Tsuchiya K, Okano H, Teramura M, Iwamoto Y, Yamashita N, Suda A, Shimada K, Nihei H, Ando M
Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan.
Clin Nephrol. 2003 Feb;59(2):115-23. doi: 10.5414/cnp59115.
The evaluation of iron status in dialysis patients provides information essential to the planning of adequate recombinant human erythropoietin (rHuEPO) treatment. Iron status of the patients can be determined from the recently available measurement of content of reticulocyte hemoglobin (CHr).
In this study, to clarify the accuracy of CHr in diagnosing iron deficiency in hemodialysis (HD) patients, we initially compared CHr with such conventional iron parameters as serum ferritin levels, transferrin saturation and serum soluble transferrin receptor levels. Secondly, we investigated the changes in CHr during iron supplementation for iron-deficient patients to determine whether this marker is a prospective and reliable indicator of iron sufficiency. The participants in this study were 149 hemodialysis (HD) patients and 53 age-matched healthy subjects. Iron deficiency was defined as having a TSAT of less than 20% and serum ferritin of less than 100 ng/ml. Conventional parameters of red blood cells and CHr were measured by an ADVIA120 autoanalyzer.
Mean CHr was 32.3 +/- 2.2 pg in the patients undergoing hemodialysis treatment. CHr significantly correlated with iron parameters in the dialysis patients. Logistic regression analysis was performed to determine the relationship between CHr and each outcome measure, and CHr was the significant multivariate predictor of iron deficiency. Iron supplements given to the patients with low CHr and hematocrit (Hct) significantly increased Hct, resulting in a decrease in the weekly dosage of rHuEPO.
CHr, measured simultaneously with Hct, is a sensitive and specific marker of iron status in dialysis patients.
评估透析患者的铁状态可为规划适当的重组人促红细胞生成素（rHuEPO）治疗提供重要信息。患者的铁状态可通过最近可用的网织红细胞血红蛋白含量（CHr）测量来确定。
在本研究中，为阐明CHr在诊断血液透析（HD）患者缺铁中的准确性，我们首先将CHr与血清铁蛋白水平、转铁蛋白饱和度和血清可溶性转铁蛋白受体水平等传统铁参数进行比较。其次，我们研究了缺铁患者补铁期间CHr的变化，以确定该标志物是否是铁充足的前瞻性可靠指标。本研究的参与者为149例血液透析（HD）患者和53例年龄匹配的健康受试者。缺铁定义为转铁蛋白饱和度低于20%且血清铁蛋白低于100 ng/ml。红细胞的传统参数和CHr通过ADVIA120自动分析仪测量。
接受血液透析治疗的患者平均CHr为32.3±2.2 pg。CHr与透析患者的铁参数显著相关。进行逻辑回归分析以确定CHr与每个结局指标之间的关系，CHr是缺铁的显著多变量预测因子。给予低CHr和血细胞比容（Hct）的患者铁补充剂可显著提高Hct，从而降低rHuEPO的每周剂量。
与Hct同时测量的CHr是透析患者铁状态的敏感和特异标志物。
