El-Khatib Mahmoud, Duncan Heather J, Kant K Shashi
University of Cincinnati College of Medicine, Division Of Nephrology and Hypertension, Department of Internal Medicine, Cincinnati, Ohio 45267-0585, USA.
Nephrology (Carlton). 2006 Oct;11(5):400-4. doi: 10.1111/j.1440-1797.2006.00676.x.
C-reactive protein (CRP) is an acute phase reactant protein, which becomes elevated in response to inflammation, infections or malignancies. These conditions are well known causes of bone marrow hyporesponsiveness and erythropoietin resistance in dialysis patients. The role of iron-deficiency as a cause of hyporesponsiveness under these conditions is not clear. Reticulocyte haemoglobin content (CHr) is one of several iron indices used to determine iron deficiency in dialysis patients. The aim of this study is to evaluate the role of CRP and CHr in iron administration and anaemia management in dialysis patients.
In 47 haemodialysis patients with ferritin levels of >500 ng/mL, CRP, CHr, transferrin saturation (TSAT), other markers and erythropoietin dose were evaluated. Patients with CRP < 5 mg/L (Group A) were compared to patients with CRP > 5 mg/L (Group B).
Ferritin levels in the two groups were not different. Weekly erythropoietin was significantly different between the two groups. Group B required an average of 121% more erythropoietin than Group A to maintain similar haemoglobin levels of 11-12 g/dL 36% of Group B had CHr < 29 pg versus 7% of patients in Group A. 39% of patients in Group B also had TSAT < 20% versus 0% in Group A. Group A also had more arteriovenous (AV) fistulae as dialysis access than group B.
Data indicate that low CHr, similar to low TSAT, could be associated with inflammatory process and erythropoietin resistance, but not necessarily with iron-deficiency. High CRP association with low CHr and low TSAT levels can explain the lack of response to further IV iron therapy. AV grafts, contrary to AV fistulae, are associated with high inflammatory markers and also with a higher erythropoietin requirement.
C反应蛋白（CRP）是一种急性期反应蛋白，在炎症、感染或恶性肿瘤时会升高。这些情况是透析患者骨髓反应低下和促红细胞生成素抵抗的常见原因。在这些情况下，缺铁作为反应低下原因的作用尚不清楚。网织红细胞血红蛋白含量（CHr）是用于确定透析患者缺铁的几种铁指标之一。本研究的目的是评估CRP和CHr在透析患者铁剂治疗和贫血管理中的作用。
对47例铁蛋白水平>500 ng/mL的血液透析患者的CRP、CHr、转铁蛋白饱和度（TSAT）、其他指标和促红细胞生成素剂量进行评估。将CRP<5 mg/L的患者（A组）与CRP>5 mg/L的患者（B组）进行比较。
两组的铁蛋白水平无差异。两组每周的促红细胞生成素用量有显著差异。B组维持11 - 12 g/dL的相似血红蛋白水平所需的促红细胞生成素平均比A组多121%。B组36%的患者CHr<29 pg，而A组为7%。B组39%的患者TSAT<20%，而A组为0%。A组作为透析通路的动静脉（AV）内瘘也比B组多。
数据表明，低CHr与低TSAT类似，可能与炎症过程和促红细胞生成素抵抗有关，但不一定与缺铁有关。高CRP与低CHr和低TSAT水平相关，可以解释对进一步静脉补铁治疗缺乏反应的原因。与AV内瘘相反，AV移植物与高炎症标志物以及更高的促红细胞生成素需求相关。
