腹膜透析患者血清铁蛋白水平与微炎症及透析效果相关性分析

Correlation of serum ferritin with microinflammation and dialysis adequacy in peritoneal dialysis patients

目的分析腹膜透析患者血清铁蛋白与C反应蛋白（CRP）之间的相关性,探讨血清铁蛋白对腹膜透析效果的影响。方法回顾性分析2009年6月至2015年7月在广西医科大学第一附属医院腹膜透析中心规律随诊的腹膜透析患者120例,根据血清铁蛋白浓度将其分成三组,Ⅰ组：男性患者血清铁蛋白≤200μg/L或女性患者血清铁蛋白≤150μg/L;Ⅱ组：男性患者血清铁蛋白浓度为200~500μg/L或女性患者150~500μg/L;Ⅲ组：血清铁蛋白≥500μg/L,将三组的临床资料进行分析。根据CRP值,将120例患者分为A组（CRP≤8 mg/L）和B组（CRP〉8 mg/L）,比较两组间血清铁、转铁蛋白饱和度、总铁结合力和血红蛋白水平差异。血清铁蛋白与各相应临床指标进行相关性分析。采用SPSS 16.0统计学软件进行数据分析。结果 （1）与Ⅰ组及Ⅱ组比较,Ⅲ组C反应蛋白水平显著升高,血红蛋白及Kt/V值均低于Ⅰ组及Ⅱ组（P〈0.05）,Ⅰ组与Ⅱ组比较无显著性差异（P〉0.05）。（2）Ⅰ组总铁结合力明显高于Ⅱ组和Ⅲ组（P〈0.05）,Ⅱ组与Ⅲ组比较无显著性差异（P〉0.05）。（3）相关性分析提示血清铁蛋白与血红蛋白及总铁蛋白结合力呈负相关（r=-0.194,r=-0.298;P〈0.05）,与血尿素氮、年龄及C反应蛋白呈正相关（r=0.234,r=0.238,r=0.203;P〈0.05）。（4）与A组比较,B组患者血清铁蛋白水平显著升高（t=2.271,P〈0.05）,两组间总铁结合力、转铁蛋白饱和度及血红蛋白无显著性差异（t=0.391,t=0.371,t=0.835;P〉0.05）。结论腹膜透析患者血清铁蛋白水平受微炎症状态的影响,高浓度的血清铁蛋白可影响腹膜透析患者的透析充分性,应该联合年龄、转铁蛋白饱和度、血红蛋白及CRP等指标,正确的判断患者缺铁情况。

Objective To analyze the correlation between serum ferritin（ SF） and C reactive protein（ CRP）,and explore the effect of SF on dialysis adequacy in maintenance peritoneal dialysis patients. Methods In this retrospective analysis,one hundred and twenty cases of maintenance peritoneal dialysis patients were enrolled,and regularly followed up in the past 5 years in the peritoneal dialysis center of the First Affiliated Hospital of Guangxi Medical University. The patients were divided into three groups based on the SF level： group I,SF level was ≤150 μg / L in female,or ≤200 μg / L in male; group Ⅱ,SF level was 150-500 μg / L in female,or 200-500 μg / L in male; and group Ⅲ,SF level was ≥500 μg / L.The clinical data of the three groups were analysed. The patients were also divided into group A（ CRP ≤8 mg / L） and group B（ CRP 8 mg / L） based on the CRP level. The differences in serum ferrum（ Fe）,transferrin saturation（ TSAT）,total iron binding capacity（ TIBC）,and hemoglobin（ Hb） were compared between the two groups. The statistical software SPSS 16. 0 was used for data analysis. Correlation analysis was made for serum ferritin and other corresponding clinical indicators. Results（ 1） When compared with groups Ⅰ and Ⅱ,group Ⅲ showed higher level of CRP,but lower levels of HB and Kt / V（ t = 2. 271,P〈0. 05）,while there was no significant difference in CRP,HB,or Kt / V between group I and group Ⅱ（ t =0. 391,t = 0. 371,t = 0. 835; P〈0. 05）.（ 2） The TIBC level of group I was significantly higher than that of group Ⅱ or Ⅲ.（ 3） Correlative analysis showed that SF level was negatively correlated with HB and TIBC（ r =- 0. 194,r =- 0. 298,respectively,P〈0. 05）,but positively correlated with blood urea nitrogen（ BUN）,age,and CRP level（ r = 0. 234,r = 0. 238,r = 0. 203,respectively,P〈0. 05）,and was not correlated with albumin,creatinine,and others（ P〈0. 05）.（ 4） When compared with group A,group B showed higher level of SF（ P〈0. 05）,while there were no significant differences in TIBC,TSAT,and HB between group A and group B（ P〈0. 05）. Conclusion In maintenance peritoneal dialysis patients,the level of SF was affected by microinflammation,and high level SF might affect the dialysis adequacy.Therefore,combining age,TSAT,HB,and CRP,may favor the correct assessment of ferrum deficiency in maintenance peritoneal dialysis patients.