使用锌原卟啉作为慢性血液透析患者内源性铁可用性标志物的经验。

Experience with zinc protoporphyrin as a marker of endogenous iron availability in chronic haemodialysis patients.

作者信息

Baldus M, Salopek S, Möller M, Schliesser J, Klooker P, Reddig J, Gansert U, Brass H

机构信息

Medizinische Klinik A, Ludwigshafen am Rhein, Germany.

出版信息

Nephrol Dial Transplant. 1996 Mar;11(3):486-91.

PMID:8710158

Abstract

BACKGROUND

Ferritin and the percentage of transferrin saturation (TS) are established parameters with which to evaluate endogenous iron availability during treatment of renal anaemia with recombinant human erythropoietin (rHuEpo). Zinc protoporphyrin (ZPP) has been proposed as another valid marker in this setting.

METHODS

We determined the following parameters in 127 patients, including 117 haemodialysis patients: haemoglobin, erythrocytes, haematocrit, mean corpuscular volume (MCV), iron, ferritin, transferrin saturation and ZPP. Of the patients treated in a cross-sectional study, 38.5% were treated with rHuEpo; 30.7% with intravenous iron; and 13.6% with intravenous iron and rHuEpo simultaneously. Median ferritin was 304 ng/ml and median transferrin saturation was 21.2%.

RESULTS

Including cases with manifest storage iron deficiency, a concordant elevated ZPP ( > 40 mumol/mol haem) and a decreased transferrin saturation ( < 20%) were found in 23 of our dialysis patients (19.6%) while 55 cases (47%) were classified as concordantly negative. However, as many as 39 cases (33.3%) showed discrepant results: in 16 cases (13.6%) ZPP was elevated but transferrin saturation was in the normal range, while in 23 cases (19.6%) the opposite results were observed.

CONCLUSIONS

We conclude that beyond the border of manifest storage iron deficiency, defined as a ferritin < 30 ng/ml in male and < 15 ng/ml in female patients, ZPP and TS cover different ranges of functional iron deficiency which is reflected in the lack of a correlation of ZPP to any other of the above-mentioned parameters. Our data suggest that a TS < 20% as a diagnostic, and thus intervention, criterion in the evaluation of functional iron deficiency and iron substitution beyond manifest storage iron deficiency might result in overestimation of iron requirements. It remains to be shown in a longitudinal study, also reflecting the course of haemoglobin and the mean rHuEpo dose, whether ZPP or TS is the more appropriate parameter in the evaluation of functional iron availability.

摘要

背景

铁蛋白和转铁蛋白饱和度（TS）百分比是在使用重组人促红细胞生成素（rHuEpo）治疗肾性贫血期间评估内源性铁可用性的既定参数。锌原卟啉（ZPP）已被提议作为该情况下的另一个有效标志物。

方法

我们测定了127例患者的以下参数，其中包括117例血液透析患者：血红蛋白、红细胞、血细胞比容、平均红细胞体积（MCV）、铁、铁蛋白、转铁蛋白饱和度和ZPP。在一项横断面研究中接受治疗的患者中，38.5%接受rHuEpo治疗；30.7%接受静脉补铁治疗；13.6%同时接受静脉补铁和rHuEpo治疗。铁蛋白中位数为304 ng/ml，转铁蛋白饱和度中位数为21.2%。

结果

包括明显储存铁缺乏的病例，我们的23例透析患者（19.6%）出现ZPP升高（>40 μmol/mol血红蛋白）且转铁蛋白饱和度降低（<20%）的一致情况，而55例（47%）被分类为一致阴性。然而，多达39例（33.3%）显示结果不一致：16例（13.6%）ZPP升高但转铁蛋白饱和度在正常范围内，而23例（19.6%）观察到相反结果。

结论

我们得出结论，在明显储存铁缺乏（定义为男性铁蛋白<30 ng/ml，女性患者<15 ng/ml）之外，ZPP和TS涵盖了不同范围的功能性缺铁，这反映在ZPP与上述任何其他参数缺乏相关性上。我们的数据表明，TS<20%作为评估功能性缺铁和明显储存铁缺乏之外的铁替代的诊断标准，进而作为干预标准，可能会高估铁需求。在一项纵向研究中，也反映血红蛋白的变化过程和rHuEpo平均剂量，ZPP或TS在评估功能性铁可用性方面哪个是更合适的参数仍有待确定。