维生素 D 状态与严重创伤患者的血红素肽和血红蛋白浓度相关。
Vitamin D status is associated with hepcidin and hemoglobin concentrations in patients with severe traumatic injury.
机构信息
From the Department of Surgery and Sepsis and Critical Illness Research Center (C.G.A., E.S.M., K.B.K., J.A.S., M.C., T.J.L., S.B., P.A.E., A.M.M.), University of Florida Health; and Department of Orthopedic Surgery (H.K.P., M.P., J.E.H.), University of Florida, Gainesville, Florida.
出版信息
J Trauma Acute Care Surg. 2020 Dec;89(6):1124-1130. doi: 10.1097/TA.0000000000002895.
BACKGROUND
Severe traumatic injury leads to persistent injury-associated anemia that is associated with hypercatecholaminemia, systemic inflammation, increased hepcidin, and a functional iron deficiency. Vitamin D has been shown to reduce proinflammatory cytokines and hepcidin concentrations. This study aimed to investigate the association of vitamin D status with inflammation, iron biomarkers, and anemia following blunt trauma.
METHODS
A prospective observational cohort study comparing blunt trauma patients (n = 45) with elective hip replacement patients (n = 22) and healthy controls (n = 8) was performed. Bone marrow ferroportin, transferrin receptor, and erythroferrone expression was measured using quantitative polymerase chain reaction (qPCR). Plasma was assessed for systemic inflammation, erythropoietin (EPO), iron regulation, and vitamin D (25-OH) concentrations using enzyme-linked immunosorbent assay. Hemoglobin was measured on the day of discharge.
RESULTS
Compared with hip replacement, trauma patients had higher plasma interleukin-6 (90.1 vs. 3.8 pg/mL), C-reactive protein (6,223 vs. 2,612 ng/mL), and hepcidin (79.3 vs. 21.2 ng/mL) concentrations. Trauma patients had lower vitamin D (25-OH) (12.8 vs. 18.1 ng/mL) and iron (23.5 vs. 59.9 μg/mL) levels compared with hip replacement patients. Despite the higher hepcidin EPO levels, bone marrow erythroferrone expression was increased 69% following trauma.
CONCLUSION
Following elective hip replacement, patients did have anemia and impaired iron homeostasis without a significant change in inflammatory biomarkers, EPO, and vitamin D status. Vitamin D status did correlate with systemic inflammation, iron dysfunction, and persistent injury-associated anemia following severe blunt trauma. Further research is needed to determine whether supplementation with vitamin D in the trauma population could improve the persistent injury-associated anemia.
LEVEL OF EVIDENCE
Prospective study, prognostic, level III.
背景
严重创伤导致持续的创伤相关贫血，与高儿茶酚胺血症、全身炎症、铁调素升高和功能性缺铁有关。维生素 D 已被证明可降低促炎细胞因子和铁调素浓度。本研究旨在探讨维生素 D 状态与钝性创伤后炎症、铁生物标志物和贫血的关系。
方法
对 45 例钝性创伤患者（创伤组）、22 例择期髋关节置换患者（髋置换组）和 8 例健康对照者（对照组）进行前瞻性观察队列研究。采用定量聚合酶链反应（qPCR）测量骨髓亚铁转运蛋白、转铁蛋白受体和红细胞生成素（erythroferrone，EPO）表达。采用酶联免疫吸附试验（ELISA）检测血浆中全身炎症、EPO、铁调节和维生素 D（25-OH）浓度。出院当天测量血红蛋白。
结果
与髋置换组相比，创伤组患者的血浆白细胞介素-6（interleukin-6，IL-6）（90.1 比 3.8 pg/mL）、C 反应蛋白（C-reactive protein，CRP）（6223 比 2612 ng/mL）和铁调素（hepcidin，Hepc）（79.3 比 21.2 ng/mL）浓度更高。与髋置换组相比，创伤组患者的维生素 D（25-OH）（12.8 比 18.1 ng/mL）和铁（23.5 比 59.9 μg/mL）水平更低。尽管 Hepc 和 EPO 水平更高，但创伤后骨髓中 EPO 的表达增加了 69%。
结论
在接受择期髋关节置换的患者中，尽管没有明显改变炎症标志物、EPO 和维生素 D 状态，但仍会出现贫血和铁稳态受损。维生素 D 状态与严重钝性创伤后全身炎症、铁功能障碍和持续的创伤相关贫血相关。需要进一步研究以确定在创伤人群中补充维生素 D 是否可以改善持续的创伤相关贫血。
证据等级
前瞻性研究，预后，III 级。
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