iron and erythropoietin （EPO） supplements in maintenance hemodialysis （MHD） patients, in order to explore the therapy for the recovery of iron homeostasis. Methods A total of 32 patients on MHD for more than 6 months were enrolled in this study. Hemoglobin was lower than 110 g/l in these patients. They were treated with iron and EPO supplements. Serum hepcidin was measured by ELISA. Iron metabolism indices including serum Fe, serum ferritin （SF） and transferrin saturation （TSAT） were measured by routine methods. The correlations of hepcidin with iron metabolism indices, erythropoiesis, and supplements of iron and EPO were analyzed. Results Serum hepcidin level was significantly higher in MHD patients than in healthy controls （324±124.2 ng/l vs. 72.4±12.3 ng/l, P〈0.001）. Serum hepcidin level was positively correlated with serum Fe （r=0.68, P=0.005）, SF （r=0.62, P=0.004） and TSAT （r=0.7, P=0.001）, and negatively correlated 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. EPO administration rather than intravenous iron supplement could reduce serum hepcidin level. Conclusions Serum hepcidin increased in MHD patients. Higher serum hepcidin may contribute to the abnormal iron metabolism and erythropoiesis. Effective removal of hepcidin from the body and treatment with EPO can improve erythropoiesis and iron recycles, restore iron homeostasis, and prevent further damage due to iron overload.

关 键 词：铁调素 维持性血液透析 铁稳态 贫血 治疗 

分 类 号：R318.16[医药卫生—生物医学工程]