基于铁调素调节铁代谢机制观察蚕砂提取物对血液透析患者促红细胞生成素抵抗的影响

目的通过观察维持性血液透析(maintenance hemodialysis,MHD)患者体内铁调素对铁代谢的调节作用,探讨蚕砂提取物对促红细胞生成素(erythropoietin,EPO)抵抗的干预机制。方法将40例MHD患者随机分为对照组和治疗组各20例,均给予常规透析、EPO皮下注射等治疗,在此基础上,对照组口服多糖铁复合物胶囊,治疗组口服蚕砂提取物,连续观察12周;同时选取20例健康人群作为正常组。空腹取血,采用酶联免疫吸附法(ELISA)检测铁调素、白细胞介素6(interleukin-6,IL-6),免疫比浊法检测超敏C反应蛋白(high sensitive C reactive protein,hs-CRP),化学发光法检测铁蛋白(serum ferritsn,SF)和转铁蛋白饱和度(transferin saturation,TSAT);并检测血常规(血红蛋白、红细胞压积),记录体质量(body weight,BW),计算重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)用量与EPO抵抗指数(erythropoietin resistance index,ERI)。结果与正常组比较,对照组和治疗组MHD患者的血清铁调素、IL-6、hs-CRP、SF均显著升高,TSAT显著降低(P0.05)。治疗前后比较,治疗组治疗后的血清铁调素、IL-6、hs-CRP、SF、rHuEPO用量、ERI均较治疗前有显著降低,血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit value,Hct)较治疗前有显著升高(P0.05),而对照组变化不明显(P0.05)。治疗后组间比较,治疗组的血清铁调素、IL-6、hsCRP、SF、rHuEPO用量、ERI均显著低于同期对照组,Hb、Hct均显著高于同期对照组(P0.05)。结论 MHD患者的EPO抵抗与微炎症状态、铁调素升高、铁代谢紊乱具有相关性;蚕砂提取物可以通过抑制机体的微炎症反应及铁调素高表达,改善铁代谢,这可能是蚕砂提取物纠正MHD患者贫血、改善EPO抵抗的重要机制之一。     

维持性血液透析患者血清中性粒细胞明胶酶相关载脂蛋白水平与透析充分性、铁代谢及微炎性反应状态的相关性

目的 研究维持性血液透析(MHD)患者血清中性粒细胞明胶酶相关载脂蛋白(NGAL)水平与透析充分性、微炎性反应状态及铁代谢的关系;探讨NGAL对判断透析充分性的价值.方法 从2010年10月开始,纳入我院MHD患者150例为对象,同时以50例健康人为对照.收集MHD患者的人口学资料、临床表现及检测参试者血清NGAL、C反应蛋白( CRP)、转铁蛋白饱和度(TSAT)、铁蛋白等水平.根据单室尿素清除指数(spKt/V)值将MHD 患者分为透析充分组和不充分组,比较组间血清NGAL差异.用Pearson相关法、多元线性回归模型和受试者工作特征(ROC)曲线分析NAGL与Kt/V、炎性因子和铁代谢指标等相关性.患者随访3个月,对比两组随访前后NAGL、Kt/V及炎性因子变化,进一步评估血清NGAL与透析充分性、炎性指标的关系.结果 MHD患者血清NGAL为(445.45±50.34) μg/L,显著高于健康对照的(50.02±6.45) μg/L(P＜0.01).150例MHD患者中,95例为充分组,55例为不充分组.充分组与不充分组NGAL分别为(589.14±56.34) μg/L和(360.13±46.23)μg/L,差异有统计学意义(P＜0.05).MHD患者血清NGAL与spKt/V、CRP、TSAT呈正相关(r=0.652、0.825、0.785,均P＜0.05).多元线性回归模型结果显示,NGAL与CRP、spKt/V、TSAT有相关关系.ROC曲线下面积(AUC)表明,NGAL水平能较好地反映透析充分性.随诊后结果显示,所有充分组患者均维持透析充分状态;经干预后,不充分组中38例达透析充分,另17例仍未达到透析充分.在这38例中,未达充分和达充分时的NGAL分别为(368.14±56.21) μg/L和( 360.56±46.23) μg/L,差异无统计学意义.CRP水平达充分后有所下降,但差异无统计学意义.结论 MHD透析充分患者血清NGAL显著高于不充分患者.MHD患者血清NGAL与spKt/V、CRP及TSAT均呈正相关.血清NGAL能较好地反映透析充分性.     

蔗糖铁在血液透析肾性贫血患者中的疗效观测

目的:观察蔗糖铁在治疗血液透析(HD)患者肾性贫血时的有效性及安全性。方法:选择2009～2011年期间符合铁剂治疗入选标准的维持性血液透析(MHD)患者48例,将蔗糖铁与重组人促红细胞生成素(rHuEPO)联合使用,观察用药前后血红蛋白(HB)、血细胞比容(HCT)、血清铁蛋白(SF)和转铁蛋白饱和度(TSAT)的变化及患者有无不良反应。结果:48例患者于用药4～8周后其HB、HCT、RBC、SF、TSAT的数值比用药前都得到明显升高,差异有显著性(P<0.05),且无不良反应。结论:静脉补充铁剂及应用rHuEPO可以明显改善贫血症状,疗效明确,可靠性高,方便可行。     

维持性血液透析患者血清铁蛋白与营养不良-炎症-动脉粥样硬化综合征及贫血的相关性研究

目的探讨终末期肾脏疾病维持性血液透析(maintenance hemodialysis,MHD)患者高水平血清铁蛋白(serum ferritin,SF)与营养不良-炎症-动脉粥样硬化(malnutrition-inflammation-atherosclerosis,MIA)综合征及肾性贫血的关系。方法选择2014年6月至2014年12月我院血液净化中心的MHD患者共182例,将其中22例SF显著升高(SF≥1 000μg/L)的MHD患者设为高SF组;选择70例SF水平较低(200μg/LSF1 000μg/L)MHD患者设为对照组。2组患者均每周透析3次,每次4~4.5 h,同时接受促红细胞生成素治疗,通过检测其SF、转铁蛋白饱和度(transferrin saturation,TSAT)、血清铁(serum iron,SI)、血红蛋白、尿素氮(BUN)、肌酐(SCr)、前白蛋白(pre albumin,PA)、白蛋白(albumin,Alb)、总胆固醇(total cholesterol,TC)、全段甲状旁腺素(intact parathyroid hormone,iPTH)和C反应蛋白(C reactive protein,CRP)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin 6,IL-6),评估并比较2组患者贫血程度、营养状态以及血管顺应性和血管内膜厚度。结果与对照组相比,高SF组患者CRP、IL-6、TNF-α水平及颈动脉内膜厚度明显高于对照组(P0.05),而PA、Alb水平、主观综合性营养评估法评分低于对照组。SF与Alb、CRP等指标的相关性分析显示,SF水平与CRP(r=0.733,P=0.008)、IL-6(r=0.549,P=0.019)、TNF-α(r=0.453,P=0.027)、RCCA内膜厚度(r=0.489,P=0.034)均呈正相关,与血Alb(r=-0.465,P=0.013)、PA(r=-0.211,P=0.042)均呈负相关。接受同等剂量促红细胞生成素治疗随访6个月结果显示,高SF组血红蛋白明显低于对照组(P0.01)。结论 MHD患者SF过高与营养状态呈负相关,与微炎症状态、血管硬化呈正相关,SF过高是MIA综合征的独立危险因素。SF过高不利于MHD患者贫血的改善。     

蔗糖铁联合促红细胞生成素治疗血液透析肾性贫血疗效观察

目的:比较静脉应用蔗糖铁联合促红细胞生成素(EPO依倍成都地奥集团九泓制药生产2000iu/支)和口服维铁缓释片联合EPO治疗MHD患者肾性贫血的疗效与安全性.方法:50 例MHD伴肾性贫血患者随机分为静脉组和口服组,两组均给予EPO 治疗,静脉组给予蔗糖铁100mg静脉滴注,口服组给予维铁缓释片(每片含硫酸亚铁525mg)口服,疗程均16周.观察并比较两组患者贫血治疗的效果、铁代谢指标的变化和不良反应发生情况.结果:静脉组Hb、Hct、及TSAT,SF的指标明显高于口服组.结论:静脉注射蔗糖铁可有效地纠正MHD的铁缺乏,提高EPO的疗效,不良反应发生率低,安全性好.     

维持性血液透析患者肾性贫血的相关因素分析

目的观察维持性血液透析(maintenance hemodialysis,MHD)患者的贫血情况,分析其相关因素,为MHD患者肾性贫血提供新的诊疗思路。方法选择2016年8月1日至28日荆州市中心医院血液净化中心的MHD患者128例,其中男72例,女56例,平均年龄(53.5±13.3)岁,平均透析时间(32.13±17.04)个月。收集患者的临床病史资料,并于透析前检测血常规、C反应蛋白、铁调素、血清铁、铁蛋白、不饱和铁结合力、叶酸、维生素B12、甲状旁腺素、钙、磷、镁,透析前后检测血肌酐和尿素氮。结果 128例患者平均血红蛋白(hemoglobin,Hb)为(98.54±16.93)g/L,其中有28例Hb 110~120 g/L(占22%)。Pearson相关分析提示,Hb浓度与白细胞(r=0.279,P=0.001)、红细胞比容(r=0.279,P=0.002)、血清铁(r=0.188,P=0.033)、spKt/V(r=0.215,P=0.015)呈正相关;与铁调素(r=-0.302,P=0.001)、铁蛋白(r=-0.207,P=0.019)、不饱和铁结合力(r=-0.195,P=0.027)、甲状旁腺素(r=-0.264,P=0.003)、C反应蛋白(r=-0.203,P=0.022)均呈负相关。多元线性逐步回归模型结果提示,Hb与红细胞容积呈显著正相关(P0.01),与铁调素(P=0.001)及甲状旁腺素(P0.05)呈显著负相关。结论 MHD患者贫血与铁调素、白细胞、红细胞比容、血清铁、spKt/V、铁蛋白、不饱和铁结合力、甲状旁腺素、C反应蛋白、血清铁因素密切相关,与叶酸、维生素B12浓度等因素相关性不大。     

血液透析患者肾性贫血的维持性补铁方式研究

目的比较不同方式补铁治疗对血液透析患者在肾性贫血得以纠正达标后长期维持治疗期间的疗效和安全性,从而选择更佳的维持性治疗方式。方法选择2014年9月至2016年3月在湖北省中医院血液净化中心行维持性血液透析的患者40例,经规范治疗肾性贫血相关指标达标后,随机分为静脉组和口服组,每组20例。静脉组患者每周第一次透析时给予静脉注射蔗糖铁100mg,口服组患者口服多糖铁复合物胶囊150 mg,每日一次。2组患者均合并使用促红细胞生成素(erythropoietin,EPO)治疗,剂量为10 000 U/10d。观察12周后2组患者红细胞数量(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、红细胞比容(hematocrit,Hct)、血清铁蛋白(serum ferritin,SF)、转铁蛋白饱和度(transferin saturation,TSAT)、C反应蛋白(C reaction protein,CRP)等指标的变化及不良反应。结果治疗前静脉组和口服组患者在Hb、RBC、SF、TSAT和Hct等方面无明显差异(P0.05)。2组患者分别经过12周治疗后,Hb、RBC、SF等水平有下降趋势,口服组患者下降幅度更为明显。静脉组患者无明显不良反应。结论血液透析患者在肾性贫血得以纠正达标后仍维持性补充铁剂是有必要的。维持性静脉注射蔗糖铁与口服多糖铁复合物胶囊联合EPO治疗都能用于稳定大多数患者相关铁参数和Hb水平,但静脉注射蔗糖铁更为安全、有效,且依从性更高。     

血液透析患者颈动脉内膜中层厚度与血清超敏C反应蛋白、血管性血友病因子的相关性研究

目的:探讨维持性血液透析(MHD)患者颈动脉内膜中层厚度(IMT)与血清超敏C反应蛋白(hs-CRP)、血管性血友病因子(v WF)的关系。方法:选择68例MHD患者为研究对象,将颈动脉IMT≥1. 2 mm者纳入增厚组(n=48),颈动脉IMT 1. 2 mm者纳入正常组(n=20),测定并比较两组患者血清hs-CRP、v WF水平。结果:IMT增厚组患者血清hsCRP、v WF水平均显著高于IMT正常组,差异均有统计学意义(P 0. 05); Pearson相关性分析显示,MHD患者血清hs-CRP、v WF水平与颈动脉IMT水平均呈正相关性(P 0. 05)。结论:炎症反应及血管内皮功能损伤与MHD患者动脉粥样硬化的发生、发展关系密切,血清hs-CRP、v WF的升高可作为MHD患者动脉粥样硬化的预测指标。     

生血宁在慢性肾脏病非透析患者肾性贫血治疗中的疗效观察

目的观察生血宁联合促红细胞生成素治疗慢性肾脏病(chronic kidney disease,CKD)非透析患者肾性贫血的疗效并和传统口服铁剂富马酸亚铁比较,以探寻治疗肾性贫血的优选方案。方法选择2012年3月至2013年9月在长航总医院肾内科住院的58例CKD非透析患者,在基础治疗[(降压、降糖、降尿酸、调脂、改善肾脏循环、维持水、电解质平衡及促红细胞生成素(erythropietin,EPO)的使用等)]相同的情况下随机分为口服生血宁与富马酸亚铁组,总疗程12周,观察血红蛋白、红细胞比容、血清铁蛋白、转铁蛋白饱和度及肾功能、血清白蛋白、超敏C反应蛋白及EPO使用剂量的变化,并对不良反应进行监测。结果治疗后2组患者的血红蛋白、红细胞比容、血清铁、总铁结合力、转铁蛋白饱和度及铁蛋白均有显著提高,EPO用量减少(P0.05)。但生血宁组转铁蛋白饱和度的升高和EPO用量的减少较富马酸亚铁组显著(P0.05),治疗前后超敏C反应蛋白无显著性变化(P0.05),且无明显的不良反应发生。富马酸亚铁组有8例出现上腹部不适、恶心、呕吐等,不良反应发生率为33.3%,治疗后超敏C反应蛋白显著升高(P0.05)。结论生血宁可显著纠正CKD非透析患者的缺铁,改善铁代谢状态,辅助治疗肾性贫血,疗效优于富马酸亚铁,且不影响患者微炎症状态,无明显不良反应。     

血清铁调素-25与维持性血液透析患者生存预后的关系研究

目的铁调素在铁代谢中起重要调节作用,抑制肠道铁吸收、肝细胞和巨噬细胞铁释放,但其临床应用价值尚不清楚。本研究旨在研究铁调素-25与维持性血液透析(MHD)患者生存预后的关系。 方法本研究为前瞻性观察性队列研究,选取2016年1月至2020年12月在徐州市中心医院血液净化中心的160例MHD患者,根据患者基线血清铁调素-25水平分为低水平组(<30.9 ng/ml)和高水平组(≥30.9 ng/ml),随访5年。采用Kaplan-Meier生存曲线、多因素Cox比例风险模型及基于限制性立方样条的Cox比例风险回归模型分析铁调素-25与死亡风险的关系。 结果与低水平组相比,高水平组患者的基线血清铁、铁蛋白、转铁蛋白饱和度(TSAT)、超敏C反应蛋白(hs-CRP)水平较高,透析前的血肌酐、白蛋白和前白蛋白水平较低。高水平组患者生存预后较差,透析龄较短(P＝0.0011),随访期死亡率较高(P＝0.0023)。血清铁调素-25增加10 ng/mL时,MHD患者全因死亡风险比为1.206(95%CI: 1.100~1.323, P<0.001)。MHD患者的全因死亡风险比在血清铁调素-25<30.9 ng/mL时相对稳定,在血清铁调素-25水平超过30.9 ng/mL之后,随着铁调素水平增加而显著升高。 结论血清铁调素-25水平可作为MHD患者全因死亡事件的独立预测因子,监测血清铁调素-25水平有助于预测MHD患者的生存预后。     

Soluble transferrin receptor is correlated with erythropoietin sensitivity in dialysis patients.

BACKGROUND: Iron deficiency is the most common cause of erythropoietin (EPO) resistance in dialyzed patients with renal anemia. Subclinical or functional iron deficiency is difficult to diagnose in these patients. The soluble transferrin receptor (sTf-R) is considered as a sensitive and specific indicator of bone marrow iron availability. PATIENTS AND METHODS: To evaluate the clinical usefulness of this novel marker, we investigated relationships between EPO requirements and various hematological and biochemical parameters of erythropoiesis in 27 pediatric end-stage renal failure patients treated by hemodialysis (HD, n = 11) or chronic peritoneal dialysis (PD, n = 16). Iron was substituted intravenously once or twice per week in HD, and by daily oral administration to PD patients. Serum sTf-R concentrations were measured by an enzyme-linked immunosorbent assay. Serum ferritin and transferrin concentrations were determined using nephelometric assays. Hemoglobin and iron levels were estimated by automated procedures. RESULTS: While neither transferrin saturation nor serum ferritin concentrations were indicative of EPO requirements, a highly significant correlation between the EPO efficacy index (EPO dose divided by hemoglobin concentration) and sTf-R was observed (r = 0.65, p = 0.001). The intravenous iron substitution in HD patients was associated with higher ferritin concentrations compared to the orally substituted PD patients (280+/-100 ng/ml vs. 124+/-83 ng/ml, p<0.002). In contrast, sTf-R concentrations were similar in both treatment groups (25.7+/-7.7 nM vs. 27+/-10.8 nM, n.s.), as were hemoglobin concentrations and EPO requirements. CONCLUSION: Our results suggest that sTf-R is a more sensitive indicator of functional iron deficiency and impaired EPO responsiveness than serum ferritin or transferrin saturation in dialyzed patients. Intensified iron substitution to patients with elevated sTf-R concentrations may considerably improve the cost efficacy of EPO treatment.     

Iron homeostasis in relapsing steroid-sensitive nephrotic syndrome of childhood.

AIM: Urinary transferrin loss is a typical feature in relapse of the idiopathic nephrotic syndrome, however, the impact on serum iron homeostasis and hematological parameters has not been studied systematically so far. PATIENTS AND METHODS: Therefore, we investigated serum iron (Fe), erythropoietin (EPO), ferritin (FN), transferrin (TF), total iron-binding capacity (TEBK), transferrin saturation and the soluble transferrin receptor (sTFR) combined with hematological parameters (hemoglobin, MCV, MCH) in 42 children with relapsing, steroid-sensitive nephrotic syndrome (NS) in remission (RM, n = 26) and relapse (RL, n = 16), including 13 patients who were studied in both states. Thirty-three age-matched healthy children served as controls. RESULTS: Fe, TEBK and TF were significantly reduced in RL compared to RM in cross-sectional as well as in paired studies while ferritin, hematological parameters and EPO levels remained unchanged. A significant increase, however, of the soluble transferrin-receptor could be demonstrated in cross-sectional analysis comparing RL to RM and healthy controls (3568+/-713 mg/ml vs 2625+/-576 vs 2646+/-697; p < 0.001 respectively) as well as in paired analysis of 13 patients in RL and RM (p < 0.001). CONCLUSION: We conclude that transient transferrin and iron deficiency occurs in RL of INS but this seems to be counterbalanced by upregulation of the sTFR, a mechanism that might be important in preventing the development of iron deficiency anemia during the active nephrotic state.     

Lower erythropoietin and iron supplementation are required in hemodialysis patients with hepatitis C virus infection

BACKGROUND: Chronic hepatitis C virus (HCV) infection is a common infectious agent in chronic hemodialysis (HD) patients. In this prospective case-control study, we aimed to investigate the influence of chronic HCV infection on erythropoietin (EPO) and iron requirement in HD patients. PATIENTS AND METHODS: 49 HD patients (24 male, 25 female, mean age 47 +/- 15 years) were included. The mean time spent on dialysis was 39 +/- 38 months, and follow-up time was 1 year for this study. Biochemical analyses and complete blood counts together with iron status of the patients (transferrin saturation and serum ferritin levels) were measured monthly. Highly sensitive C-reactive protein (hs-CRP) levels were measured within 3-month intervals. Endogenous EPO levels were measured by enzyme-linked immunoassay 2 weeks after cessation of EPO treatment. RESULTS: Eleven of the HD patients (22%) were anti-HCV(+). There was no difference in age, sex, time on dialysis, distribution of primary renal diseases, predialytic BUN, Kt/V, albumin and i-PTH levels between HCV(+) and (-) patients. Anti-HCV-positive patients required significantly lower weekly doses of EPO (87 +/- 25 IU/kg vs 129 +/- 11 IU/kg, p = 0.042) and iron (16.8 +/- 12.2 mg vs 32.6 +/- 16.1 mg, p = 0.02) replacement than anti-HCV(-) group; hs-CRP levels were similar between study groups. Serum endogenous EPO levels were significantly higher in HCV(+) patients than HCV(-) HD patients (9.43 +/- 6.47 mU/ml vs 3.59 +/- 2.08 mU/ml, p = 0.008). CONCLUSION: Anti-HCV(+) HD patients had higher serum EPO levels and required less EPO and iron replacement as compared to anti-HCV(-) patients. Because of the changes in iron metabolism, iron treatment should be carefully administered in HD patients with HCV.     

Acute-phase response predicts erythropoietin resistance in hemodialysis and peritoneal dialysis patients

We defined erythropoietin (EPO) resistance by the ratio of the weekly EPO dose to hematocrit (Hct), yielding a continuously distributed variable (EPO/Hct). EPO resistance is usually attributed to iron or vitamin deficiency, hyperparathyroidism, aluminum toxicity, or inflammation. Activation of the acute-phase response, assessed by the level of the acute-phase C-reactive protein (CRP), correlates strongly with hypoalbuminemia and mortality in both hemodialysis (HD) and peritoneal dialysis (PD) patients. In this cross-sectional study of 92 HD and 36 PD patients, we examined the contribution of parathyroid hormone (PTH) levels, iron indices, aluminum levels, nutritional parameters (normalized protein catabolic rate [PCRn]), dialysis adequacy (Kt/V), and CRP to EPO/Hct. Albumin level serves as a measure of both nutrition and inflammation and was used as another independent variable. Serum albumin level (deltaR2 = 0.129; P < 0.001) and age (deltaR2 = 0.040; P = 0.040) were the best predictors of EPO/Hct in HD patients, and serum albumin (deltaR2 = 0.205; P = 0.002) and ferritin levels (deltaR2 = 0.132; P = 0.015) in PD patients. When albumin was excluded from the analysis, the best predictors of EPO/Hct were CRP (deltaR2 = 0.105; P = 0.003) and ferritin levels (deltaR2 = 0.051; P = 0.023) in HD patients and CRP level (deltaR2 = 0.141; P = 0.024) in PD patients. When both albumin and CRP were excluded from analysis in HD patients, low transferrin levels predicted high EPO/Hct (deltaR2 = 0.070; P = 0.011). EPO/Hct was independent of PTH and aluminum levels, PCRn, and Kt/V. High EPO/Hct occurred in the context of high ferritin and low transferrin levels, the pattern expected in the acute-phase response, not in iron deficiency. In well-dialyzed patients who were iron replete, the acute-phase response was the most important predictor of EPO resistance.     

Endogenous erythropoietin levels and anemia in long-term renal transplant recipients

BACKGROUND/AIM: Although anemia is a common complication after renal transplantation (RT), data concerning endogenous erythropoietin (EPO) levels in long-term RT recipients are rare. The goal of this study was to evaluate the prevalence of anemia within 6 months to 5 years after RT and to assess the relationship between the serum concentrations of endogenous EPO, graft function and grade of improvement of anemia. METHODS: 140 patients who had undergone RT were included in the group: 89 males (63.6%) and 51 females (36.4%), with an average age 46.8 +/- 12.8 years. The serum concentrations of EPO and creatinine (Cr) were tested in all the individuals and the values of the red blood component of blood count, serum ferritin (SF), plasma iron concentration, plasma total iron-binding capacity (TIBC), transferrin saturation (TS), folic acid and vitamin B(12) levels in the serum were determined. A statistical analysis of the results was performed using the correlation analysis, Mann-Whitney U test and Duncan's multiple range test. RESULTS: Normal blood count values were found in 91 patients (65%), and a mild grade of anemia with a mean hemoglobin (Hb) 114.4 +/- 11.9 g/l was observed in 45 patients (32.1%), and 4 patients (2.9%) fulfilled the diagnostic criteria for post-transplantation erythrocytosis. Individuals with normal Hb values had a mean EPO serum concentration of 39.3 +/- 12.3 mU/ml (median 37.2) and the mean Cr was 133.8 +/- 36.9 micromol/l (median 122). Patients with anemia (Hb <120 g/l in females, Hb <130 g/l in males) had a mean EPO value of 47.0 +/- 26.6 mU/ml (median 36.0) and a mean Cr of 203.8 +/- 108.9 micromol/l (median 181). The difference in the Cr values was statistically significant (p < 0.0001), while the difference between the EPO concentrations was not significant. No relation of EPO serum concentration with regard to graft function was found in the analysis. A lack of storage iron (SF <10 microg/l in females, SF <22 microg/l in males) was found in 16 patients (11.4%), and a lack of functional iron (TS <20%) was found in 27 patients (19.3%). CONCLUSIONS: Theprevalence of anemia in patients after transplantation was 32.1%. The most common cause of anemia is insufficient graft function development. The achieved values of the red component of blood count have no relation to the endogenous EPO serum concentrations.     

持续性血液透析患者铁代谢与贫血状况的研究

目的 观察维持性血液透析(maintenance hemodialysis,MHD)患者铁过载的相关情况及其与贫血的相关性.方法 采用单中心、回顾性临床研究.选择2014年6月至2014年12月本院维持血液透析患者120例,按SF水平分为三组.A组(SF≤500 mg/L,n=60),B组(500 mg/L＜ SF≤1000 mg/L,n =35)和C组(SF＞ 1000 mg/L,n =25).调查患者的促红细胞生成素的用量、静脉补铁剂量、血红蛋白的变化、尿素氮、肌酐、全段甲状旁腺激素以及铁调素的水平.结果 C组患者的静脉铁补充剂量、输血量均大于A、B两组(P＜0.05),A组血红蛋白变化量大于B、C两组(P＜0.05),C组铁调素高于A、B两组(P＜0.05).结论 慢性肾衰竭维持血液透析的患者在SF≤500 mg/L,静脉补铁能有效地改善贫血,如补铁过量;SF＞ 1000 mg/L并不能显著的改善贫血及表现出铁代谢紊乱.     

多囊卵巢综合征合并妊娠期糖尿病患者铁代谢与胰岛素抵抗的关系

目的分析多囊卵巢综合征(polycystic ovary syndrome,PCOS)合并妊娠期糖尿病(gestational diabetes mellitus,GDM)患者铁代谢改变及与胰岛素抵抗(insulin resistance,IR)的关系。方法选择2017年1月至2018年2月在烟台毓璜顶医院常规产检,妊娠24~28周的孕妇为筛查对象。确诊为GDM的孕妇60例为GDM组,既往诊断为PCOS且合并GDM的孕妇60例为多囊卵巢合并妊娠期糖尿病(polycystic ovary syndrome with gestational diabetes mellitus,PGDM)组,同时按年龄段进行1∶1∶1匹配,选择正常孕妇60例为正常对照(NC)组。检测3组患者血糖、胰岛素、血红蛋白(Hb)、铁代谢(血清铁、铁蛋白、转铁蛋白饱和度)水平,并评估患者氧化应激损伤及炎症水平的改变,利用多元线性回归法分析铁代谢指标与炎症指标及IR的关系。结果与NC组相比,PGDM组Hb水平降低,铁蛋白(SF)、转铁蛋白饱和度(TS)升高(F=3.55、8.24、5.10,均P<0.05);丙二醛(MDA)水平升高,超氧化物歧化酶(SOD)水平降低(F=11.11、7.24,均P<0.01);肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平升高(F=4.02、19.06,均P<0.05);与GDM组相比,PGDM组Hb水平降低,SF、TS升高,HOMA-IR、MDA、TNF-α、IL-6水平均升高(均P<0.05)。MDA、TNF-α、IL-6与SF呈正相关(r=0.42、0.43、0.56,均P<0.05),与TS呈正相关(r=0.61、0.42、0.52,均P<0.01);SF、TS与胰岛素抵抗指数呈正相关(r=0.39、0.41,均P<0.01)。结论PGDM患者铁沉积状况导致机体氧化应激损伤程度升高,炎症反应增加,从而加重了IR程度。铁代谢紊乱可能与PGDM患者血糖升高机制有关。     

Determinants of circulating soluble transferrin receptor level in chronic haemodialysis patients.

BACKGROUND: The aim of this study was to identify the factors determining the circulating soluble transferrin receptor (sTfR) concentrations in haemodialysis (HD) patients on maintenance recombinant human erythropoietin (rHuEpo) treatment. METHODS: In a prospective cross-sectional study, 91 chronic HD patients and 18 anaemic controls with normal renal function were recruited. For each subject, blood samples were measured for complete blood count, reticulocyte count, percentage of hypochromic red cells (% HRC), serum ferritin, serum iron, transferrin saturation (TS), serum erythropoietin (sEpo), C-reactive protein (CRP), and sTfR. HD patients received constant rHuEpo doses and basal sEpo was measured > or = 86 h after the last injection. The age, gender, dialysis vintage, and the above-mentioned parameters were used as independent variables and logarithmic sTfR (log(10)sTfR) as a dependent variable in the forward stepwise multiple regression model. RESULTS: HD patients were similar to controls regarding haematocrit, serum ferritin, TS, and % HRC, but had significantly lower sTfR, sEpo, and reticulocyte index. Univariate analyses showed that the sTfR level strongly correlated with sEpo (r=0.60, P<0.001) and % HRC (r=0.60, P<0.001), and significantly with serum ferritin (r=-0.29, P<0.01), TS (r=-0.27, P<0.05), and dose of rHuEpo administered (r=0.27, P<0.05) in HD patients. sTfR also had a positive correlation with haematocrit (r=0.26, P<0.05), red blood cell (RBC) count (r=0.23, P<0.05), and reticulocyte count (r=0.24, P<0.05), but not with CRP (r=0.16, P>0.05). Multivariate regression analysis disclosed that sEpo, HRC, and serum ferritin were the independent predictors of sTfR level. Overall, the model explained 58.8% of the variability in sTfR (R(2)=0.588, P<0.001). CONCLUSIONS: Circulating sTfR is a good index of marrow erythropoietic activity in HD patients during rHuEpo treatment. Its level is also independently up-regulated by functional iron deficiency in the process of enhanced erythropoiesis. Our study showed that sTfR levels quantitatively reflect the integrated effects of iron availability, iron reserves, and erythropoietic stimulation.