Hepcidin/SF比值在维持性腹膜透析患者中的临床价值分析

Clinical value of Hepcidin/SF ratio in patients with maintenance peritoneal dialysis

目的 探讨Hepcidin/SF比值在维持性腹膜透析(maintenance peritoneal dialysis,MPD)患者中的潜在临床价值。方法 (1)以本中心维持性腹膜透析患者为研究对象,同期健康体检者为对照组,收集各项实验室检测指标。(2)运用ELISA方法检测血清可溶性转铁蛋白受体(sTfR)、总铁结合力(TIBC)、铁调素(Hepcidin),计算Hepcidin/SF比值及转铁蛋白饱和度(TSAT),TSAT=SI/TIBC×100%。(3)根据实验结果对MPD患者进行分组:①TSAT≥20%为铁充足组(A组);②TSAT<20%且SF≥100μg/L为功能性缺铁组(B组);③TSAT<20%且SF<100μg/L为绝对性缺铁组(C组),健康体检者为对照组(D组),用统计学分析以上4组间各项指标的差异及进行Spearman相关性分析。结果①MPD患者中A组、B组、C组与D组相比,C反应蛋白(CRP)、白细胞(WBC)、红细胞分布密度CV值(RDW-CV)、红细胞分布宽度SD值(RDW-SD)、血磷(P)、血肌酐(Scr)、尿素氮(BUN)、Hepcidin、Hepcidin/SF均高于D组(P <0.05),血红蛋白(Hb)、红细胞计数(RBC)、白蛋白(Alb)、TIBC、sTfR、TSAT均低于D组(P <0.05);②B组β2-微球蛋白(β2-MG)、Hepcidin、Hepcidin/SF均比A组高,SI比A组低(P <0.05);B组Hepcidin、Hepcidin/SF比C组高,TIBC比C组低(P <0.05);C组Hepcidin/SF、TIBC比A组高,SI、Hepcidin比A组低(P <0.05);③Spearman相关性分析显示,Hepcidin/SF与CRP、Hepcidin呈强正相关(r=0.449,0.610,P <0.001),与SF、SI、Hb呈强负相关(r=-0.578,-0.615,-0.353,P <0.001)。结论 ①CKD患者普遍存在贫血及处在不同状态的铁缺乏;②Hepcidin/SF与炎症反应相关;③Hepcidin/SF升高提示CKD患者发生功能缺铁,对临床诊断MPD患者发生功能性缺铁具有一定的诊断价值。

Objective To investigate the potential clinical value of Hepcidin/SF ratio in patients with maintenance peritoneal dialysis(MPD).Methods(1)Patients with MPD in our center were selected as the research subjects,and healthy subjects examined physically at the same period were selected as the control group.Various laboratory test indicators were collected.(2)ELISA was employed to detect the soluble transferrin receptor(sTfR),total iron binding capacity(TIBC)and Hepcidin in the serum of these subjects.Hepcidin/SF ratio and TSAT(transferrin saturation)were calculated with the formula TSAT=SI/TIBC×100%.(3)Patients with MPD were grouped according to the experiment results:①Patients with TSAT≥20%as the iron sufficient group(group A);②Patients with TSAT<20%and SF≥100μg/L as the functional iron deficiency group(group B);③Patients with TSAT<20%and SF<100μg/L as the absolute iron deficiency group(group C).Healthy subjects as the control group(group D).This study made an analysis of the differences of all indicators among the above 4 groups and Spearman correlation analysis was conducted.Results①Compared with group D,C reactive protein(CRP),white blood cell(WBC),coefficient of variation of red blood cell distribution width(RDW-CV),standard deviation of red blood cell distribution width(RDW-SD),phosphorus(P),serum creatinine(Scr),blood urea nitrogen(BUN),Hepcidin,Hepcidin/SF of MPD patients in group A,B and C were higher than those in group D(P<0.05),while hemoglobin(Hb),red blood cell count(RBC),albumin(Alb),TIBC,sTfR and TSAT were lower than those in group D(P<0.05).②The levels ofβ2-microglobulin(β2-MG),Hepcidin and Hepcidin/SF in group B were higher than those in group A,and SI was lower than that in group A(P<0.05).Hepcidin and Hepcidin/SF in group B were higher than those in group C,and TIBC was lower than that in group C(P<0.05).Hepcidin/SF and TIBC in group C were higher than those in group A,while SI and Hepcidin were lower than those in group A(P<0.05).③Spearman correlation analysis showed that Hepcidin/SF was strong positively correlated with CRP and Hepcidin(r=0.449,0.610,P<0.001),and strong negatively correlated with SF,SI and Hb(r=0.578,0.615,0.353,P<0.001).Conclusion①Anemia and iron deficiency of different degree are common in CKD patients.②Hepcidin/SF is associated with inflammatory response.③Increased Hepcidin/SF indicates functional iron deficiency in CKD patients,which has certain value for the clinical diagnosis of functional iron deficiency in patients with MPD.