高通量血液透析对血清铁调素水平变化的影响及相关因素分析

目的 观察维持性血液透析患者高通量透析治疗后血清铁调素（Hepcidin）水平的变化,并探讨相关影响因素.方法 维持性血液透析患者40例,高通量透析治疗12月.分别于0月、2月、6月、12月采血,检测血清Hepcidin、铁代谢相关指标、贫血指标及炎症指标超敏C反应蛋白（hs-CRP）.采用Pearson相关和多元回归方法分析血清铁调素与其它指标的相关性. 结果 高通量透析后各时间点血清Hepcidin水平均显著高于0月（P＜0.01）.铁蛋白、hs-CRP与Hepcidin水平变化趋势大致相符.Pearson相关分析显示,Hepcidin与血清铁、转铁蛋白铁饱和度、铁蛋白、hs-CRP和β2微球蛋白呈正相关（r=0.164、P＜0.05,r=0.168、P＜0.05,r=0.173、P＜0.05,r=0.204、P＜0.01,r=0.692、P＜0.01）.多元回归显示,高通量透析治疗患者的转铁蛋白饱和度、hs-CRP、血红蛋白及β2微球蛋白水平与血清Hepcidin水平密切相关.结论 Hepcidin水平可以反映机体铁储备的状况,微炎症状态是影响Hepcidin表达的关键因素.高通量透析治疗可以改善维持性血液透析患者的铁代谢状态,患者的炎症状态变化是其改变的重要影响因素.

Impact of high-flux hemodialysis on serum hepcidin and its related factors

Objective To investigate the change of serum hepcidin in patients after switching from maintenance hemodialysis （MHD） to high-flux hemodialysis （HFD）,and to analyse its related factors.Methods Forty MHD patients were enrolled.They were then changed to HFD for 12 months.Serum hepcidin,blood indices of iron metabolism,anemia and inflammation （high sensitivity C-reactive protein,hs-CRP） were assayed at 0 month,2 months,6 months and 12 months after the switching.Pearson correlation and multiple stepwise regression methods were used to analyze the relationship between serum hepcidin and these indices.Results Serum hepcidin levels after the switching for 2,6 and 12 months were significantly higher than the level at 0 month （P＜0.01）.Changes of ferritin and hs-CRP were consistent with the change of serum hepcidin.Pearson correlation analysis showed that serum hepcidin was positively correlated with serum iron （r=0.164,P＜0.05）,transferrin saturation （r=0.168,P＜0.05）,ferritin （r=0.173,P＜0.05）,hs-CRP （r=0.204,P＜0.01） and β2-microglobulin （r=0.692,P＜0.01）.Multiple stepwise regression showed that transferrin saturation,hs-CRP,hemoglobin and β2-microglobulin levels were closely related to serum hepcidin level in HFD patients.Conclusions Serum hepcidin can reflect the iron storage in the body.Microinflammatory state is a key factor affecting hepcidin expression in hemodialysis patients.HFD may improve the iron metabolism starus in MHD patients.Microinflammatory status is the important factor that influences the improvement processes.