血清可溶性转铁蛋白受体、红细胞分布宽度-变异系数与维持性血液透析患者铁代谢的关系  

Relationship between serum sTFR,RDW-CV and iron metabolism in maintenance hemodialysis patients

作　　者：顾铜 方倩 何阳[1] 李慧妍[1] Gu Tong;Fang Qian;He Yang;Li Hui-yan(Hemodialysis Room,First Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院血液透析室,秦皇岛066000

出　　处：《临床肾脏病杂志》2023年第6期461-466,共6页Journal Of Clinical Nephrology

基　　金：秦皇岛市科学技术研究与发展计划(202004A097)。

摘　　要：目的研究血清可溶性转铁蛋白受体(soluble transferrin receptor,sTFR)、红细胞分布宽度-变异系数(red blood cell distribution width-coefficient of variation,RDW-CV)与维持性血液透析患者铁代谢的关系。方法选取2019年1月至2020年6月秦皇岛市第一医院收治的98例终末期肾病患者,其中48例患者为维持性血液透析患者(A组),48例为非透析终末期肾病患者(B组)。另外,选取同期在秦皇岛市第一医院进行健康体检的受试者48例作为对照组。入组后第二天,测定受试者sTFR水平、RDW-CV水平、肾功能参数水平、铁代谢参数水平。结果A组的sTFR水平为(49.78±17.43)nmol/L、RDW-CV水平为(16.21±2.43)%,均显著高于B组的(31.01±5.23)nmol/L、(14.87±4.88)%和对照组的(13.79±3.72)nmol/L、(12.89±3.92)%(P<0.05)。与B组相比,A组患者的超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、血红蛋白(hemoglobin,Hb)、血清铁蛋白(ferritin,Fer)水平显著增加(P<0.05),白蛋白(albumin,Alb)、血清转铁蛋白(transferrin,TRF)、血清铁及转铁蛋白饱和度(transferrin saturation,TSAT)水平显著降低(P<0.05)。患者血清sTFR和RDW-CV水平均与血肌酐(serum creatinine,Scr)、尿酸(uric acid,UA)、hs-CRP、甲状旁腺激素(parathyroid hormone,PTH)、FER和TSAT水平呈正相关(P<0.05);与估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、红细胞计数(red blood cell,RBC)、Alb、Hb、TRF和血清铁(serum iron,SI)水平呈负相关(P<0.05)。多元逐步回归分析结果显示,维持性血液透析患者血清sTFR、RDW-CV水平与患者铁代谢参数FER和血清总铁结合力水平均有密切关系(P<0.05)。血清sTFR的曲线下面积(area under curve,AUC)和95%置信区间为0.874、0.823~0.909,血清RDW-CV的AUC和95%置信区间为0.888、0.812~0.899。血清sTFR的截断值为32.12 nmol/L,对维持性血液透析患者铁代谢预测的特异性为71.2%,敏感性为76.3%。血清RDW-CV的截断值为15.42%,对维持性血液透�Objective To explore the relationship between serum soluble transferrin receptor(sTFR),red blood cell distribution width-CV(RDW-CV)and iron metabolism in maintenance hemodialysis(MHD)patients.Methods From January 2019 to June 2020,98 patients of end-stage renal disease(ESRD)were selected,including 48 patients on maintenance hemodialysis(group A)and 48 patients with non-dialysis ESRD(group B).Another 48 subjects receiving physical examination during the same period were selected as control group.At Day 2 post-recruitment,the levels of sTFR,RDW-CV,kidney function and iron metabolism parameters(FER&TIBC)were measured.Results Serum levels of sTFR and RDW-CV in group A(49.78±17.43)nmol/L,(16.21±2.43)%were significantly higher than those in group B(31.01±5.23)nmol/L,(14.87±4.88)%and control group(13.79±3.72)nmol/L,(12.89±3.92)%(P<0.05).Compared with group B,the levels of hs-CRP,Hb and FER spiked markedly in group A(P<0.05)while the levels of albumin(Alb),transferrin(TRF)and transferrin saturation(TSAT)declined significantly(P<0.05).Serum levels of sTFR and RDW-CV were correlated positively with the levels of Scr,UA,hs-CRP,iPTH,FER and TSAT(P<0.05).There was a negative correlation with the levels of eGFR,RBC,Alb,Hb,TRF and SI(P<0.05).Multiple regression analysis indicated that serum levels of sTFR and RDW-CV were correlated closely with FER and TIBC(P<0.05).AUC and 95%confidence interval of serum sTFR were 0.874(95%CI:0.823-0.909)and AUC and 95%confidence interval of serum RDW-CV 0.888(95%CI:0.812-0.899).The cut-off value of serum sTFR was 32.12 nmol/L and the specificity and sensitivity of predicting iron metabolism 71.2%and 76.3%respectively.The cutoff value of serum RDW-CV was 15.42%and the specificity and sensitivity of predicting iron metabolism were 68.0%and 76.4%respectively.Conclusion Serum levels of sTFR and RDW-CV are correlated negatively with iron metabolism level.Both parameters may reflect the iron metabolism level of MHD patients to some extent.

关 键 词：可溶性转铁蛋白受体 红细胞分布宽度-变异系数 维持性血液透析 铁代谢 

分 类 号：R692.5[医药卫生—泌尿科学]