Diagnostic Value Of Serum Hepcidin In Rheumatoic Chronic Disease Anemia

Background: The most common extra articular symptom of rheumatoidarthritis is anemia, which is many caused by iron deficiency and chronicimmflammation. Hepcidin is the key regulator of iron metabolism. It affectsutilization of iron through inhibiting iron release from liver and macrophagesor absorption from intestinal epithelial cells. Inflammatory cytokines fromrheumatoid arthritis patients stimulate hepcidin secretion, which inhibits theutilization of iron. Some studies have proposed hepcidin could be a goodcandidate to differentiate the cause of rheumatic anemia. Based on manyfactors are participated rheumatic anemia, we believed that the value ofhepcidin to differentiate the cause of anemia in rheumatoid arthritis needfurther investigation.Objiective: To evaluate the diagnostic value of serum hepcidin in thediagnosis of anemia of chronic disease in patients with rheumatoid arthritis.Methods: Rheumatoid arthritis patients were screened for theHb,ESR,CRP. Serum samples from anemia patients were tested for paferritin,transferrin, ferritin, total iron binding capacity. Iron deficiency was madebased on no stainable marrow iron.47RA patients were enrolled into thislongitudinal follow-up study. Hepcidin-25and IL-6were tested throughELISA.,ESR, CRP, hepcidin-25, IL-6were monitored during the treatment ofRA.Results:（1）Hepcidin-25level was higher in RAwithACD（56.78±38.26ng/ml） than healthy control（15.46±7.35ng/ml）（p=0.007）, Hepcidin-25level washigher in RA without anemia（46.37±45.65ng/ml） than healthy control（p=0.005）,no difference of hepcidin-25level between RA with ACD andRA without anemia（p=0.2867）.（2）Hepcidin-25level was positively correlated with SR（r=0.280，p=0.032）, and it was also positively correlated with IL-6（r=0.656，p=0.000）.（3）The levels of hepcidin-25were not correlated with Hb（r=0.105,p=0.843）.（4）Hb was negatively related to SR（r=-0.338，p=0.009）,it was alsonegatively related to CRP (r=-0.297，p=0.023).（5）Hb level was higher after anti-rheumatic treatment than basement（87.50±13.66g/L）vs（74.42±19.62g/L）（p=0.006）,IL-6level was lowerthan basement（10.09±6.87pg/ml）vs（46.28±43.32pg/ml）（p=0.018.Hepcidin-25level represented different fluctuation tendency afteranti-rheumatic treatment.Conclusions: Hepcidin is associated with inflammation and ironmetabolism. Even in the condition that eliminated interference of irondeficiency, it is not a good parameter to predict the cause of anemia inpatients with RA. Our results reinforced that pathogenesis of ACD ismultifactor, impaired iron utilization due to high level hepcidin is the one, butnot the decisive cause...