Mitsuiki Koji, Harada Atsumi, Miyata Yasuji
The Kidney Center, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama 790-8524, Japan.
Clin Exp Nephrol. 2003 Mar;7(1):52-7. doi: 10.1007/s101570300007.
Recently, the usefulness of reticulocyte hemoglobin content (CHr) as a ferrokinetic marker in hemodialysis patients who receive recombinant human erythropoietin (rHuEPO) has been reported. However, a definite index for iron deficiency has not been established. In this study, a CHr cutoff value was investigated.
We retrospectively selected 27 hemodialysis patients by the following criteria: (1) hematocrit (Ht) values less than 30%, (2) patients receiving a stable dose of rHuEPO for at least 3 months, (3) patients who had not received iron supplements for at least 3 months, and had begun receiving iron supplements, (4) the doses of rHuEPO and iron supplements were unchanged for 8 weeks following the start of iron administration. The iron supplement was administered at a dose of 40 mg/week, and Ht, CHr, transferrin saturation (TSAT), and serum ferritin were measured. The difference between the peak Ht value obtained at weeks 4-8 and Ht at baseline was calculated (DeltaHt). Patients with a DeltaHt of 3% or more were categorized as iron-deficient at baseline (group 1; n = 17). Patients with a DeltaHt of less than 3% were categorized as iron-sufficient at baseline (group 2; n = 10). Each parameter was compared between the groups.
Significant negative correlations between DeltaHt and CHr at baseline, and DeltaHt and TSAT at baseline were observed. CHr and TSAT were significantly lower in group 1 than in group 2 at baseline. CHr was less than 32 pg in all patients in group 1, and greater than 32 pg in nine of the ten patients in group 2. If the CHr cutoff value was 32 pg, sensitivity was 100% and specificity was 90%.
It is considered that 32 pg is appropriate for the CHr cutoff value.
最近,有报道称网织红细胞血红蛋白含量(CHr)作为接受重组人促红细胞生成素(rHuEPO)的血液透析患者铁动力学标志物的有用性。然而,尚未建立明确的缺铁指标。在本研究中,对CHr临界值进行了调查。
我们根据以下标准回顾性选择了27例血液透析患者:(1)血细胞比容(Ht)值低于30%;(2)接受稳定剂量rHuEPO至少3个月的患者;(3)至少3个月未接受铁补充剂且已开始接受铁补充剂的患者;(4)铁剂给药开始后8周内rHuEPO和铁补充剂的剂量不变。铁补充剂以40mg/周的剂量给药,并测量Ht、CHr、转铁蛋白饱和度(TSAT)和血清铁蛋白。计算第4 - 8周获得的峰值Ht值与基线Ht之间的差异(ΔHt)。ΔHt为3%或更高的患者在基线时被分类为缺铁(第1组;n = 17)。ΔHt小于3%的患者在基线时被分类为铁充足(第2组;n = 10)。比较两组之间的每个参数。
观察到基线时ΔHt与CHr之间以及基线时ΔHt与TSAT之间存在显著负相关。第1组的CHr和TSAT在基线时显著低于第2组。第1组所有患者的CHr均小于32pg,第2组10例患者中有9例大于32pg。如果CHr临界值为32pg,则敏感性为100%,特异性为90%。
认为32pg适用于CHr临界值。