Hou C C, Wu S C, Wu S C, Yang W C, Huang T P, Ng Y Y
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Aug;61(8):456-62.
Serum transferrin receptor (sTfR) is a transmembrane glycoprotein derived from erythroid precursors in the bone marrow. Its concentration provides a quantitative measure of total erythropoietic activity and an indication of functional iron deficiency. This study was conducted to investigate whether sTfR is a useful index of erythropoietic activity in chronic hemodialysis patients with poor response to maintenance recombinant human erythropoietin (rHuEPO) therapy.
Using an enzyme-linked immunosorbent assay, sTfR concentration was measured in 67 uremic patients who had been on hemodialysis for a mean of 42 months (3-242 months). rHuEPO was administered three times a week to keep the hematocrit above 30%. Hemoglobin, red blood cell indices, serum ferritin, serum total iron binding capacity and unsaturated iron binding capacity were determined. Of the 67 patients, 35 who responded favorably to rHuEPO with hematocrits above 30% were categorized as Group I and 32 who did not attain the target hematocrit were categorized as Group II. As a control group, 31 healthy subjects were also investigated.
The serum iron, ferritin, transferrin iron saturation, dialysis efficiency and nutritional state were not different between groups of hemodialysis patients. The mean sTfR concentration was 2.1 +/- 0.6 micrograms/ml (range, 1.15-3.53 micrograms/ml) in Group I patients, compared with 1.9 +/- 0.9 micrograms/ml (range, 1.03-2.65 micrograms/ml) in Group II. The difference was not significant. In addition, the mean sTfR concentration of 1.8 +/- 0.4 micrograms/ml (range, 0.86-2.76 micrograms/ml) in the healthy controls was not significantly different from Groups I and II.
sTfR concentration cannot be used to distinguish good from poor rHuEPO responders among chronic hemodialysis patients who have elevated serum ferritin (> 300 micrograms/l) and transferrin iron saturation (> 25%) during the course of maintenance rHuEPO therapy.
血清转铁蛋白受体（sTfR）是一种源自骨髓红系前体细胞的跨膜糖蛋白。其浓度可定量反映总的红细胞生成活性，并提示功能性缺铁。本研究旨在探讨sTfR是否是对维持性重组人促红细胞生成素（rHuEPO）治疗反应不佳的慢性血液透析患者红细胞生成活性的有用指标。
采用酶联免疫吸附测定法，检测了67例平均血液透析42个月（3 - 242个月）的尿毒症患者的sTfR浓度。每周3次给予rHuEPO以维持血细胞比容高于30%。测定血红蛋白、红细胞指数、血清铁蛋白、血清总铁结合力和不饱和铁结合力。67例患者中，35例对rHuEPO反应良好，血细胞比容高于30%，归为I组；32例未达到目标血细胞比容，归为II组。作为对照组，还对31名健康受试者进行了研究。
血液透析患者组间血清铁、铁蛋白、转铁蛋白铁饱和度、透析效率和营养状态无差异。I组患者的平均sTfR浓度为2.1±0.6微克/毫升（范围为1.15 - 3.53微克/毫升），II组为1.9±0.9微克/毫升（范围为1.03 - 2.65微克/毫升）。差异无统计学意义。此外，健康对照组的平均sTfR浓度为1.8±0.4微克/毫升（范围为0.86 - 2.76微克/毫升），与I组和II组无显著差异。
在维持性rHuEPO治疗过程中血清铁蛋白升高（>300微克/升）且转铁蛋白铁饱和度升高（>25%）的慢性血液透析患者中，sTfR浓度不能用于区分rHuEPO反应良好者和反应不佳者。
