HEP/SF比值对维持性腹膜透析患者贫血的评估价值

doi:10.3969/j.issn.1004-583X.2025.05.009

摘要/Abstract

摘要：

目的探讨铁调素(hepcidin,HEP)/血清铁蛋白(serum ferritin,SF)比值对维持性腹膜透析(peritoneal dialysis,PD)患者贫血的评估价值。方法选取2020年1月-2021年12月在临沂市人民医院PD中心规律随访的PD患者238例。其中男107例,女131例,年龄(50.21±13.92)岁,透析龄中位数16个月。依据血红蛋白(hemoglobin,HGB)水平分组,HGB<110 g/L为贫血组(n=130),HGB≥110 g/L为非贫血组(n=108)。比较两组临床资料, 对相关指标进行Pearson相关分析,采用多因素logistic 回归分析PD患者贫血的危险因素,绘制受试者工作特征曲线评估HEP、SF和HEP/SF比值对PD患者贫血的预测价值。结果与非贫血组比较,贫血组HEP、HEP/SF比值均较高,SF较低,差异均有统计学意义( P<0.05)。Pearson相关性分析显示,SF与HGB呈正相关(P<0.01),HEP和HEP/SF比值均与HGB呈负相关(P<0.01)。Logistic回归分析显示:HEP、SF和HEP/SF比值均为PD患者贫血的独立危险因素(P<0.05)。受试者工作特征曲线显示,HEP/SF比值对维持性PD患者评估肾性贫血有较为重要的价值,曲线下面积为0.892,95%CI:0.846~0.937,P<0.01,最佳截断值为0.63,敏感度为76.9%,特异度为96.3%。结论 HEP、SF、HEP/SF比值是维持性PD患者并发肾性贫血的独立危险因素,且在一定程度上反映贫血的严重程度,对PD患者并发肾性贫血有一定的评估价值。

关键词: 慢性肾脏病, 腹膜透析, 贫血, 铁调素/铁蛋白

Abstract:

Objective To investigate the value of hepcidin (HEP)/serum ferritin (SF) ratio in the evaluation of anemia in patients with maintenance peritoneal dialysis (PD). Methods A total of 238 PD patients who were regularly followed up in the PD Center of Linyi People 's Hospital from January 2020 to December 2021 were selected. There were 107 males and 131 females, with an average age of (50.21±13.92) years, and a median dialysis age of 16 months. According to the level of hemoglobin (HGB), patients were divided into the anemia group (HGB<110 g/L, n=130) and non-anemia group (HGB≥110 g/L, n=108). The clinical data of the two groups were compared. Pearson correlation analysis was performed on the relevant indicators. Multivariate logistic regression was used to analyze the risk factors for anemia in PD patients. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of HEP, SF and HEP/SF ratio in anemia among PD patients. Results Compared with the non-anemia group, the HEP and HEP/SF ratio in the anemia group were significantly higher, while SF was significantly lower (P<0.05). Pearson correlation analysis showed that SF was positively correlated with HGB (P<0.01), while HEP and HEP/SF ratio were negatively correlated with HGB (P<0.01). Logistic regression analysis showed that HEP, SF and HEP/SF ratio were independent risk factors for anemia in PD patients (P<0.05). ROC curve showed that the HEP/SF ratio was of great value in evaluating renal anemia in patients with maintenance PD, with an area under the curve (AUC) of 0.892 (95% confidence interval [CI]: 0.846-0.937, P<0.01). The optimal cut-off value was 0.63, with a sensitivity of 76.9%, and a specificity of 96.3%. Conclusion HEP, SF and HEP/SF ratio are independent risk factors for renal anemia in patients with maintenance PD that reflect the severity of anemia to a certain extent. They have certain evaluation value for renal anemia in patients with maintenance PD.

Key words: chronic kidney disease, peritoneal dialysis, anemia, hepcidin/serum ferritin

中图分类号:

R692

张宏涛, 钟美娇, 高敬洋, 李士杰, 于娜新, 范鑫, 陈立宁, 张扬, 王志奎, 边爱淑. HEP/SF比值对维持性腹膜透析患者贫血的评估价值[J]. 临床荟萃, 2025, 40(5): 434-438.

Zhang Hongtao, Zhong Meijiao, Gao Jingyang, Li Shijie, Yu Naxin, Fan Xin, Chen Lining, Zhang Yang, Wang Zhikui, Bian Aishu. The potential of hepcidin/serum ferritin ratio in assessing anemia in patients with maintenance peritoneal dialysis[J]. Clinical Focus, 2025, 40(5): 434-438.

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链接本文: http://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.05.009

http://www.lchc.cn/CN/Y2025/V40/I5/434

图/表 6

参考文献 15

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项目	非贫血组(n=108)	贫血组(n=130)	t/Z值	P值
透析龄(月)	21.23±11.59	20.62±13.89	0.367	0.714
收缩压(mmHg)	144.56±21.12	143.77±24.20	0.271	0.787
PLT(×10⁹/L)	220.00±70.36	220.13±84.09	-0.013	0.990
RDW(fL)	44.90±5.39	44.90±6.27	0.002	0.998
ALB(g/L)	36.39±7.12	34.73±6.61	1.861	0.044
UCB(μmol/L)	5.13±2.85	4.63±2.42	1.470	0.143
ALP(U/L)	89.30±50.03	85.76±48.37	0.551	0.582
PAB(mg/L)	30.68±8.72	32.01±9.97	-0.790	0.431
BUN(mmol/L)	23.44±7.00	25.25±7.60	-1.884	0.061
UA(μmol/L)	396.38±98.40	404.54±115.71	-0.580	0.563
TC(mmol/L)	4.93±1.34	4.68±1.39	1.410	0.160
LDL-C(mmol/L)	3.07±1.04	2.92±1.01	1.090	0.277
K⁺(mmol/L)	4.37±0.82	4.37±0.69	0.092	0.927
CO₂(mmol/L)	23.87±4.22	23.81±4.02	0.122	0.903
P(mmol/L)	1.77±0.61	1.89±0.52	-1.619	0.107
总CCr(ml/min)	66.80±27.14	62.96±17.67	0.734	0.465
腹膜CCr(ml/min)	38.01±16.34	42.75±16.94	-1.250	0.215
NE(×10⁹/L)	4.6(3.5, 6.4)	4.5(3.6, 6.3)	-0.080	0.936
CB(μmol/L)	2.0(1.4, 2.7)	1.7(1.3, 2.4)	-1.924	0.054
AST(U/L)	16.3(11.8, 21.1)	15.1(11.7, 21.3)	-0.462	0.644
ALT(U/L)	12.0(8.4, 17.8)	11.1(7.2, 18.1)	-0.912	0.362
FPG(mmol/L)	5.6(5.0, 6.6)	5.4(4.8, 7.1)	-0.364	0.716
TG(mmol/L)	1.3(0.9, 1.9)	1.2(0.8, 1.6)	-1.701	0.089
PTH(ng/L)	192.8(93.7, 385.0)	253.9(133.6, 480.9)	-1.857	0.063
HEP(μg/L)	79.80±7.58	112.33±32.12	-11.181	0.020
SF(μg/L)	240.52±68.74	120.67±71.86	13.063	0.038
HEP/SF比值	0.37±0.14	1.45±1.05	-11.612	0.041

项目	非贫血组(n=108)	贫血组(n=130)	t/Z值	P值
透析龄(月)	21.23±11.59	20.62±13.89	0.367	0.714
收缩压(mmHg)	144.56±21.12	143.77±24.20	0.271	0.787
PLT(×10⁹/L)	220.00±70.36	220.13±84.09	-0.013	0.990
RDW(fL)	44.90±5.39	44.90±6.27	0.002	0.998
ALB(g/L)	36.39±7.12	34.73±6.61	1.861	0.044
UCB(μmol/L)	5.13±2.85	4.63±2.42	1.470	0.143
ALP(U/L)	89.30±50.03	85.76±48.37	0.551	0.582
PAB(mg/L)	30.68±8.72	32.01±9.97	-0.790	0.431
BUN(mmol/L)	23.44±7.00	25.25±7.60	-1.884	0.061
UA(μmol/L)	396.38±98.40	404.54±115.71	-0.580	0.563
TC(mmol/L)	4.93±1.34	4.68±1.39	1.410	0.160
LDL-C(mmol/L)	3.07±1.04	2.92±1.01	1.090	0.277
K⁺(mmol/L)	4.37±0.82	4.37±0.69	0.092	0.927
CO₂(mmol/L)	23.87±4.22	23.81±4.02	0.122	0.903
P(mmol/L)	1.77±0.61	1.89±0.52	-1.619	0.107
总CCr(ml/min)	66.80±27.14	62.96±17.67	0.734	0.465
腹膜CCr(ml/min)	38.01±16.34	42.75±16.94	-1.250	0.215
NE(×10⁹/L)	4.6(3.5, 6.4)	4.5(3.6, 6.3)	-0.080	0.936
CB(μmol/L)	2.0(1.4, 2.7)	1.7(1.3, 2.4)	-1.924	0.054
AST(U/L)	16.3(11.8, 21.1)	15.1(11.7, 21.3)	-0.462	0.644
ALT(U/L)	12.0(8.4, 17.8)	11.1(7.2, 18.1)	-0.912	0.362
FPG(mmol/L)	5.6(5.0, 6.6)	5.4(4.8, 7.1)	-0.364	0.716
TG(mmol/L)	1.3(0.9, 1.9)	1.2(0.8, 1.6)	-1.701	0.089
PTH(ng/L)	192.8(93.7, 385.0)	253.9(133.6, 480.9)	-1.857	0.063
HEP(μg/L)	79.80±7.58	112.33±32.12	-11.181	0.020
SF(μg/L)	240.52±68.74	120.67±71.86	13.063	0.038
HEP/SF比值	0.37±0.14	1.45±1.05	-11.612	0.041

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
HEP	0.052	0.007	54.087	0.040	1.053	1.039~1.068
SF	-0.022	0.003	63.590	0.021	0.979	0.973~0.984
HEP/SF比值	6.632	0.956	48.102	0.039	759.118	116.505~4 946.210

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
HEP	0.052	0.007	54.087	0.040	1.053	1.039~1.068
SF	-0.022	0.003	63.590	0.021	0.979	0.973~0.984
HEP/SF比值	6.632	0.956	48.102	0.039	759.118	116.505~4 946.210

项目	平均值	标准差	HGB	HEP	SF	HEP/SF比值
HGB	103.845	19.133	1
HEP	97.567	29.169	-0.468^*	1
SF	175.053	92.301	0.840^*	-0.477^*	1
HEP/SF比值	0.960	0.951	-0.760^*	0.608^*	-0.806^*	1