血清中性粒细胞明胶酶相关脂质运载蛋白与肾性贫血的关系

The relationship between serum neutrophil gelatinase associated lipocalin and renal anemia

目的研究血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与肾性贫血的关系。方法筛选124例慢性肾脏病(CKD)患者,根据是否伴有贫血分为贫血组(n=84)和非贫血组(n=40)。进一步亚组分组将贫血患者根据是否进行维持性血液透析分为透析组(n=72)和非透析组(n=12)。观察贫血组与非贫血组,透析组与非透析组间的血红蛋白、血清肌酐、血尿素氮、β2-微球蛋白、维生素B12、叶酸、血清铁蛋白、血清铁、总铁结合力、转铁蛋白饱和度、超敏C反应蛋白、NGAL等的水平。进一步进行NGAL与各组各指标的相关性分析。结果贫血组患者转铁蛋白饱和度低于非贫血组,血清NGAL、血肌酐、血尿素氮水平高于非贫血患者(P<0.05)。血清NGAL与血红蛋白(r=-0.30)、转铁蛋白饱和度(r=-0.30)、维生素B12(r=-0.28)呈负相关,与血肌酐(r=0.56)、血尿素氮(r=0.26)、总铁结合力(r=0.28)、血清铁蛋白(r=0.27)呈正相关。维持性血液透析的贫血患者血清NGAL与血红蛋白(r=-0.30)、转铁蛋白饱和度(r=-0.31)、维生素B12(r=-0.32)呈负相关,与血肌酐(r=0.35)、总铁结合力(r=0.30)呈正相关。结论血清NGAL是慢性肾脏病患者铁代谢及炎症反应的影响因素,在铁代谢尤其是在铁的转运过程中有负面影响。在维持性血液透析的贫血患者中,NGAL是维生素B12吸收代谢过程中的危险因素。

Objective To discuss the relationship between the level of serum neutrophil gelatinase associated lipocalin(NGAL)and renal anemia.Methods A total of 124 patients with chronic kidney disease(CKD)were screened and divided into anemia group and non-anemia group according to whether they were anemia or not.The patients with anemia were further divided into two subgroups:dialysis group and non-dialysis group according to whether the maintenance hemodialysis(MHD)was conduct.The levels of hemoglobin,serum creatinine,blood urea nitrogen,β2-microglobulin,vitamin B12,folic acid,serum ferritin,serum iron,total iron binding capacity,transferrin saturation,hypersensitive C-reactive protein and NGAL were observed between the anemia group and the non-anemia group and between the dialysis group and the non-dialysis group.Correlation analysis between NGAL and each index in each group was further carried out.Results Anemia group and non-anemia group.Comparison of basic data,the transferrin saturation of the anemia group was lower than that of the non-anemia group,and the levels of serum NGAL,serum creatinine and blood urea nitrogen were higher than those of the non-anemia patients(P<0.05).In univariate analysis,serum NGAL in anemia group was negatively correlated with hemoglobin(r=-0.30),transferrin saturation(r=-0.30),and vitamin B12(r=-0.28),and the serum creatinine(r=0.56),blood urea nitrogen(r=0.26),total iron binding capacity(r=0.28),and ferritin(r=0.27)were positively correlated with serum NGAL;in multivariate analysis,In univariate analysis,serum NGAL in dialysis group was negatively correlated with hemoglobin(r=-0.30),transferrin saturation(r=-0.31),and vitamin B12(r=-0.32),which was positively correlated with blood Creatinine(r=0.35)and total iron binding capacity(r=0.30).Conclusion Serum NGAL is an influencing factor of iron metabolism and inflammatory response in patients with chronic kidney disease,and it has a negative impact on iron metabolism,especially in the process of iron transport.In anemia patients on maintenance hemodialysis,NGAL is also a risk factor in the absorption and metabolism of vitamin B12.