血清铁调素25水平与腹膜透析患者冠状动脉钙化及心血管事件的关系

目的 探讨持续性腹膜透析患者血清铁调素25（hepcidin-25）水平和冠状动脉钙化（coronary artery calcification,CAC）及心血管事件的关系.方法 选择210例持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）患者血清hepcidin-25的平均值为界,分为CAPD高hepcidin-25组107例、CAPD低hepcidin-25组103例;另选择在本院进行健康体检者90名作为健康对照组.通过酶联免疫法（enzyme-linked immunosorbent assay,ELISA）测定所有CAPD患者和健康对照组血清hepcidin-25水平.对所有入选者进行冠状动脉多层螺旋电子计算机断层扫描成像（multi-slice computed tomography,MSCT）钙化评价研究.结果 CAPD高hepcidin-25组在随访12个月内发生心血管事件71例次,因心血管事件死亡21例（占19.6%）;而CAPD低hepcidin-25组发生心血管事件27例次,因心血管事件死亡仅10例（占9.7%）.CAPD高hepcidin-25组和CAPD低hepcidin-25组心血管事件发生率比较,差异有统计学意义（P＜0.01）,以上2组无心血管事件生存率无统计学差异（P=0.055）.CAPD患者心血管事件发病率46.7%（98/210）]与健康对照组心血管事件发病率5.6%（5/90）]比较,差异有统计学意义（P＜0.01）.CAPD高hepcidin-25组CAC发病率均明显高于CAPD低hepcidin-25组（P＜0.01）;而且相关性分析显示,hepcidin-25水平与CAC积分呈正相关（r=0.980,P＜0.01）.多元逐步回归分析显示血清hepcidin-25水平偏回归系数（B）=0.402,P＜0.01]和CAC（B=-0.015,P＜0.01）是CAPD患者心血管事件发生的重要危险因素.结论 血清hepcidin-25水平升高及CAC是CAPD患者发生心血管事件的重要原因,提示铁代谢紊乱可能参与,且促进了CAC的发生、发展,并最终导致心血管事件的发生.

Relationship between serum hepcidin-25 level with coronary artery calcification and cardiovascular events in patients with peritoneal dialysis

Objective To evaluate the relationship between serum hepcidin-25 level with coronary artery calcification （CAC） and the cardiovascular events in patients subject to continuous ambulatory peritoneal dialysis （CAPD）. Methods 210 cases of CAPD were divided into CAPD high hepcidin- 25 group （107 cases） and CAPD low hepcidin-25 group （103 cases） by the average value of serum hepcidin-25. Ninety cases in our hospital for physical examination served as healthy controls. The serum hepcidin-25 levels were determined by using enzyme-linked immunosorbent assay （ELISA）. The CAC was evaluated with multistice computed tomography （MSCT） in all patients. Results Seventy-one ca- ses of cardiovascular events occurred in CAPD high hepcidin-25 group during the follow-up peirod of 12 months, and there were 21 cases （19. 6 % ） of deaths from cardiovascular events. Twenty-seven cases of cardiovascular events occurred in CAPD low hepcidin-25-group and there were only 10 cases （9. 7 %） deaths from cardiovascular events. There was significant difference in the incidence of cardioascular events between CAPD high hepcidi-25 group and CAPD low bepcidin-25 group （P〈0.01）, and the survival rate showed no significant difference between the two groups without cardiovascular events （P = 0. 055）. There was significant difference in the incidence of cardiovascular events between CAPD group （46.7%） and health control group （5.6%） （P〈0. （1）.The incidence of CAC in CAPD high hepcidin-25 group was significantly higher than in CAPD low hepcidin-25 group （P〈0. 01）.Correlation analysis revealed that serum hepcidin-25 levels were positively correlated with CAC integration （r= 0. 980,P〈0. 980）. Multiple stepwise regression analysis indicated the serum hepcidin-25 level （B = 0. 4D2,P〈0. 01） and CAC （B= - 0. 015,P〈0. 01） are important risk factors for cardiovascular e vents in CAPD patients. ConclusionsElevated serum hepcidin-25 levels and CAC are the important reasons of CAPD patients with cardiovascular events. The results suggested that iron metabolism dis orders may participate in and promote the development of CAC and eventually lead to the occurrence of cardiovascular events.