血透患者可溶性转铁蛋白受体测定及其影响因素

Influence Factors of Soluble Transferrin Receptor Level in Hematodialysis Patients

目的探讨慢性血液透析(HD)并用重组人促红细胞生成素(rHuEpo)治疗的患者,体内可溶性转铁蛋白受体水平(sTfR)测定的临床意义及其相关影响因素。方法随机观察35例慢性HD患者和18例贫血但肾功能正常的患者,测定血红蛋白(Hb)、红细胞压积(HCT)、网织红细胞百分比(Ret%)、血清铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)、转铁蛋白饱和度(TS)、血清促红细胞生成素(sEpo)、C-反应蛋白(CRP)、sTfR,并将结果进行组间对比。结果两组在Hb,HCT,SF,SI,TIBC以及TS方面差异均无显著性(P>0.05),HD组sTfR,sEpo和Ret%则低于对照组(P<0.05),HD患者CRP水平高于对照组(P<0.05)。单变量相关分析表明,HD组sTfR水平与sEpo呈正相关(r=0.770,P<0.01),与SF呈负相关(r=-0.523,P<0.01),与TS呈负相关(r=-0.325,P<0.01)。多变量逐步回归分析表明,sEpo,SF是两个能够独立影响sTfR水平的因素。结论在HD患者接受rHuEpo治疗时,循环中sTfR水平是反映骨髓红细胞生成活性的良好指标,反映了HD患者铁的贮存和红细胞生成刺激的综合效应。

Objective To explore the clinical significance and influence factors of the circulating sTfR concentrations in hematodialysis patients received maintenance rHuEpo treatment. Methods In a prospective cross sectional study,35chronie HD patients and 18 anaemic controls with normal renal function were recruited. For each subject,blood samples were measured for hemoglobin（HB） , haematoerit （ SF）, serum iron （ SI ）, total iron-bingding capacity （ TIBC C-reactive protein（CRP） and sTfR. Results HD patients HCT）, percent of reticulncyte connt（Ret% ）, serum ferritin , transferrin saturation （ TS ）, serum crythropoietin （ sEpo ）, ad no difference with controls about hemoglobin, haematocrit, serum ferritin,TIBC and TS, but HD patients had lower sTfR, sEpo anti reticulocyte percent than controls, had higher CRP than controls. Univariate analyses showed that the sTfR level positively correlate with sEpo（ r = 0. 770, P 〈 0.01） and inversely correlate with SF（ r = -0. 523, P 〈0.01 ） ,TS（ r = -0.325, P 〈0.05 ） Multivariate regression analysis discloses that sEpo and SF were the two independent factors of effecting sTfR level. Conclusion Circulating sTfR is a good index of marrow erythropoietic activity in HD patients during rHuEpo treament. That sTfR levels reflect the comprehensive effects of iron reserves and erythropoietic stimulation and it can become a significant and useful index of iron deftcieney.