血清可溶性转铁蛋白受体、红细胞分布宽度-变异系数与维持性血液透析患者铁代谢的关系

    Relationship between serum sTFR, RDW-CV and iron metabolism in maintenance hemodialysis patients

      摘要
    • 摘要:
      目的  研究血清可溶性转铁蛋白受体（soluble transferrin receptor，sTFR）、红细胞分布宽度-变异系数（red blood cell distribution width-coefficient of variation，RDW-CV）与维持性血液透析患者铁代谢的关系。
      方法  选取2019年1月至2020年6月秦皇岛市第一医院收治的98例终末期肾病患者，其中48例患者为维持性血液透析患者（A组），48例为非透析终末期肾病患者（B组）。另外，选取同期在秦皇岛市第一医院进行健康体检的受试者48例作为对照组。入组后第二天，测定受试者sTFR水平、RDW-CV水平、肾功能参数水平、铁代谢参数水平。
      结果  A组的sTFR水平为（49.78 ± 17.43）nmol/L、RDW-CV水平为（16.21 ± 2.43）%，均显著高于B组的（31.01 ± 5.23）nmol/L、（14.87 ± 4.88）%和对照组的（13.79 ± 3.72）nmol/L、（12.89 ± 3.92）%（P＜0.05）。与B组相比，A组患者的超敏C反应蛋白（high sensitivity C-reactive protein，hs-CRP）、血红蛋白（hemoglobin，Hb）、血清铁蛋白（ferritin，Fer）水平显著增加（P＜0.05），白蛋白（albumin，Alb）、血清转铁蛋白（transferrin，TRF）、血清铁及转铁蛋白饱和度（transferrin saturation，TSAT）水平显著降低（P＜0.05）。患者血清sTFR和RDW-CV水平均与血肌酐（serum creatinine，Scr）、尿酸（uric acid，UA）、hs-CRP、甲状旁腺激素（parathyroid hormone，PTH）、FER和TSAT水平呈正相关（P＜0.05）；与估算肾小球滤过率（estimated glomerular filtration rate，eGFR）、红细胞计数（red blood cell，RBC）、Alb、Hb、TRF和血清铁（serum iron，SI）水平呈负相关（P＜0.05）。多元逐步回归分析结果显示，维持性血液透析患者血清sTFR、RDW-CV水平与患者铁代谢参数FER和血清总铁结合力水平均有密切关系（P＜0.05）。血清sTFR的曲线下面积（area under curve，AUC）和95%置信区间为0.874、0.823～0.909，血清RDW-CV的AUC和95%置信区间为0.888、0.812～0.899。血清sTFR的截断值为32.12 nmol/L，对维持性血液透析患者铁代谢预测的特异性为71.2%，敏感性为76.3%。血清RDW-CV的截断值为15.42%，对维持性血液透析患者铁代谢预测的特异性为68.0%，敏感性为76.4%。
      结论  血清sTFR、RDW-CV水平与维持性血液透析患者的铁代谢水平呈负相关，可以在一定程度上反映患者的铁代谢水平。

       

      Abstract:
      Objective  To explore the relationship between serum soluble transferrin receptor（sTFR）, red blood cell distribution width-CV（RDW-CV） and iron metabolism in maintenance hemodialysis（MHD） patients.
      Methods  From January 2019 to June 2020, 98 patients of end-stage renal disease（ESRD） were selected, including 48 patients on maintenance hemodialysis （group A） and 48 patients with non-dialysis ESRD（group B）. Another 48 subjects receiving physical examination during the same period were selected as control group. At Day 2 post-recruitment, the levels of sTFR, RDW-CV, kidney function and iron metabolism parameters（FER&TIBC） were measured.
      Results  Serum levels of sTFR and RDW-CV in group A （49.78 ± 17.43） nmol/L, （16.21 ± 2.43）% were significantly higher than those in group B （31.01 ± 5.23） nmol/L, （14.87 ± 4.88）% and control group （13.79 ± 3.72） nmol/L, （12.89 ± 3.92）%（P＜0.05）. Compared with group B, the levels of hs-CRP, Hb and FER spiked markedly in group A（P＜0.05） while the levels of albumin （Alb）, transferrin（TRF） and transferrin saturation（TSAT） declined significantly（P＜0.05）. Serum levels of sTFR and RDW-CV were correlated positively with the levels of Scr, UA, hs-CRP, iPTH, FER and TSAT（P＜0.05）. There was a negative correlation with the levels of eGFR, RBC, Alb, Hb, TRF and SI（P＜0.05）. Multiple regression analysis indicated that serum levels of sTFR and RDW-CV were correlated closely with FER and TIBC（P＜0.05）. AUC and 95% confidence interval of serum sTFR were 0.874（95%CI: 0.823-0.909） and AUC and 95% confidence interval of serum RDW-CV 0.888（95%CI: 0.812-0.899）. The cut-off value of serum sTFR was 32.12 nmol/L and the specificity and sensitivity of predicting iron metabolism 71.2% and 76.3% respectively. The cutoff value of serum RDW-CV was 15.42% and the specificity and sensitivity of predicting iron metabolism were 68.0% and 76.4% respectively.
      Conclusion  Serum levels of sTFR and RDW-CV are correlated negatively with iron metabolism level. Both parameters may reflect the iron metabolism level of MHD patients to some extent.

       

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