通过低铁蛋白水平和适度转铁蛋白饱和度实现有效改善贫血的网织红细胞血红蛋白含量目标值:一项回顾性观察研究
The target hemoglobin content values of reticulocytes for efficient anemia improvement are achieved by low ferritin levels and moderate transferrin saturation: a retrospective observational study.
作者信息
Ogawa Chie, Tsuchiya Ken, Tomosugi Naohisa, Shimada Katsunori, Kanda Fumiyoshi, Maeda Kunimi
机构信息
Maeda Institute of Renal Research, Kawasaki, Japan.
Biomarker Society, Inc, Kawasaki, Japan.
出版信息
Hematology. 2020 Dec;25(1):71-78. doi: 10.1080/16078454.2020.1720103.
The optimal iron level in hemodialysis (HD) patients remains unclear. The hemoglobin content of reticulocytes (CHr) is a sensitive indicator of iron used for hematopoiesis. To identify the optimal iron content for HD patients, we investigated the relation between CHr levels and iron status, as well as the levels of hepcidin, a main regulator of iron metabolism. This study enrolled 181 HD outpatients treated with recombinant human erythropoietin (rHuEPO). A sensitivity analysis, using a generalized linear regression model that included the interaction term, was applied to determine the correlations between levels of CHr and those of serum ferritin (s-ft), transferrin saturation (TSAT), and hepcidin. The greatest changes in correlation coefficients for levels of s-ft and TSAT with CHr levels indicated optimal cut-off points of 50 ng/mL (≤50 ng/mL, = 0.47 vs >50 ng/mL, = 0.22) and 24% (≤24%, = 0.58 vs >24%, = 0.08), respectively. The correlation coefficient for levels of CHr and hepcidin showed that the optimal lower and upper cut-off points were 20 ng/mL (≤20 ng/mL, = 0.52 vs >20 ng/mL, = -0.01) and 70 ng/mL (≤70 ng/mL, = 0.36 vs >70 ng/mL, = -0.45), respectively. This study indicates that the amount of iron in HD patients is sufficient for hematopoiesis under conditions of low s-ft and moderate TSAT levels. High levels of hepcidin could induce negative iron metabolism in hematopoiesis. Therefore, controlling hepcidin levels to within approximately 20-70 ng/mL may prevent iron deficiency and reduced Hb synthesis, and may thus facilitate effective iron utilization in hematopoiesis.
血液透析(HD)患者的最佳铁水平仍不明确。网织红细胞血红蛋白含量(CHr)是用于造血的铁的敏感指标。为了确定HD患者的最佳铁含量,我们研究了CHr水平与铁状态之间的关系,以及铁代谢的主要调节因子铁调素的水平。本研究纳入了181例接受重组人促红细胞生成素(rHuEPO)治疗的HD门诊患者。采用包含交互项的广义线性回归模型进行敏感性分析,以确定CHr水平与血清铁蛋白(s-ft)、转铁蛋白饱和度(TSAT)和铁调素水平之间的相关性。s-ft和TSAT水平与CHr水平的相关系数变化最大,表明最佳切点分别为50 ng/mL(≤50 ng/mL,=0.47 vs>50 ng/mL,=0.22)和24%(≤24%,=0.58 vs>24%,=0.08)。CHr水平与铁调素的相关系数表明,最佳下限和上限切点分别为20 ng/mL(≤20 ng/mL,=0.52 vs>20 ng/mL,=-0.01)和70 ng/mL(≤70 ng/mL,=0.36 vs>70 ng/mL,=-0.45)。本研究表明,在低s-ft和中度TSAT水平的情况下,HD患者的铁量足以支持造血。高水平的铁调素可能会在造血过程中诱导负性铁代谢。因此,将铁调素水平控制在约20-70 ng/mL以内可能会预防缺铁和血红蛋白合成减少,从而有助于造血过程中铁的有效利用。