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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 273 -278. doi: 10.3877/cma.j.issn.1674-0785.2018.05.004

所属专题： 文献；

临床研究

持续不卧床腹膜透析患者血清铁调素水平与钙磷代谢的相关性
牟洪宾1, 王海霞2,†(), 刘昌华1, 高波1, 陈蕊1, 周刚1, 孔亚玲1   
  1. 1. 225001　江苏扬州，苏北人民医院血液净化中心
    2. 225001　江苏扬州，苏北人民医院重症医学科
  • 收稿日期:2017-11-03 出版日期:2018-03-01
  • 通信作者: 王海霞
  • 基金资助:
    2014前瞻性研究-社会发展前瞻性研究(SQZ201430047)

Correlation between serum hepcidin and calcium-phosphorus metabolism indices in continuous ambulatory peritoneal dialysis patients

Hongbin Mou1, Haixia Wang2,†(), Changhua Liu1, Bo Gao1, Rui Chen1, Gang Zhou1, Yaling Kong1   

  1. 1. Department of Nephrology, Subei People′s Hospital, Yangzhou 225001, China
    2. Intensive Care Unit, Subei People′s Hospital, Yangzhou 225001, China
  • Received:2017-11-03 Published:2018-03-01
  • Corresponding author: Haixia Wang
  • About author:
    Corresponding author: Wang Haixia, Email:
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牟洪宾, 王海霞, 刘昌华, 高波, 陈蕊, 周刚, 孔亚玲. 持续不卧床腹膜透析患者血清铁调素水平与钙磷代谢的相关性[J]. 中华临床医师杂志(电子版), 2018, 12(05): 273-278.

Hongbin Mou, Haixia Wang, Changhua Liu, Bo Gao, Rui Chen, Gang Zhou, Yaling Kong. Correlation between serum hepcidin and calcium-phosphorus metabolism indices in continuous ambulatory peritoneal dialysis patients[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(05): 273-278.

目的

研究持续不卧床腹膜透析（CAPD）患者血清铁调素（hepcidin）水平变化以及钙磷代谢状况与铁调素水平的相关性。

方法

选取2014年6月至12月在江苏省苏北人民医院血液净化中心进行CAPD治疗的患者45例，将同期该院健康体检中心体检健康者40例作为健康对照组。采用ELISA法检测血清铁调素水平；采用成组t检验比较CAPD组和对照组的年龄、体质量指数（BMI）、血尿素氮（BUN）、肌酐（cr）、白蛋白、磷、钙、25（OH）-维生素D3、血清铁、总铁结合力（TIBC）、可溶性转铁蛋白受体（sTfR）、血红蛋白、红细胞比容等指标；采用秩和检验（Mann-Whitney rank）比较两组全段甲状旁腺激素（iPTH）、铁蛋白、铁调素等指标；采用χ2检验比较两组性别分布；采用Pearson相关及多元逐步线性回归方法分析铁调素与钙磷代谢指标之间的相关性。

结果

CAPD组患者与对照组比较，血清中血红蛋白、红细胞比容、白蛋白、血清铁、TIBC、转铁蛋白饱和度、25（OH）-维生素D3水平明显降低，差异具有统计学意义［（89.62±20.04）g/L vs（121.53±4.06）g/L，t=-8.72，P<0.001；（26.81±5.68）% vs（40.82±2.04）%，t=-9.64，P<0.001；（43.25±1.23）g/L vs（45.26±1.29）g/L，t=-1.27，P=0.046；（10.27±2.36）μmol/L vs（18.52±4.41）μmol/L，t=-5.71，P<0.001；（65.40±2.89）μmol/L vs（75.84±5.03）μmol/L，t=-2.34，P=0.037；（15.34±5.44）% vs（29.65±4.77）%，t=-9.31，P<0.001；（39.57±7.23）nmol/L vs（79.12±10.38）nmol/L，t=-10.34，P<0.001］；CAPD组患者与对照组比较，BUN、cr、铁蛋白、sTfR、铁调素、iPTH和磷的水平明显升高，差异具有统计学意义［（18.87±7.64）mmol/L vs（4.26±1.18）mmol/L，t=8.27，P<0.001；（647.43±56.78）μmol/L vs（54.81±6.74）μmol/L，t=8.26，P<0.001；260.41（109.31，423.33）μg/L vs 109.33（60.54，159.62）μg/L，Z=-4.24，P=0.001；（4.27±1.45）mg/L vs（2.89±1.22）mg/L，t=1.79，P=0.048；234.24（134.22，437.19）μg/L vs 87.51（40.54，132.57）μg/L，Z=-5.27，P<0.001；26.10（15.04，50.35）ng/L vs 3.30（1.78，6.25）ng/L，Z=-5.61，P<0.001；（2.73±0.47）mmol/L vs （1.24±0.65）mmol/L，t=12.09，P<0.001］；pearson相关分析结果显示CAPD患者血清铁调素与血磷（r=0.300，P=0.003）和iPTH（r=0.313，P=0.02）水平呈正相关，但血清铁调素水平与血钙（r=0.064，P=0.531）及25（OH）-维生素D3（r=0.007，P=0.943）水平无相关性。

结论

血清铁调素水平在CAPD患者体内明显升高，与血清磷和iPTH水平呈正相关，血磷及iPTH可能参与铁调素的调节。

关键词: 持续不卧床腹膜透析, 铁调素, 钙磷代谢
Objective

To investigate the changes of serum hepcidin levels and the relationship between calcium and phosphorus metabolism and hepcidin levels in patients with continuous ambulatory peritoneal dialysis (CAPD).

Methods

Forty-five patients who underwent CAPD treatment at the Blood Purification Center of Jiangsu Subei People's Hospital from June to December 2014 were selected. Forty healthy people who underwent health check-up at the hospital were used as healthy controls. Serum hepcidin levels were detected by ELISA. The two sample t-test was used to compare age, body mass index (BMI), blood urea nitrogen (BUN), creatinine, albumin, phosphorus, calcium, 25(OH)-vitamin D3, serum iron, total iron binding capacity (TIBC), soluble transferrin receptor (sTfR), hemoglobin, and hematocrit between the CAPD group and the control group. The Mann-Whitney rank test was used to compare whole-stage parathyroid hormone (iPTH) and ferritin as well as hepcidin levels. The χ2 test was used to compare the gender distribution of the two groups. Pearson correlation and multiple stepwise linear regression were used to analyze the correlation between hepcidin and calcium and phosphorus metabolic indicators.

Results

Compared with the control group, serum levels of hemoglobin, hematocrit, albumin, iron, TIBC, transferrin saturation, and 25(OH)-vitamin D3 were significantly lower in the CAPD group [(89.62±20.04) g/L vs (121.53±4.06) g/L, t=-8.72, P<0.001; (26.81±5.68)% vs (40.82±2.04)%, t=-9.64, P<0.001; (43.25±1.23) g/L vs (45.26±1.29) g/L, t=-1.27, P=0.046; (10.27±2.36) μmol/L vs (18.52±4.41) μmol/L, t=-5.71, P<0.001; (65.40±2.89) μmol/L vs (75.84±5.03) μmol/L, t=-2.34, P=0.037; (15.34±5.44)% vs (29.65±4.77)%, t=9.31, P<0.001; (39.57±7.23) nmol/L vs (79.12±10.38) nmol/L, t=-10.34, P<0.001]. Compared with the control group, the levels of BUN, creatinine, ferritin, sTfR, hepcidin, iPTH, and phosphorus in the CAPD group were significantly higher [(18.87±7.64) mmol/L vs (4.26±1.18) mmol/L, t=8.27, P<0.001; (647.43±56.78) μmol/L vs (54.81±6.74) μmol/L, t=8.26, P<0.001; 260.41 (109.31, 423.33) μg/L vs 109.33 (60.54, 159.62) μg/L, Z=-4.24, P=0.001; (4.27±1.45) mg/L vs (2.89±1.22) mg/L, t=1.79, P=0.048; 234.24 (134.22, 437.19) μg/L vs 87.51 (40.54, 132.57) μg/ L, Z=-5.27, P<0.001; 26.10 (15.04, 50.35) ng/L vs 3.30 (1.78, 6.25) ng/ L, Z=-5.61, P<0.001; (2.73±0.47) mmol/L vs (1.24±0.65) mmol/L, t=12.09, P<0.001]. Pearson correlation analysis showed that serum hepcidin was positively correlated with serum phosphorus (r=0.300, P=0.003) and iPTH (r=0.313, P=0.02) levels in patients with CAPD, but was not associated with serum calcium (r=-0.064,P=0.531) or 25(OH)-vitamin D3 levels (r=0.007, P=0.943).

Conclusion

Serum hepcidin levels are significantly elevated in patients with CAPD, and are positively correlated with serum phosphorus and iPTH levels. Serum phosphorus and iPTH may be involved in the regulation of hepcidin.

Key words: Continuous ambulatory peritoneal dialysis, Hepcidin, Calcium and phosphorus metabolism
表1 CAPD组及对照组一般临床资料比较
组别 例数 性别（例，男/女） 平均年龄（岁，±s） 平均BMI （kg/m2，±s）
CAPD组 45 20/25 66.31±6.18 23.84±4.27
对照组 40 21/19 64.56±5.26 22.14±3.51
统计值 ? χ2=0.55 t=1.68 t=1.31
P值 ? 0.46 0.097 0.196
表2 CAPD组及对照组血常规及血生化检查指标比较（±s）
组别 例数 血红蛋白（g/L） 红细胞比容（%） BUN（mmol/L） cr（μmol/L） 白蛋白（g/L）
CAPD组 45 89.62±20.04 26.81±5.68 18.87±7.64 647.43±56.78 43.25±1.23
对照组 40 121.53±4.06 40.82±2.04 4.26±1.18 54.81±6.74 45.26±1.29
t值 ? -8.72 -9.64 8.27 8.26 -1.27
P值 ? <0.001 <0.001 <0.001 <0.001 0.046
表3 CAPD组及对照组铁代谢指标比较
组别 例数 血清铁（μmol/L，±s） 铁蛋白［（μg/L），M（Q1，Q3）］ TIBC（μmol/L，±s） sTfR（mg/L，±s） 转铁蛋白饱和度（%，±s）
CAPD组 45 10.27±2.36 260.41（109.31，423.33） 65.40±2.89 4.27±1.45 15.34±5.44
对照组 40 18.52±4.41 109.33（60.54，159.62） 75.84±5.03 2.89±1.22 29.65±4.77
统计值 ? t=-5.71 Z=-4.24 t=-2.34 t=1.79 t=-9.31
P值 ? <0.001 0.001 0.037 0.048 <0.001
表4 CAPD组及对照组铁调素和钙磷代谢相关指标比较
组别 例数 铁调素［μg/L，M（Q1，Q3）］ 钙（mmol/L，±s） 磷（mmol/L，±s） 25（OH）-维生素D3（nmol/L，±s） iPTH［（ng/L，M（Q1，Q3）］
CAPD组 45 234.24（134.22，437.19） 2.28±0.20 2.73±0.47 39.57±7.23 26.10（15.04，50.35）
对照组 40 87.51（40.54，132.57） 2.23±0.17 1.24±0.65 79.12±10.38 3.30（1.78，6.25）
统计值 ? Z=-5.27 t=1.61 t=12.09 t=-10.34 Z=-5.61
P值 ? <0.001 0.065 <0.001 <0.001 <0.001
表5 铁调素的多元逐步回归分析
自变量 非标准回归系数 标准误 标准回归系数 t值 P值
常数项 4.606 0.527 - 8.738 0.000
血磷 0.158 0.065 0.244 2.442 0.016
iPTH 0.347 0.153 0.227 2.264 0.026
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