铁调素在血液透析患者相对红细胞增多的发生机制中的作用

Low Hepcidin level associated with relative erythrocytosis in chronic hemodialysis patients

目的探索血液透析患者中相对红细胞增多的原因。方法纳入规律血液透析患者,根据基线血红蛋白浓度及是否接受红细胞生成刺激剂(erythropoietin stimulating agent,ESA)治疗分2组。横断面收集临床信息,比较2组贫血,铁代谢及甲状旁腺功能亢进程度。对比检测铁调素,铁代谢指标,红细胞生成素水平以及炎症因子水平。随访84个月。结果纳入的161例患者中,14例(8.7%)符合相对红细胞增多即无ESA治疗组,其血红蛋白浓度高于ESA治疗组(t=6.108,P<0.001);铁调素水平低于ESA治疗组(t=-4.857,P<0.001),且铁调素水平与血液透析患者的血红蛋白浓度呈负相关(r=-0.491,P=0.007),与铁蛋白水平呈正相关(r=0.684,P<0.001),与可溶性转铁蛋白受体呈负相关(r=-0.406,P=0.029)。血清铁调素与超敏C反应蛋白(r=-0.098,P=0.614),白细胞介素-6(r=-0.140,P=0.469)以及肿瘤坏死因子-α(r=-0.091,P=0.639)水平无相关性。结论血液透析患者中少部分患者不需要接受ESA或铁剂治疗,可能与较低的铁调素水平有关。而铁调素水平越高,组织可利用铁越少,而红细胞生成水平越低。

Objective To explore the mechanism of relative erythrocytosis in hemodialysis patients.Methods Patients on chronic hemodialysis were divided into subgroups according to the baseline hemoglobin levels and whether they treated with erythropoiesis stimulating agent(ESA).Clinical characteristics and laboratory data was collected at baseline.The degree of anemia,hyperparathyroidism,and iron metabolism were compared between the two groups.All patients were followed up for 84 months.Results In total,161 patients were enrolled.Fourteen(8.7%)were diagnosed as relative erythrocytosis,with significantly higher level of hemoglobin compared to ESA treated group[(130.8±13.3)vs.(110.3±11.8)g/L,t=6.108,P<0.001].The level of hepcidin was significantly lower in patients without ESA treatment[(5.33±5.21)vs.(20.07±10.17)×10^(4) pg/ml,t=-4.857,P<0.001].And in both of groups,there was a negative correlation between hepcidin level and hemoglobin concentration(r=-0.491,P=0.007).The level of hepcidin positively correlated with ferritin(r=0.684,P<0.001)and negatively correlated with the level of soluble transferrin receptor(sTfR,r=-0.406,P=0.029).There was no association between hepcidin and proinflammatory cytokines.Conclusion A small portion of hemodialysis patients may maintain reasonable activity of erythropoiesis with no need of treatment with ESA or supplement of iron.They show a relatively lower level of circulating hepcidin than patients treated with ESA.And the higher the level of hepcidin,the less iron available for the tissue,and the lower activity of erythropoiesis.