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促红细胞生成素抵抗的血液透析患者铁调素升高

ISSN号：1001-764X
期刊名称：临床检验杂志
时间：2015.9.10
页码：687-689
分类：R446[医药卫生—诊断学;医药卫生—临床医学]
作者机构：[1]苏州大学附属第三医院肿瘤生物诊疗中心,江苏常州213003
相关基金：国家自然科学基金（81171653,30950022）; 江苏省自然科学基金（BK2011246）
相关项目：B7-H4在胃癌肿瘤微环境中表达的临床意义及调控机制

关键词：铁调素, 促红细胞生成素抵抗, 血液透析, hepcidin, erythropoietin resistance, hemodialysis

中文摘要：

目的探讨铁稳态调节分子铁调素（hepcidin）在促红细胞生成素（EPO）抵抗的维持性血液透析（MHD）患者中的表达及其与机体慢性炎症、铁稳态的关系,分析铁调素对EPO抵抗的MHD患者的影响。方法 ELISA法测定30例EPO抵抗MHD患者、30例无贫血MHD患者以及30例健康人对照者的血清铁调素和IL-6水平,分析其与Hb、肾小球滤过率（GFR）和血清铁蛋白（SF）的相关性。结果 MHD组患者铁调素、IL-6、SF均高于健康人对照组,EPO抵抗MHD组铁调素、IL-6、SF均高于无贫血MHD组,差异均有统计学意义（P〈0.01）。血清铁调素水平在所有标本中与SF、IL-6呈正相关（r=0.929、0.962）;与GFR、Hb呈负相关（r=-0.649、-0.736）,均有统计学意义（P〈0.01）。铁调素和IL-6预测MHD患者EPO反应性的ROC曲线下面积为0.933及0.917,通过临床治疗后EPO抵抗MHD组铁调素、IL-6、SF表达降低,Hb升高（P均〈0.05）。结论 EPO抵抗患者铁调素表达升高,铁调素与机体炎症水平、铁代谢状态及肾功能损害程度相关,或可用于预测MHD患者EPO反应性。

英文摘要：

Objective To examine the expression of hepcidin,an iron homeostasis regulator,in erythropoietin（ EPO）-resistant maintenance hemodialysis（ MHD） patients,and explore the correlations between hepcidin and iron homeostasis,chronic inflammation for understanding the effect of hepcidin on EPO-resistant patients. Methods The levels of plasma hepcidin and IL-6 in 30 EPO-resistant MHD patients,30 MHD patients without anemia,and 30 healthy controls were examined with ELISA. The hemoglobin（ Hb）,glomerular filtration rate（ GFR） and serum ferritin（ SF） of all the specimens were examined. The correlations between hepcidin and the other parameters were analyzed. Results The levels of plasma hepcidin,IL-6 and SF in MHD group were much higher than those in healthy control group. The levels of plasma hepcidin,IL-6 and SF in EPO-resistant MHD patients were higher than those in MHD patients without anemia. The increases were statistically significant（ P〈0. 01）. The plasma hepcidin level in all the specimens correlated positively with SF（ r = 0. 929） and IL-6 levels（ r = 0. 962） but negatively correlated with Hb（ r =- 0. 736） and GFR（ r =- 0. 649） with significant difference（ P〈0. 01）. The area under ROC curve of hepcidin and IL-6 were 0. 933 and 0. 917 for predicting EPO-responsiveness of MHD patients. After a series of clinical treatments the hepcidin,IL-6 and SF level significantly declined in EPO-resistant MHD patients,and the Hb level rised（ P〈0. 05）. Conclusion The elevated expression of hepcidin in EPO-resistant MHD patients may be associated with chronic inflammation,disorders of iron metabolism and impaired renal function. Hepcidin level can be used as a marker for predicting EPO-responsiveness in MHD patients who were undergoing hemodialysis,therefore it should be available in clinical practice.

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