目的：调查非透析期糖尿病合并慢性肾病（chronic kidney disease,CKD）患者的铁蛋白水平,研究其与促红细胞生成素（erythropoietin,EPO）水平以及CKD、贫血和炎症的关系。方法：2018年至2019年期间,选择在汕头大学医学院第二附属医院肾病住院的糖尿病合并CKD患者作为研究对象,收集患者的铁蛋白水平、EPO等临床资料。记录患者随访中的生存状态、肾脏替代疗法（renal replacement therapy,RRT）的开始和患者最近一次的血清肌酐（serum creatinine,SCr）测量值。终点是随访期内的CKD进展,定义为非RRT患者开始RRT或SCr成倍增加。结果：铁蛋白高三分位数组中男性、高血压例数、贫血例数、铁调素水平、铁蛋白水平、肾脏替代疗法例数和CKD进展例数较铁蛋白低三分位数组显著增加,EPO水平显著降低。与非贫血患者相比,贫血患者血清铁蛋白、EPO、铁调素水平均显著增加。在线性回归分析中,铁蛋白水平与EPO、铁调素水平显著相关,但不完全共线性（VIF<10）。Kaplan-Meier分析显示,铁蛋白水平升高与CKD进展的高风险相关（Plog-rank=0.011）。多变量Cox比例风险分析显示,GFR（OR=0.898,95%CI：0.837~0.964）,血红蛋白（OR=0.116,95%CI：0.023~0.596）,蛋白尿（OR=7.601,95%CI：2.415~23.923）,CRP（OR=6.716,95%CI：1.716~26.289）,铁蛋白（OR=1.013,95%CI：1.005~1.021）是CKD进展的独立影响因素。结论：在非透析期糖尿病合并CKD患者中,铁蛋白水平升高与内源性EPO水平降低和铁调素水平升高独立相关,并且铁蛋白可预测CKD的进展。
Abstract
Objective To investigate the level of ferritin in patients with chronic kidney disease (CKD) in non-dialysis diabetes, and to study its relationship with EPO level, CKD, anemia and inflammation. Method From 2018 to 2019, diabetic patients with CKD hospitalized in the Second Affiliated Hospital of Shantou University School of Medicine were selected as the research object, and the clinical data such as ferritin level and EPO were collected. The survival status, the beginning of renal replacement therapy (RRT) and the latest measurement of Serum creatinine (SCr) were recorded. The end point was the progress of CKD during the follow-up period, defined as the doubling of RRT or SCr in non-RRT patients. Results The number of males, hypertension cases, anemia cases, hepcidin level, ferritin level, renal replacement therapy cases and CKD progression cases in the ferritin high third group were significantly higher than those in the ferritin low third group, while EPO level was significantly lower. Compared with non-anemic patients, the levels of ferritin, EPO and hepcidin in anemic patients increased significantly. In linear regression analysis, ferritin levels were significantly correlated with EPO and hepcidin levels, but not completely collinear (VIF<10). Kaplan-Meier analysis showed that the increase of ferritin level was related to the high risk of CKD progression (Plog-rank=0.011). Multivariate Cox proportional hazard analysis showed that GFR (OR=0.898, 95%CI: 0.837-0.964), hemoglobin (OR=0.116, 95%CI: 0.023-0.596), proteinuria (OR=7.601, 95%CI: 2.415-23.923), CRP (OR=6.716, 95%CI: 1.716-26.289) and ferritin (OR=1.013, 95%CI: 1.005-1.021) were independent influencing factors of CKD progress. Conclusion In patients with non-dialysis diabetes complicated with CKD, the increase of ferritin level is independently related to the decrease of endogenous EPO level and the increase of hepcidin level, and ferritin can predict the progress of CKD.
关键词
非透析期 /
糖尿病合并CKD /
铁蛋白 /
贫血
Key words
non-dialysis period /
chronic kidney disease /
ferritin /
anemia
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基金
汕头市科技计划医疗卫生类别项目“非透析期慢性肾脏病患者血清EPO水平与肾性贫血关系研究”（200624095260153）
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