维持性血液透析患者血清铁蛋白与营养不良-炎症-动脉粥样硬化综合征及贫血的相关性研究

Correlationship between serum ferritin and malnutrition-inflammation-atherosclerosis(MIA) syndrome,renal anemia in hemodialysis patients

目的探讨终末期肾脏疾病维持性血液透析（maintenance hemodialysis,MHD）患者高水平血清铁蛋白（serum ferritin,SF）与营养不良-炎症-动脉粥样硬化（malnutrition-inflammation-ath-erosclerosis,MIA）综合征及肾性贫血的关系。方法选择2014年6月至2014年12月我院血液净化中心的 MHD 患者共182例,将其中22例 SF 显著升高（SF≥1000μg/L）的 MHD 患者设为高 SF组；选择70例 SF 水平较低（200μg/L〈SF〈1000μg/L）MHD 患者设为对照组。2组患者均每周透析3次,每次4～4.5 h,同时接受促红细胞生成素治疗,通过检测其 SF、转铁蛋白饱和度（transferrin saturation,TSAT）、血清铁（serum iron,SI）、血红蛋白、尿素氮（BUN）、肌酐（SCr）、前白蛋白（pre al-bumin,PA）、白蛋白（albumin,Alb）、总胆固醇（total cholesterol,TC）、全段甲状旁腺素（intact para-thyroid hormone,iPTH）和 C 反应蛋白（C reactive protein,CRP）、肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、白细胞介素6（interleukin 6,IL-6）,评估并比较2组患者贫血程度、营养状态以及血管顺应性和血管内膜厚度。结果与对照组相比,高 SF 组患者 CRP、IL-6、TNF-α水平及颈动脉内膜厚度明显高于对照组（P 〈0.05）,而 PA、Alb 水平、主观综合性营养评估法评分低于对照组。SF与 Alb、CRP 等指标的相关性分析显示,SF 水平与 CRP（r =0.733,P =0.008）、IL-6（r =0.549,P =0.019）、TNF-α（r=0.453,P =0.027）、RCCA 内膜厚度（r =0.489,P =0.034）均呈正相关,与血 Alb （r=-0.465,P =0.013）、PA（r=-0.211,P =0.042）均呈负相关。接受同等剂量促红细胞生成素治疗随访6个月结果显示,高 SF 组血红蛋白明显低于对照组（P 〈0.01）。结论MHD 患者 SF 过高与营养状态呈负相关,与微炎症状态、血管硬化呈正相关,SF 过高是 MIA 综合征的独立危险因素。SF过高不利于 MHD 患者贫血的改善。

Objective To understand the relationship between high levels of ferritin and malnutrition-inflammation-atherosclerosis （MIA） syndrome, renal anemia in hemodialysis patients. Methods A total of 92 patients with maintenance hemodialysis （MHD） were involved in this retrospective study in Blood Purification Center of Jiangning Hospital during June 2014 to December 2014, in which 22 cases had high levels of SF（SF≥1 000μg/L） and 70 cases served as control group （200 μg/L〈 SF〈1 000 μg/L）. All patients accepted hemodialysis three times per week, 4～4. 5 h each time, and were given the treatment with erythropoietin（EPO）. Biochemical parameters and inflammatory markers were detected and anemia, nutritional status, vascular compliance and intimal thickness of blood vessel were assessed. Results As compared with the control group, levels of C-reactive protein（CRP）,IL-6,TNF-αand carotid intima-media thickness were significantly increased in the group with high SF（P 〈0.05）,and the levels of PA,Alb and SGA were significantly reduced.Correlation analysis showed that increased SF levels had positive correlations with CRP（r =0.733,P =0.008）, IL-6 （r=0.549,P =0.019）,TNF-α（r=0.453,P =0.027）and endometrial thickness of RCCA（r =0.489,P =0.034）,and negative correlation with Alb（r=-0.465,P =0.013）,PA（r =-0.21 1 ,P=0.042）.By treatment with the same dose of EPO for 6 months,Hb in high SF group was signifi-cantly lower than other groups（P 〈0.01）.Conclusions High SF had a negative correlation with nutri-tional status and positive correlation with micro-inflammatory state and atherosclerosis.High SF was independent risk factor of MIA syndrome.It is hard to improve Hb in MHD patients with high SF.