透析液葡萄糖对维持性血液透析患者血清铁调素合成的影响  

Effect of dialysate glucose on synthesis of serum hepcidin in patients on maintenance hemodialysis

作　　者：滑瑞雪 邹陆曦 吴雨 孙玲 Hua Rui-xue;Zou Lu-xi;Wu Yu;Sun Ling(The Xuzhou Clinical College of Xuzhou Medical University,Xuzhou 221000,China;School of Management,Xuzhou Medical University,Xuzhou 221006,China)

机构地区：[1]徐州医科大学徐州临床学院,徐州221000 [2]徐州医科大学管理学院,徐州221006

出　　处：《临床肾脏病杂志》2022年第5期359-364,共6页Journal Of Clinical Nephrology

基　　金：国家自然科学基金项目(81600540);江苏省自然科学基金(BK20150224);徐州市科技局重点研发计划(社会发展)项目(KC20182);徐州市卫生健康委科技面上项目(XWKYHT20200020)。

摘　　要：目的铁调素是机体利用铁环节的重要调节因子,其参与了维持性血液透析(maintenance hemodialysis,MHD)患者贫血和心血管疾病的病理生理进程。本研究旨在比较无糖透析液和含糖透析液在血液透析过程中对铁调素-25合成的影响,并讨论其可能的潜在机制。方法本研究为自身前后对照研究,纳入31例病情稳定且无糖尿病的MHD患者,常规使用无糖透析液,后改用5.5 mmol/L葡萄糖的含糖透析液(透析液其他成分保持不变)血液透析6次,分别测量末次无糖透析液及含糖透析液治疗第6次治疗的透析前、第120分钟及结束时血清铁调素-25和血浆儿茶酚胺(肾上腺素、去甲肾上腺素和多巴胺)。采用方差分析比较两种透析液治疗过程中血清铁调素-25清除效率和血浆儿茶酚胺浓度变化,Pearson和Spearman相关系数描述血清铁调素-25与血浆儿茶酚胺水平的相关性。结果在单次血液透析中,使用无糖透析液比含糖透析液更有利于降低铁调素-25[(-8.45±18.46)%比(0.37±17.24)%,P=0.0308]。血浆多巴胺和肾上腺素浓度变化趋势与血清铁调素-25相似,相关性分析发现透析前,第120分钟和结束时的血清铁调素-25与血浆儿茶酚胺水平呈正相关性(r=0.34,0.25,0.62,P<0.05)。结论本研究结果提示,含糖透析液可能通过上调儿茶酚胺水平、激活交感神经系统及氧化应激,从而上调铁调素的合成和(或)分泌。仍需要更充分设计及更大样本人群的研究来验证和探讨在MHD中铁调素-25水平与透析液葡萄糖的关系和机制。Objective As an important regulator of iron homeostasis,hepcidin participates in the pathophysiology of anemia and cardiovascular events in maintenance hemodialysis(MHD)patients.This study was designed to compare the effect of glucose-free versus glucose-containing dialysate on the synthesis of hepcidin-25 during hemodialysis(HD)and elucidate its potential mechanism in MHD patients.Methods In a self-before and after control study of 31 stable MHD non-diabetics,serum hepcidin-25and plasma catecholamines(adrenaline,noradrenaline&dopamine)were measured at pre-dialysis,intradialysis(120th min of HD)and post-dialysis using glucose-free dialysate and then switched to 5.5 mmol/L glucose-containing dialysate.One-way analysis of variance was utilized for identifying the effect of two dialysates on intra-dialysis%changes of serum hepcidin-25 and plasma catecholamines.Pearson/Spearman’s correlation coefficients were utilized for examining the relationships between serum hepcidin-25 and plasma catecholamines.Results Glucose-free dialysate achieved a greater reduction of serum hepcidin-25 than 5.5 mmol/L glucose-containing dialysate during a single HD[(-8.45±18.46)%vs(0.37±17.24)%,P=0.0308].Serum level of hepcidin-25 was positively associated with plasma levels of catecholamines at pre-,intra-and post-HD(r=0.34,0.25,0.62,P<0.05).Conclusion Glucosecontaining dialysate may up-regulate hepcidin synthesis and/or secretion via an activation of sympathetic nervous system or oxidative stress,possibly due to elevated catecholamines.Adequately designed studies are still required for elucidating the mechanisms of dialysate glucose on hepcidin kinetics during HD.

关 键 词：铁调素 儿茶酚胺 无糖透析液 含糖透析液 

分 类 号：R692.5[医药卫生—泌尿科学]