Hepcidin在慢性肾脏病不同分期患者血清中的检测及意义

【目的】探讨hepcidin在判定慢性肾脏病（CKD）不同分期患者机体铁贮存和功能性缺铁方面的价值以及对促红细胞生成素（EPO）治疗反应的影响。【方法】检测70例CKD不同分期患者血清Hepcidin水平以及血液铁代谢指标、高敏C反应蛋白（hsCRP）和相关生化指标。【结果】患者血清Hepcidin水平随着肾小球滤过功能减退，逐渐升高，CKD5期血透组Hepcidin水平最高（120．81±6．65μg／L）（P〈0．001）。血透组Hepcidin水平与血清铁蛋白和转铁蛋白饱和度呈正相关。在不考虑cKD分期的情况下，血清hepcidin水平与hsCRP呈正相关，与肾小球滤过率（GFR），外周红细胞计数和红细胞压积呈负相关。在血透组A、B亚组中，EPO≥9000IU的A组血清hepcidin水平高于EPO〈9000IU的B组（P〈0.001）。【结论】慢性肾脏病时随着GFR的下降，血清hepcidin水平增加，这可能与肾脏清除hepcidin减少和CKD时存在微炎症状态有关。血清hepcidin升高引起功能性铁缺乏，贮存铁利用障碍和EPO低反应，最终使贫血难以纠正。

Significance of the Detection of Serum Hepcidin Level in Different Stages of Chronic Kidney Disease

Objective] To explore the value of the detection of serum hepcidin in evaluating iron storage and deficiency in patients with different stages of chronic kidney disease（CKD） and its effect on the response to erythropoietin（EPO） treatment. Methods] Serum hepcidin, iron metabolic index, high sensitive C-reactive protein（hsCRP） and related biochemical indicators of 70 patients with different stages of CKD were detected. Results]Serum hepcidin gradually increased with the declining of glomerular filtration rate（GFR）. Serum hepcidin in hemodialysis group at CKD5 stage was the highest（120.81±6.65 vg/L）（ P〈0. 001）. Serum hep- cidin in hemodialysis group was correlated positively with serum ferritin and transferin saturation. In spite of the stage of CKD, serum hepcidin was correlated positively with hsCRP and negatively with GFR, periphery red blood cell count and hematocrit. In hemodialysis group, serum hepcidin in subgroup A with EPO≥9000IU was higher than that in subgroup B with EPO〈 9000IU（ P 〈0. 001）. Conclusion] Serum hepcidin level in CKD patients increases with the declining of GFR. The increasing of serum hepcidin may be correlated with the decreased hepcidin clearance and microinflammation status in CKD patients. The rising level of serum hep- cidin can induce functional iron deficiency, the disorder of stored iron utilization and EPO,hyporesponsiveness, subsequently result in refractoriness to anemia therapy.