维持性血液透析患者血清Hepcidin、sTfR测定在铁缺乏中的应用价值  

Application value of detection of serum hepcidin and serum transferrin receptor in maintenance hemodialysis of iron metabolism

作　　者：张妍[1] 李银岚[1] 陈孟华[1] 

机构地区：[1]宁夏医科大学第二附属医院肾脏内科,宁夏银川750001

出　　处：《西安交通大学学报（医学版）》2015年第1期102-105,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：宁夏自然科学基金资助项目(No.NZ13202);宁夏医科大学科学研究基金资助项目(No.XM2012036)~~

摘　　要：目的检测维持性血液透析患者(MHD)、非透析终末期肾脏疾病患者(ESRD)血清中铁调素(hepcidin)和血清转铁蛋白受体(serum transferring receptor,sTfR)的水平变化,探讨其在肾性贫血铁缺乏中的作用。方法选择维持性血液透析患者80例、非透析终末期肾脏疾病患者80例,健康体检者80例作为对照组。ELISA法检测血清Hepcidin、sTfR、总铁结合力(TIBC),同时测定血清铁(Fe)、铁蛋白(FER)、血清转铁蛋白(TRF),比较组间差异。结果 1维持性血液透析患者和非透析终末期肾脏疾病患者血清hepcidin和sTfR水平均明显升高,差异有统计学意义(P<0.01)。2与非透析ESRD组相比,MHD组的血清hepcidin和sTfR水平显著升高,差异有统计学意义(P<0.05)。3相关分析显示,血清hepcidin与Scr、hs-CRP、血清铁(Fe)、铁蛋白(FER)呈正相关,r分别为0.515、0.312、0.290、0.286,P均<0.01;与HGB、eGFR、HCT、TRF、TIBC呈负相关,r分别为-0.466、-0.362、-0.285、-0.248、-0.224,P<0.05。4血清sTfR水平与铁蛋白、转铁蛋白饱和度(TSAT)有相关性,相关系数分别为-0.764、-0.519,P均<0.01;与血红蛋白和红细胞压积有相关性,相关系数分别为0.378和0.514,P均<0.01。5血清hepcidin、sTfR联合铁蛋白或转铁蛋白饱和度诊断缺铁时,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),曲线下面积为90.8%,对应的灵敏度为93.3%,特异度为77%。结论血清hepcidin、sTfR联合铁蛋白或转铁蛋白饱和度对于ESRD患者合并肾性贫血铁缺乏的评估及治疗有重要意义。Objective To detect the changes of serum hepcidin and serum transferrin receptor （sTfR） levels in patients on maintenance hemodialysis （MHD） and those end-stage renal disease （ESRD） patients not on dialysis so as to explore their role in renal iron-deficiency anemia. Methods A total of 80 patients on MHD, 80 ESRD patients not on dialysis, and 80 healthy controls were enrolled in this study. Serum hepcidin, sTfR and total ironbinding 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 （1） Serum hepcidin and sTfR levels were significantly higher in patients on MHD and ESRD patients not on dialysis than in the healthy controls （P〈 0.01）. （2） Serum hepcidin and sTfR were significantly higher in patients on MHD than in ESRD patients not on dialysis （P〈0.05）. @ Pearson correlation analysis revealed that serum hepcidin was positively correlated with Scr （r=0.515）, hs-CRP （r=0.312）, serum Fe （r=0.290） and FER （r=0.286） （all P〈0.01）; but negatively correlated with HGB（r=-0.466）, eGFR （r=-0.362）, HCT（r=-0.285）, TRF（r=-0.248） and TIBC （r =- 0. 224） （P〈20.05）. （4） Pearson correlation analysis revealed that sTfR was positively correlated with HGB （r=0.378） and HCT （r=0.514） （both P〈0.01）, but negatively correlated with FER （r= -0.764） and TSAT（r=-0.519） （both P〈0.01）. （5） The area of serum hepcidin, sTfR and FER or TSAT under the ROC curve was 90.8%, and the sensitivity and specificity were 93.3% and 77%, respectively. Conclusion Serum hepcidin, sTfR and ferritin or transferrin saturation is important for assessing and treating ESRD patients with renal iron-deficiency anemia

关 键 词：铁调素 血清转铁蛋白受体 维持性血液透析 铁缺乏 终末期肾病 

分 类 号：R692.5[医药卫生—泌尿科学]