铁调素/铁蛋白比值在预测维持性血液透析患者心功能的应用

doi:10.3969/j.issn.1007-3205.2022.05.006

摘要/Abstract

摘要：

目的评价血清铁调素（hepcidin）和铁蛋白（serumferritin, SF）在预测维持性血液透析患者发生心力衰竭的应用价值，为临床诊疗提供理论依据。

方法根据中国心力衰竭诊疗指南诊断标准，选取维持性血液透析合并心力衰竭患者110例作为心力衰竭组，同时选取同期住院且具有可比性的非心力衰竭维持性血液透析患者110例作为非心力衰竭组。采用Spearman方法分析相关性，采用多因素Logistic 回归分析危险因素，受试者工作特征曲线（receiver operator characteristic curve，ROC）评价hepcidin/SF比值对维持性血液透析患者心功能的预测价值。

结果心力衰竭组透析时间、吸烟比例、高脂血症病史比例、超敏C反应蛋白（hypersensitive C-reactive protein，hs-CRP）、N末端B型利钠肽原（N-terminal pro-B-type natriuretic peptide，NT-proBNP）、hepcidin、hepcidin/SF、左心室舒张末内径和左心房内径高于非心力衰竭组，血红蛋白、SF、左心室射血分数低于非心力衰竭组，差异有统计学意义（P＜0.05）；2组体重指数、血钙、血磷、白蛋白、空腹血糖和室间隔厚度差异无统计学意义（P＞0.05）。在维持性血液透析患者中，血清hepcidin/SF比值与NT-proBNP呈正相关（r=0.706，P＜0.001）。多因素Logistic回归分析结果显示，透析时间、吸烟病史、高脂血症病史、hs-CRP和hepcidin/SF比值是维持性血液透析患者发生心力衰竭患者的独立危险因素。ROC曲线分析结果显示，hepcidin/SF比值能够很好的区分伴有心力衰竭的维持性血液透析患者，曲线下面积0.929，95%CI：0.897~0.961，P＜0.001。

结论在伴有心力衰竭的维持性血液透析患者中，hepcidin/SF比值显著升高，能够很好地预测维持性血液透析患者心力衰竭的发生，可以作为维持性血液透析患者发生心力衰竭的早期诊治生物标志物。

关键词: 肾透析, 心力衰竭, 铁调素/铁蛋白比值

Abstract:

Objective To evaluate the application value of serum hepcidin and serum ferritin(SF) in predicting heart failure in patients undergoing maintenance hemodialysis, and to provide theoretical basis for clinical diagnosis and treatment.

Methods A total of 110 heart failure patients undergoing maintenance hemodialysis were selected as heart failure group according to the Chinese guidelines for the diagnosis and treatment of heart failure. Meanwhile, 110 patients without heart failure undergoing maintenance hemodialysis admitted to this hospital were selected as non-heart failure group. Spearman method was used for correlation analysis, multivariate Logistic regression was used to analyze risk factors, and receiver operating characteristic curve(ROC) was used to evaluate the predictive value of hepcidin/SF ratio in cardiac function of patients undergoing maintenance hemodialysis.

Results Compared with the non-heart failure group, the duration of dialysis, proportion of smoking and history of hyperlipidemia, hypersensitive C-reactive protein(hs-CRP), N-terminal pro-B-type natriuretic peptide(NT-proBNP), hepcidin, hepcidin/SF ratio, left ventricular end-diastolic diameter(LVEDD) and left atrial diameter(LAD) were higher, while hemoglobin, SF, and left ventricular ejection fraction(LVEF) were lower, with significant difference(P＜0.05). There were no significant differences in body mass index(BMI), serum calcium, serum phosphorus, albumin(ALB), fasting blood glucose(FBG) and interventricular septal thickness(IVS) between two groups(P＞0.05). In patients undergoing maintenance hemodialysis, serum hepcidin/SF ratio was positively correlated with NT-proBNP(r=0.706, P＜0.001). Multivariate Logistic regression analysis showed that duration of dialysis, smoking history, history of hyperlipidemia, hs-CRP and hepcidin/SF ratio were independent risk factors for heart failure in patients undergoing maintenance hemodialysis. In addition, ROC curve analysis showed that hepcidin/SF ratio could well distinguish patients undergoing maintenance hemodialysis who had heart failure(area under the curve was 0.929, 95%CI: 0.897-0.961, P＜0.001).

Conclusion Hepcidin/SF ratio is significantly increased in heart failure patients undergoing maintenance hemodialysis, which can well predict the occurrence of heart failure in patients undergoing maintenance hemodialysis, and can be used as a biomarker for the early diagnosis and treatment of heart failure in patients undergoing maintenance hemodialysis.

Key words: renal dialysis, heart failure, hepcidin/serum ferritin ratio

张文川. 铁调素/铁蛋白比值在预测维持性血液透析患者心功能的应用[J]. 河北医科大学学报, 2022, 43(5): 525-529.

ZHANG Wen-chuan. Role of the hepcidin/ferritin ratio in predicting heart failure in patients undergoing maintenance hemodialysis[J]. Journal of Hebei Medical University, 2022, 43(5): 525-529.

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铁调素/铁蛋白比值在预测维持性血液透析患者心功能的应用

Role of the hepcidin/ferritin ratio in predicting heart failure in patients undergoing maintenance hemodialysis

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