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。

Relationship between serum hepcidin-25 and survival prognosis in patients undergoing maintenance hemodialysis

ObjectiveHepcidin plays an important regulatory role in iron metabolism, which can inhibit intestinal iron absorption and iron release from hepatocytes and macrophages, while its clinical application value is unclear yet. This study aimed to investigate the relationship between serum hepcidin-25 and survival prognosis in patients undergoing maintenance hemodialysis (MHD). MethodsThis study was a prospective observational cohort study. A total of 160 MHD patients, who were admitted to the Blood Purification Center of Xuzhou Central Hospital from January 2016 to December 2020, were selected and divided into two groups, low-level group (hepcidin-25 < 30.9 ng/ml) and high-level group (hepcidin-25≥30.9 ng/ml) according to their baseline level of serum hepcidin-25, with a follow-up period of 5 years. Kaplan-Meier survival curve, multivariate Cox proportional hazards model, and Cox proportional hazards regression model based on restricted cubic splines were used to analyze the relationship between hepcidin-25 and mortality risk. ResultsCompared with the low-level group, the high-level group had higher baseline levels of serum iron, ferritin, transferrin saturation (TSAT), high-sensitivity C-reactive protein (hs-CRP), while the pre-dialysis levels of serum creatinine, albumin, and prealbumin were lower. Patients in the high-level group showed poorer survival prognosis, shorter dialysis age (P=0.0011), and higher mortality during follow-up (P=0.0023). When serum hepcidin-25 increased by 10 ng/mL, the hazard ratio of all-cause mortality in the MHD patients was 1.206 (95%CI: 1.100-1.323, P<0.001). The hazard ratio of all-cause mortality in the MHD patients was relatively stable when the serum hepcidin-25 level was less than 30.9 ng/mL, but increased apparently as the serum hepcidin-25 level was over 30.9 ng/ml. ConclusionSerum hepcidin-25 could be an independent predictor for all-cause mortality of the MHD patients. Monitoring the serum level of hepcidin-25 could help to predict the survival prognosis of the MHD patients.