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

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。
ABSTRACT: 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 iron-binding 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). ③ 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<0.05). 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