Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
BMC Nephrol. 2012 Jul 7;13:56. doi: 10.1186/1471-2369-13-56.
Patients with chronic HCV infection have increased liver iron. Recently identified protein hepcidin synthesized in the liver, is thought to be a key regulator for iron homeostasis and is induced by infection and inflammation. Lower erythropoietin and iron supplementation requirements were previously reported in HD patients with HCV infection. We investigated the association of prohepcidin with inflammation and iron parameters in HD patients with and without chronic HCV infection.
Sixty patients (27 male, 33 female, mean age 50±15 years) on chronic HD were included. Parameters related to iron metabolism (ferritin, serum iron and total iron binding capacity (TIBC)), inflammation (hs-CRP, TNF-α and IL-6) and prohepcidin levels were measured. The response to treatment (erythropoiesis-stimulating agent (ESA) resistance index) was assessed from the ratio of the weekly erythropoietin (rhuEPO) dose to hemoglobin (Hb) per unit weight.
Serum prohepcidin levels of HCV positive patients (135±25 ng/mL) were significantly lower than HCV negative patients [148±18 ng/mL, (p=0.025)]. Serum IL-6 levels of HCV positive patients were also significantly lower than HCV negative patients (p=0.016). Serum prohepcidin levels were positively correlated with ferritin (r=0.405, p=0.001) and IL-6 (r=0.271, p=0.050) levels in HD patients. In the HCV positive group, serum prohepcidin levels significantly correlated with ferritin levels (r=0.514 p=0.004). In the HCV negative group, serum prohepcidin levels significantly correlated with serum IL-6 levels (r=0.418, p=0.027). In multiple regression analysis performed to predict prohepcidin in HCV positive patients, serum ferritin was found to be an independent variable (r=0.28, p=0.008).
HCV positive HD patients have low levels of serum prohepcidin and IL-6 which might account for iron accumulation together with lower iron and rhuEPO requirements in these patients.
慢性 HCV 感染患者的肝脏铁含量增加。最近在肝脏中发现的一种名为铁调素的蛋白质被认为是铁稳态的关键调节剂，并且受到感染和炎症的诱导。先前有报道称，患有 HCV 感染的 HD 患者的促红细胞生成素和铁补充剂需求较低。我们研究了 HD 患者中慢性 HCV 感染与炎症和铁参数相关的铁调素前肽。
纳入 60 例（27 名男性，33 名女性，平均年龄 50±15 岁）慢性 HD 患者。测定与铁代谢相关的参数（铁蛋白、血清铁和总铁结合能力（TIBC））、炎症（hs-CRP、TNF-α 和 IL-6）和铁调素前肽水平。从每周促红细胞生成素（rhuEPO）剂量与单位体重血红蛋白（Hb）的比值评估治疗反应（促红细胞生成素刺激剂（ESA）抵抗指数）。
HCV 阳性患者（135±25ng/mL）的血清铁调素前肽水平明显低于 HCV 阴性患者[148±18ng/mL，（p=0.025）]。HCV 阳性患者的血清 IL-6 水平也明显低于 HCV 阴性患者（p=0.016）。HD 患者的血清铁调素前肽水平与铁蛋白呈正相关（r=0.405，p=0.001）和 IL-6（r=0.271，p=0.050）。在 HCV 阳性组中，血清铁调素前肽水平与铁蛋白水平显著相关（r=0.514，p=0.004）。在 HCV 阴性组中，血清铁调素前肽水平与血清 IL-6 水平显著相关（r=0.418，p=0.027）。在对 HCV 阳性患者进行预测铁调素的多元回归分析中，发现血清铁蛋白是一个独立变量（r=0.28，p=0.008）。
HCV 阳性 HD 患者的血清铁调素前肽和 IL-6 水平较低，这可能与这些患者的铁积累以及较低的铁和 rhuEPO 需求有关。
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