Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
Clin Chem Lab Med. 2010 Sep;48(9):1217-26. doi: 10.1515/CCLM.2010.264.
Anemia of chronic disease (ACD), the most frequent anemia among hospitalized patients, occurs in chronic inflammatory disorders, such as chronic infections, cancer and autoimmune diseases. Different causes contribute to ACD including diversion of iron traffic, diminished erythropoiesis, blunted response to erythropoietin, erythrophagocytosis, hematologic malignancies and solid tumors. A particular case of ACD is represented by anemia of chronic kidney disease (CKD). ACD is characterized by hyposideremia and altered iron transport. Cytokines are implicated in the ACD by reducing erythropoiesis and increasing iron sequestration in the reticuloendothelial system. The regulation of iron absorption across the epithelium of the proximal small intestine is essential for maintaining body iron concentrations within a physiologically defined range. Hepcidin controls cellular iron efflux by binding to the iron export protein ferroportin, causing ferroportin to be phosphorylated and degraded in lysosomes. Finally, hepcidin inhibits iron release from the reticulo-endothelial system. Increased expression of hepcidin leads to decreased iron absorption and iron deficient anemia. Hepcidin, therefore, is a negative regulator of iron transport in plasma. Causes of anemia in patients with CKD are multifactorial, but the most well-known cause is inadequate erythropoietin production. In these patients, anemia increases the risk of either cardiovascular disease or renal failure.
慢性病性贫血（ACD）是住院患者中最常见的贫血，发生于慢性炎症性疾病，如慢性感染、癌症和自身免疫性疾病。ACD 的不同病因包括铁运输分流、红细胞生成减少、促红细胞生成素反应减弱、红细胞吞噬、血液恶性肿瘤和实体瘤。慢性肾脏病（CKD）贫血是 ACD 的一个特殊病例。ACD 的特征是低血清铁和铁转运改变。细胞因子通过减少红细胞生成和增加网状内皮系统中铁的摄取，参与 ACD 的发生。对近端小肠上皮中铁吸收的调节对于维持体内铁浓度在生理定义范围内至关重要。铁调素通过与铁输出蛋白铁蛋白结合来控制细胞内铁的外流，导致铁蛋白在溶酶体中被磷酸化和降解。最后，铁调素抑制网状内皮系统中铁的释放。铁调素表达增加导致铁吸收减少和缺铁性贫血。因此，铁调素是血浆中铁转运的负调节剂。CKD 患者贫血的原因是多因素的，但最常见的原因是促红细胞生成素产生不足。在这些患者中，贫血增加了心血管疾病或肾衰竭的风险。
