基于铁调素调节铁代谢机制观察蚕砂提取物对血液透析患者促红细胞生成素抵抗的影响  

Effects of faeces bombycis extract in treatment of erythropoietin resistance in hemodialysis patients based on the mechanism of Hepcidin regulating iron metabolism

作　　者：金华[1] 孔敏[1] 王亿平[1] 程皖[1] 

机构地区：[1]安徽中医药大学第一附属医院肾病科,合肥230038

出　　处：《临床肾脏病杂志》2016年第5期294-298,共5页Journal Of Clinical Nephrology

摘　　要：目的通过观察维持性血液透析(maintenance hemodialysis,MHD)患者体内铁调素对铁代谢的调节作用,探讨蚕砂提取物对促红细胞生成素(erythropoietin,EPO)抵抗的干预机制。方法将40例MHD患者随机分为对照组和治疗组各20例,均给予常规透析、EPO皮下注射等治疗,在此基础上,对照组口服多糖铁复合物胶囊,治疗组口服蚕砂提取物,连续观察12周;同时选取20例健康人群作为正常组。空腹取血,采用酶联免疫吸附法(ELISA)检测铁调素、白细胞介素6(interleukin-6,IL-6),免疫比浊法检测超敏C反应蛋白(high sensitive C reactive protein,hs-CRP),化学发光法检测铁蛋白(serum ferritsn,SF)和转铁蛋白饱和度(transferin saturation,TSAT);并检测血常规(血红蛋白、红细胞压积),记录体质量(body weight,BW),计算重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)用量与EPO抵抗指数(erythropoietin resistance index,ERI)。结果与正常组比较,对照组和治疗组MHD患者的血清铁调素、IL-6、hs-CRP、SF均显著升高,TSAT显著降低(P<0.05)。治疗前后比较,治疗组治疗后的血清铁调素、IL-6、hs-CRP、SF、rHuEPO用量、ERI均较治疗前有显著降低,血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit value,Hct)较治疗前有显著升高(P<0.05),而对照组变化不明显(P>0.05)。治疗后组间比较,治疗组的血清铁调素、IL-6、hsCRP、SF、rHuEPO用量、ERI均显著低于同期对照组,Hb、Hct均显著高于同期对照组(P<0.05)。结论 MHD患者的EPO抵抗与微炎症状态、铁调素升高、铁代谢紊乱具有相关性;蚕砂提取物可以通过抑制机体的微炎症反应及铁调素高表达,改善铁代谢,这可能是蚕砂提取物纠正MHD患者贫血、改善EPO抵抗的重要机制之一。[Abstract] Objective To explore the intervention mechanism of faeces bombycis extract （Shengxfiening tablet） in treatment of erythropoietin resistance through the observation of hepcidin regulating iron metabolism in maintenance hemodialysis （MHD） patients. Methods MHD patients were randomly divided into the control group and the experimental group （n = 20 each）, and were giv- en conventional hemodialysis, subcutaneous injection of EPO, and so on. On the basis, the control group was orally administered polysaccharide iron complex capsule, and the experimental group was treated by oral administration of Shengxuening tablets. The patients were observed continuous 12 weeks. At the same time, 20 healthy volunteers were selected as the normal group. Hepcidin, and in- terleukin-6 （IL-6） were measured by enzyme linked immunosorbent assay （ELISA）, high sensitive C reactive protein （hs-CRP） by immunoturbidimetry, serum ferritsn （SF） and transferin saturation （TSAT） by chemiluminescence, blood routine （hemoglobin and hematocrit）test was performed, body weight （BW） was recorded, and the amount of recombinant human erythropoietin （rHuEPO） and erythropoietin resistance index （ERI） were calculated. Results As compared with the normal group,MHD patients in control group and experimental group showed significantly increased serum hepcidin, IL-6, hs-CRP, SF, while decreased TSAT （P〈0. 05）. Serum hepcidin, IL-6, hs CRP and SF, rHuEPO dosage, and ERI after the treatment in experimental group patients were markedly de- creased, and Hb and Hct were markedly increased, as compared with those before the treatment, while there were no significant differences in control group patients （P〈0. 05）. After treatment, ser- um hepcidin, IL-6, hs-CRP, SF, rHuEPO dosage, and ERI in experimental group patients were sig- nificantly lower than those of the patients in control group, while Hb and Hct showed the opposite tendency （P〈0. 05）. Conclusioas EPO resistance in MHD patients is

关 键 词：铁调素 铁代谢 血液透析 EPO抵抗 蚕砂提取物 

分 类 号：R692.5[医药卫生—泌尿科学]