Mitsuiki Koji, Harada Atsumi, Miyata Yasuji
The Kidney Center, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama 790-8524, Japan.
Clin Exp Nephrol. 2004 Sep;8(3):257-62. doi: 10.1007/s10157-004-0295-x.
Reticulocyte hemoglobin content (CHr) has recently become available as a direct marker of the iron status in hemodialysis patients undergoing recombinant human erythropoietin (rHuEPO) therapy. This study evaluated the stability of CHr in hemodialysis patients with acute infectious disease.
We retrospectively selected 22 hemodialysis patients who had acute respiratory tract infection and who showed transient elevation of C-reactive protein (CRP), and we investigated changes in parameters for erythropoiesis, iron status, and inflammation, i.e., hematocrit (Ht), transferrin saturation (TSAT), CHr, serum ferritin, and CRP, in the preinfection, infection, and postinfection phases. Throughout the observation period, doses of rHuEPO and iron supplements had not been changed. We divided the patients into two groups, those who showed a decrease in Ht in the infection phase (group 1; n = 12) and those who did not show a change in Ht in this phase (group 2; n = 10). We defined the differences between the parameters in the preinfection phase and the infection phase as Delta, and performed correlation analysis between them.
CRP in group 1 was significantly higher than that in group 2 in the infection phase. In group 1, TSAT significantly decreased, from 32.9 +/- 8.8% (preinfection phase) to 16.9 +/- 5.0% (infection phase), and CHr also significantly decreased, from 33.1 +/- 1.5 pg to 30.4 +/- 2.0 pg. In group 2, however, although TSAT significantly decreased, from 34.8 +/- 4.6% to 27.0 +/- 9.3%, CHr showed no significant change (from 33.4 +/- 0.9 pg to 33.0 +/- 1.4 pg). There was a significantly high correlation between DeltaHt and DeltaCHr, but there was a low correlation between DeltaHt and DeltaTSAT ( r = 0.505; P = 0.0153 versus r = 0.175; P = 0.4420). Furthermore, the correlation between DeltaCRP and DeltaCHr was quite high ( r = -0.722; P = 0.0001).
TSAT overreacts to inflammation, failing to reveal the correct status of available iron for erythropoiesis in acute inflammatory disease, but the use of CHr is expected to avoid these disadvantages, providing a reliable direct marker of iron status in the acute infection phase.
网织红细胞血红蛋白含量（CHr）最近已成为接受重组人促红细胞生成素（rHuEPO）治疗的血液透析患者铁状态的直接标志物。本研究评估了急性传染病血液透析患者CHr的稳定性。
我们回顾性选择了22例患有急性呼吸道感染且C反应蛋白（CRP）短暂升高的血液透析患者，并研究了感染前、感染期和感染后阶段红细胞生成、铁状态和炎症参数的变化，即血细胞比容（Ht）、转铁蛋白饱和度（TSAT）、CHr、血清铁蛋白和CRP。在整个观察期内，rHuEPO和铁补充剂的剂量未发生变化。我们将患者分为两组，在感染期Ht降低的患者（第1组；n = 12）和在该阶段Ht未发生变化的患者（第2组；n = 10）。我们将感染前阶段和感染阶段参数之间的差异定义为Delta，并对它们进行相关性分析。
在感染期，第1组的CRP显著高于第2组。在第1组中，TSAT显著降低，从32.9±8.8%（感染前阶段）降至16.9±5.0%（感染期），CHr也显著降低，从33.1±1.5 pg降至30.4±2.0 pg。然而，在第2组中，尽管TSAT显著降低，从34.8±4.6%降至27.0±9.3%，但CHr没有显著变化（从33.4±0.9 pg降至33.0±1.4 pg）。DeltaHt与DeltaCHr之间存在显著的高度相关性，但DeltaHt与DeltaTSAT之间的相关性较低（r = 0.505；P = 0.0153，而r = 0.175；P = 0.4420）。此外，DeltaCRP与DeltaCHr之间的相关性非常高（r = -0.722；P = 0.0001）。
TSAT对炎症反应过度，无法揭示急性炎症性疾病中用于红细胞生成的可用铁的正确状态，但使用CHr有望避免这些缺点，提供急性感染期铁状态的可靠直接标志物。
