血清铁和铁调素在心衰患者中的表达及其与心功能的相关性分析

The Correlation of Serum Iron and Hepcidin Levels with Cardiac Function in Heart Failure Patients

目的探讨血清铁和铁调素在心力衰竭(HF)患者中的表达水平及其与心功能的相关性。方法选取2020年11月—2021年6月于河北省人民医院心内科住院治疗的非贫血HF患者为研究对象。根据患者左室射血分数(LVEF),分为射血分数保留的心力衰竭(HFpEF)组及射血分数降低的心力衰竭(HFrEF)组,另选取同期因其他系统疾病住院治疗的非贫血患者为对照组。收集患者一般临床资料、空腹血液指标、心脏超声指标,检测血清铁和血清铁调素水平,评估三组患者各临床指标和心功能指标的相关性,采用多因素logistic回归分析HF及HF类型的相关因素以及血清铁和铁调素水平与HF的相关性。结果对照组血清铁及铁调素水平最高[血清铁:4.30(2.61,6.79)mg/L;铁调素:(108.96±39.17)pg/mL],HFpEF组次之[血清铁:2.63(1.67,3.85)mg/L;铁调素:(80.84±34.81)pg/mL],HFrEF组最低[血清铁:1.44(0.85,1.99)mg/L;铁调素:(62.75±21.79)pg/mL](P<0.05)。三组患者中,血清铁及铁调素与N末端脑钠肽前体(NT-proBNP)负相关(血清铁:r=-0.525,P<0.001;铁调素:r=-0.436,P<0.001),与LVEF正相关(血清铁:r=0.563,P<0.001;铁调素:r=0.374,P<0.001)。多因素logistic回归分析结果显示估算的肾小球滤过率(eGFR)(OR=0.902,95%CI 0.838~0.970,P=0.005)和血清铁(OR=0.458,95%CI 0.279~0.754,P=0.002)是HF的独立负相关因素,eGFR=86.285 mL/(min·1.73 m^(2))及血清铁3.589 mg/L是有助于诊断HF的临界值。血清铁(OR=0.303,95%CI 0.153~0.600,P=0.001)是HF类型的独立负相关因素,血清铁2.0835 mg/L是有助于诊断HF类型的临界值。结论血清铁及铁调素在HF患者血清中表达水平降低,HFrEF患者更显著。血清铁是HF及HF类型的独立负相关因素。

Objective To detect serum iron and hepcidin levels in patients with heart failure(HF)and analyze their correlations with cardiac function.Methods The non-anemic patients with HF hospitalized in Department of Cardiology,Hebei General Hospital from November 2020 to June 2021 were selected as research objects,and divided into HF with preserved ejection fraction(HFpEF)and reduced ejection fraction(HFrEF)groups.Non-anemic patients contemporarily hospitalized for other systemic diseases were assigned as control group.We collected the general clinical data,fasting blood indexes,cardiac ultrasound indexes and detected serum iron and hepcidin levels.The correlation between clinical indicators and cardiac function indicators was evaluated.HF and HF type associated factors,the correlation of serum iron and hepcidin with HF were analyzed by multivariate logistic regression.Results Serum iron and hepcidin levels were the highest in control group[serum iron 4.30(2.61,6.79)mg/L,hepcidin(108.96±39.17)pg/mL],followed by HFpEF group[serum iron 2.63(1.67,3.85)mg/L,hepcidin(80.84±34.81)pg/mL],and the lowest in HFrEF group[serum iron 1.44(0.85,1.99)mg/L,hepcidin(62.75±21.79)pg/mL](P<0.05).Serum iron and hepcidin levels were negatively correlated with NT-proBNP[serum iron(r=-0.525,P<0.001),hepcidin(r=-0.436,P<0.001)],and positively correlated with left ventricular ejection fraction[serum iron(r=0.563,P<0.001),hepcidin(r=0.374,P<0.001)].Multivariate logistic regression analysis showed estimated glomerular filtration rate(eGFR)(OR=0.902,95%CI 0.838~0.970,P=0.005)and serum iron(OR=0.458,95%CI 0.279~0.754,P=0.002)were the independently negative correlation factors for HF.The eGFR of 86.285 mL/(min·1.73 m^(2))and serum iron concentration of 3.589 mg/L were considered as critical value for the diagnosis of HF.Serum iron(OR=0.303,95%CI 0.153~0.600,P=0.001)was an independently negative correlation factor for HF types.The serum iron concentration of 2.0835 mg/L was considered as critical value for the diagnosis of HF types.Conclusion The expression levels of serum iron and serum hepcidin were decreased in HF patients,especially in HFrEF patients.Serum iron was an independently negative correlation factor for HF and HF types.