Przybylowski P, Malyszko J, Malyszko J S, Koc-Zorawska E, Sadowski J, Mysliwiec M
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland.
Transplant Proc. 2010 Dec;42(10):4255-8. doi: 10.1016/j.transproceed.2010.09.034.
The production by hepatocytes of hepcidin, a small defensin-like peptide, is modulated in response to anemia, hypoxia, or inflammation. We studied hepcidin as a marker of iron status (serum iron, ferritin, and soluble receptor of transferrin [sTfR], and as a marker of inflammation among 170 prevalent kidney transplantation (KT) patients and 168 prevalent orthotopic heart transplant (OHT) patients. In addition, we assessed the prevalence of anemia and its relation to measurements of hepcidin, sTfR, and high-sensitivity C-reactive protein, using commercially available enzyme-linked immunosorbent assay (ELISA) kits. Prevalence of anemia was 37% in KT patients and 34% in OHT patients according to the World Health Organisation (WHO) definition. Anemic KT patients displayed significantly higher values of serum creatinine, hepcidin, hsCRP, ferritin, and proteinuria associated with greater use of mTOR and significantly lower CSA therapy. The hemoglobin and estimated glomerular filtration rate (eGFR). Upon multiple regression analysis eGFR, ferritin, and hsCRP independently predicted hepcidin levels, explaining 78% of the variation in hepcidin. Anemic OHT patients showed significantly lower GFR, red blood cell (RBC), and hemoglobin values and significantly higher creatinine and NT-proBNP content. Upon multiple regression analysis the predictors of serum hepcidin were eGFR and ferritin, which explained 68% of the variation in hepcidin. The prevalence of anemia is relatively high and not adequately treated (mainly due to reimbursement regulations) among heart and kidney allograft recipients. In conclusion, elevated hepcidin levels in heart and kidney transplant recipients suggest subclinical inflammation and impaired kidney function.
肝细胞产生的铁调素是一种类似防御素的小肽，其生成会根据贫血、缺氧或炎症情况进行调节。我们将铁调素作为铁状态标志物（血清铁、铁蛋白和转铁蛋白可溶性受体[sTfR]）以及炎症标志物，对170例肾移植（KT）患者和168例原位心脏移植（OHT）患者进行了研究。此外，我们使用市售酶联免疫吸附测定（ELISA）试剂盒评估了贫血的患病率及其与铁调素、sTfR和高敏C反应蛋白测量值之间的关系。根据世界卫生组织（WHO）的定义，KT患者贫血患病率为37%，OHT患者为34%。贫血的KT患者血清肌酐、铁调素、hsCRP、铁蛋白和蛋白尿水平显著升高，mTOR的使用更多，环孢素A（CSA）治疗显著减少，血红蛋白和估计肾小球滤过率（eGFR）降低。多元回归分析显示，eGFR、铁蛋白和hsCRP独立预测铁调素水平，解释了铁调素变异的78%。贫血的OHT患者GFR、红细胞（RBC）和血红蛋白值显著降低，肌酐和NT-proBNP含量显著升高。多元回归分析显示，血清铁调素的预测指标为eGFR和铁蛋白，解释了铁调素变异的68%。心脏和肾移植受者中贫血患病率相对较高且治疗不足（主要由于报销规定）。总之，心脏和肾移植受者铁调素水平升高提示存在亚临床炎症和肾功能受损。
