Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients
Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients
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DOI：
10.1093/ndt/gfg493
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发表时间：
2004-01-01
影响因子：
6.1
通讯作者：
Humphreys, MH
中科院分区：
文献类型：
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作者：
Kalantar-Zadeh, K;Rodriguez, RA;Humphreys, MH
背景。血清铁蛋白是透析患者铁状态的常用标记物。根据K/DOQI指南，铁蛋白值为100 - 800 ng/ml时，应停止给铁。我们假设诸如营养不良-炎症复合综合征（MICS）的非铁相关因素可能独立于铁状态而增加血清铁蛋白浓度。我们研究了82例维持性血液透析（MHD）患者（包括43例男性），年龄55.7±15.3岁。采用血清c反应蛋白（CRP）、主观整体评估（SGA）及其更新的全定量版本，即透析营养不良评分（DMS）和营养不良炎症评分（MIS）来评估炎症和营养状况。除6名患者外，所有患者在测量前10周内均静脉注射葡聚糖铁维持剂量（100至200毫克/月）。血清铁蛋白水平在SGA各类别中均升高（方差分析p值为0.03）。血清铁蛋白和CRP的未校正和多变量校正相关系数(r)与相关值在DMS和MIS以及其他一些营养状况和铁指标上均有统计学意义。在剔除10例缺铁（铁蛋白< 200 ng/ml）或铁蛋白过量（铁蛋白> 2000 ng/ml）的MHD患者后，其余72例MHD患者的双变量和多变量相关性更强，具有统计学意义（r分别= -0.33和-0.29,P < 0.01）。多变量模型显示血清铁蛋白与其他两种标志物同时存在显著相关性。根据K/DOQI推荐的血清铁蛋白临界值为800 ng/ml，将72例MHD患者分为血清铁蛋白水平两组，高铁蛋白水平组的MIS和CRP对数均显著升高。血清铁蛋白值在200-2000 ng/ml范围内可能由于包括MICS元素在内的非铁相关因素而升高。
Background. Serum ferritin is a frequently used marker of iron status in dialysis patients. Iron administration is to be withheld for ferritin values >800 ng/ml according to K/DOQI guidelines. We hypothesized that such non-iron-related factors as elements of the malnutrition-inflammation complex syndrome (MICS) may increase serum ferritin concentration independently of iron status.Methods. We studied 82 prevalent maintenance haemodialysis (MHD) patients (including 43 men), aged 55.7 +/- 15.3 years. The inflammatory and nutritional status was evaluated by serum C-reactive protein (CRP), Subjective Global Assessment (SGA) and its newer, fully quantitative versions, i.e. Dialysis Malnutrition Score (DMS) and Malnutrition-Inflammation Score (MIS).Results. All but six patients had been on maintenance doses of intravenous iron dextran (between 100 and 200 mg/month) during the 10 weeks prior to the measurements. Serum ferritin levels were increased across SGA categories: (ANOVA P-value 0.03). Both unadjusted and multivariate adjusted correlation coefficients (r) for serum ferritin and CRP vs pertinent values were statistically significant for DMS and MIS and some other measures of nutritional status and iron indices. After deleting 10 MHD patients with either iron deficiency (ferritin < 200 ng/ml) or iron overload (ferritin > 2000 ng/ml), in the remaining 72 MHD patients both bivariate and multivariate correlations were much stronger and statistically significant (r = -0.33 and -0.29, respectively, P < 0.01). A multivariate model showed simultaneous, significant correlations between serum ferritin and both markers other. After dividing the 72 MHD patients into two groups of serum ferritin based on a K/DOQI recommended serum ferritin cut-off of 800 ng/ml, the MIS and logarithm of serum CRP were significantly higher in the higher ferritin group.Conclusions. Serum ferritin values in the range of 200-2000 ng/ml may be increased due to non-iron-related factors including elements of MICS.