维持性血液透析患者外周动脉疾病与血清铁蛋白的相关性
摘要
目的探讨维持性血液透析(MHD)患者血清铁水平是否与外周动脉疾病的发病率及进展有关。方法选择2012年6月至2013年3月于河北北方学院附属第一医院血液透析室进行MHD的47例患者作为研究对象,测量其血清铁及其他实验室指标变化情况,同时测定两年内踝臂指数(ABI)变化情况,并分析两者变化相关性,间接反映血清铁蛋白与患者外周动脉疾病进展情况相关性。结果入选研究时踝臂指数(ABI)基数为(1.01±0.16),两年研究结束时ABI为(0.94±0.18),两年后ΔABI为(-0.07±0.15)。ABI基数与血清铁蛋白水平呈负相关(r=-0.23,P=0.05),与其他基本临床指标有一定相关性;两年后ΔABI与血磷、Ca×P及血清铁蛋白水平呈负相关(r=-0.28,P=0.02;r=-0.23,P=0.05;r=-0.25,P=0.03),与其他基本临床指标无显著相关性;多变量回归分析结果显示两年内平均血清铁蛋白和Ca×P是决定两年后ΔABI的主要指标(β=-0.27,P=0.02;β=-0.23,P=0.04);两年内平均血清铁蛋白≥600 ng/ml患者ΔABI水平与<600 ng/ml患者差异显著[(-0.13±0.03)vs(-0.05±0.02),P=0.03]。结论高水平血清铁蛋白与MHD患者外周动脉疾病进展相关,需进一步明确其能否作为与外周动脉疾病进展有关的生物学指标。
引文
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7 Esteve-Simo V,Pou-Potau M,Fulquet-Nicolas M,et al.Comment on metabolic syndrome is associated with cardiovascularevents in haemodialysis[J].Nefrologia,2014;34(5):675-6.
8 Menke A,Fernandez-Real JM,Muntner P,et al.The association of biomarkers of iron status with peripheral arterial disease in US adults[J].BMC Cardiovasc Disord,2009;9(6):34.
9 Depalma RG,Hayes VW,Chow BK,et al.Ferritin levels,inflammatory biomarkers and mortality in peripheral arterial disease:a substudy of the iron(Fe)and atherosclerosis study(FEAST)trial[J].J Vasc Surg,2010;51(6):1498-503.
10 O'Hare AM,Hsu CY,Bacchetti P,et al.Peripheral vascular disease risk factors among patients undergoing hemodialysis[J].J Am Soc Nephrol,2002;13(2):497-503.
11 Ohtake T,Oka M,Ikee R,et al.Impact of lower limbs'arterial calcification on the prevalence and severity of pad in patients on hemodialysis[J].J Vasc Surg,2011;53(3):676-83.
12 Bresgen N,Eckl PM.Oxidative stress and the homeodynamics of iron metabolism[J].Biomolecules,2015;5(2):808-47.
13 Kletzmayr J,Horl WH.Iron overload and cardiovascular complications in dialysis patients[J].Nephrol Dial Transplant,2002;17(Suppl 2):25-9.
2付强,李崟,耿敬肖.踝臂指数的内科应用[J].河北医药,2007;29(8):806.
3 Camaschella C.Iron-deficiency anemia[J].N Engl J Med,2015;372(19):1832-43.
4 Tasic NM,Tasic D,Veselinovic M,et al.Iron concentrations in atherosclerotic plaque and serum in patients with carotid atherosclerosis[J].Acta Physiol Hung,2015;102(2):143-50.
5 Kaluza J,Larsson SC,Hakansson N,et al.Heme iron intake and acute myocardial infarction:a prospective study of men[J].Int J Cardiol,2014;172(1):155-60.
6赵国东,郭瑞敏,王红梅.蔗糖铁注射液在血液透析患者中的应用[J].河北联合大学学报(医学版),2013;15(6):843-4.
7 Esteve-Simo V,Pou-Potau M,Fulquet-Nicolas M,et al.Comment on metabolic syndrome is associated with cardiovascularevents in haemodialysis[J].Nefrologia,2014;34(5):675-6.
8 Menke A,Fernandez-Real JM,Muntner P,et al.The association of biomarkers of iron status with peripheral arterial disease in US adults[J].BMC Cardiovasc Disord,2009;9(6):34.
9 Depalma RG,Hayes VW,Chow BK,et al.Ferritin levels,inflammatory biomarkers and mortality in peripheral arterial disease:a substudy of the iron(Fe)and atherosclerosis study(FEAST)trial[J].J Vasc Surg,2010;51(6):1498-503.
10 O'Hare AM,Hsu CY,Bacchetti P,et al.Peripheral vascular disease risk factors among patients undergoing hemodialysis[J].J Am Soc Nephrol,2002;13(2):497-503.
11 Ohtake T,Oka M,Ikee R,et al.Impact of lower limbs'arterial calcification on the prevalence and severity of pad in patients on hemodialysis[J].J Vasc Surg,2011;53(3):676-83.
12 Bresgen N,Eckl PM.Oxidative stress and the homeodynamics of iron metabolism[J].Biomolecules,2015;5(2):808-47.
13 Kletzmayr J,Horl WH.Iron overload and cardiovascular complications in dialysis patients[J].Nephrol Dial Transplant,2002;17(Suppl 2):25-9.