Relationship Between Hepcidin、IL-1β、hs-CRP And Erythropoietin Responsiveness In MHD Patients With Anemia

Objective: By detecting the level of hepcidin、interleukin-1beta(IL-1β)、high-sensitivity C-reactive protein(hs-CRP)and iron metabolism related markers in maintenance hemodialysis(MHD)patients with an-emia,to study the factors related to the efficacy of erythropoietin,and focus on the relationship between hepcidin and erythropoietin responsiveness,so as to provide reference for the formulation of treatment plan for MHD anemia patients and the clinical value of hepcidin.Methods: Select 40 cases of maintenance hemodialysis(MHD)anemia patients with regular application of erythropoietin in the Hemodialysis Center of the Nephrology Department of the Third Hospital of Hebei Medical University from June to December 2020.Inclusion criteria: stable hemodialysis for more than 6 months,stable condition,dialysis frequency 2-3 times / week,4 hours each time.Recombinant human erythropoietin(r Hu EPO)and iron were used regularly for more than 3 months.The dosage of r Hu EPO and hemoglobin(Hb)were basically stable.Exclusion criteria:(1)application of hormone or immunosuppressant in recent 6 months;(2)history of blood transfusion,operation and acute cardi-ovascular and cerebrovascular diseases in recent 3 months;(3)presence of definite infection focus and significant increase of CRP(> 10 mg / L);(4)iron deficiency,malnutrition and severe secondary hyperparathyroidism;(5)combined with hepatitis,liver dysfunction,malignant tumor and other diseases.The population was divided into groups according to the therapeutic dose of r Hu EPO,more than150IU/(Kg·w)were divided into the high-dose group with 13 cases,and≤150IU/(Kg·w)was divided into the normal-dose group with 27 cases.Compare the differences of the two groups of blood cytology parameters,iron metabolism indicators,hepcidin,high-sensitivity C-reactive protein(hs-CRP),interleukin-1β(IL-1β),erythropoietin response index(r Hu EPO),and Analyze the correlation between hepcidin and various indicators and the influencing factors of r Hu EPO.Diagnostic value of ROC curve in predicting the adverse reaction of erythropoietin to hepcidin and inflammatory factors.Results:1.There was no significant difference in age,gender,dialysis age,BMI,BUN,Scr,i PTH,Kt/V between the two groups(P>0.05).The r Hu EPO of the high-dose group was significantly higher than that of the normal-dose group,and the difference was statistically significant(P<0.05).2.Compared with the normal dose group,the platelet count of high-dose group was lower,the difference was statistically significant(P < 0.05),other red blood cell count,hemoglobin,hematocrit,red blood cell distribution width,white blood cells,neutrophils,lymphocytes had no statistical difference(P>0.05).3.Compared with the normal dose group,hepcidin,hs CRP and IL-1 βwere significantly increased in the high-dose group(P < 0.05);serum ferritin,serum iron,total iron binding capacity and transferrin saturation were not significantly different between the two groups.According to hs CRP,they were divided into hs CRP ≥ 0.3mg/dl group and hs CRP < 0.3mg/dl group.Compared with low hs CRP level group,hepcidin in high hs CRP level group was significantly increased,serum iron,total iron binding capacity and transferrin saturation were significantly decreased,and the difference was statistically significant(P > 0.05).4.There was a significant positive correlation between hepcidin and serum ferritin in both high-dose group and normal dose group(P < 0.001),but no correlation between hepcidin and hs CRP,IL-1 β,r Hu EPO,hemoglobin.5.In high dose erythropoietin group,r Hu EPO / Hb was negatively correlated with serum ferritin and transferrin saturation,but not with hepcidin.In normal dose group,r Hu EPO / Hb was negatively correlated with transferrin saturation,but not with ferritin and hepcidin.6.The area under the ROC curve of hs CRP and hepcidin were 0.721 and0.755,respectively,which were all > 0.7.The area under the ROC curve of hepcidin was the largest.Conclusions:1.The level of hepcidin is higher in patients with higher hs-CRP,and inflammation can promote the expression of hepcidin.2.Patients with poor response to erythropoietin have high levels of hepcidin、hs-CRP、IL-1β,hepcidin and inflammation play an important role in erythropoietin resistance,which has predictive value for poor response to erythropoietin.