| Objective:Chronic kidney disease(CKD)is a global public health problem which can rapidly develop into the End-Stage Renal Disease(ESRD)if not positively treated and can only be treated by sustainable renal replacement.Anemia and mineral and bone disorder are the normal complications of CKD and iron deficiency plays an important role in the anemia of patients.In recent years,studies have discovered that Hepcidin(Hepc)is an important hormone to regulate iron homeostasis in which BMP6-HJV-SMAD signaling pathway is a critical regulation channel and Bone Morphogenetic Protein6(BMP6)plays an essential role here.New evidence has showed that Hepc is not only related to iron metabolism but also mineral metabolism,indicating that interaction between iron metabolism and mineral metabolism might be related to Hepc.This study aims to investigate the significant function of Hepc and BMP6 for anemia and iron metabolism of maintenance hemodialysis(MHD)patients by the analysis on the relation between Hepc and BMP6 with the anemia and iron metabolism indexes of MHD patients.Meanwhile,we also have analyzed the correlation between Hepc and mineral metabolism indexes to further investigate the significance of Hepc for the mineral metabolism of MHD patients.Methods:1.Select 67 cases of MHD patients(MHD group)and 30 cases of Healthy examined people(healthy control group)in the Nephrology dept of the Second peoples' hospital in Neijiang City;2.Draw venous blood from people in the two groups,according to the instructions of kit to determine the serum BMP6,Hepc,the total iron binding capacity(TIBC)and 1,25(OH)2 D level,at the same time testing anemia indicators in the clinical laboratory: red blood cell count(RBC),hemoglobin(Hb),red blood cells deposited(Hct);3.Serum iron(SI)and Serum ferritin(SF)of iron metabolism index and Ca,P and PTH of mineral metabolism in MHD group must be measured and the transferrin saturation(TSAT)can be calculated by SI and TIBC with TSAT=SI/TIBC×100%.Meanwhile,high sensitivity C-reactve protein(hsCRP)of inflammation markers and liver renal function of clinic factors are also needed to be measured.4.Collect and conduct a statistical analysis of the clinical information and experimental data of all patients.Normal distribution data is represented by mean±standard deviation,non-normal distribution data can be represented by median and semi-guartile range and counting data is represented by ratio.As for the comparison of factors in MHD group and healthy control group,normal distribution datas use t-test,non-normal distribution datas use rank-sum test and counting datas use four table chi-square test.As for the correlation analysis on factors in MHD group,Pearson linear correlation analysis is adopted for normal distribution data adopts,Spearman correlation analysis for non-normal distribution data and multiple regression analysis for influencing factors,inspection level ?=0.05,P<0.05 which indicates statistic difference here.Results:1.Analysis on the anemia and correlative factors in MHD group.(1).Hb level in MHD group is lower than that in healthy control group(92.36±18.49g/L?142.17±11.95g/L,P<0.05),anemia occurrence is 97%(65 cases),Hb qualification ratio is 32.8%(22 cases)and non-standardized rate is 67.2%(45 cases);(2).Correlative analysis on Hb and iron metabolism factors has showed that Hb show a negative correlation with Hepc(r value is-0.484,P<0.05),a positive correlation with SI,TSAT and SF(r values are 0.875,0.556 and 0.527 respectively,P<0.05)and non-correlation with TIBC(r=-0.052,P=0.676);(3).Correlative analysis on Hb and mineral metabolism factors has showed that Hb show a negative correlation with P and PTH(r values are-0.500 and-0.528,P<0.05),a positive correlation with Ca(r =0.580,P<0.001)and non-correlation with 1,25(OH)2D(r=0.042,P=0.736);(4).Correlative analysis on Hb and inflammation markers has showed that Hb show a negative correlation with hsCRP(r value is-0.572,P<0.05);(5).By multiple regression analysis,we have found that SI and Ca are independent influencing factors of Hb.2.Analysis on Hepc level and correlative factors in MHD group.(1).Hepc level in MHD group has significantly increased than that in healthy control group(49.74±17.42ng/ml and 41.89±18.37ng/ml respectively,P<0.05);(2).Correlative analysis on Hepc and anemia factors has showed that Hepc shows a negative correlation with Hb,RBC and Hct(r values are-0.484,-0.502 and-0.475,P<0.05);(3).Correlative analysis on Hepc and iron metabolism factors has showed that Hepc shows a negative correlation with SI(r =-0.398,P<0.05),a positive correlation with TSAT and SF(r values are0.573 and 0.483 respectively,P<0.05)and non-correlation with TIBC(r=0.039,P=0.754);(4).Correlative analysis on Hepc and inflammation markers has showed that Hepc shows a positive correlation with hsCRP(r values is 0.402,P<0.05);(5).By multiple regression analysis,we have found that SI and hsCRP are independent influencing factors of Hepc.3.BMP6 level in MHD group has significantly increased than that in healthy control group(medians are 42.48pg/ml and 26.16pg/m respectively,P<0.05).And the results of correlative analysis showed that BMP6 is not obviously related to anemia and iron metabolism factors;4.Through the analysis on Hepc and mineral metabolism factors in MHD group,we have found that Hepc has a positive correlation with PTH(r = 0.368,P<0.05)and non-correlation withP,Ca and 1,25(OH)2D(r values are-0.049,0.026 and 0.012 respectively,P values are 0.691,0.079 and 0.147 respectively).Conclusions:1.MHD patients have a high incidence of anemia,Hb is closely associated with iron metabolism,mineral metabolism and inflammatory markers;2.Hepc level in MHD patients has significantly increased which is correlative with anemia and iron metabolism factors,indicating that increased Hepc level is related to the iron metabolism disorders in MHD patients and plays an important role in anemia development;3.BMP6 level in MHD patients has increased but has no obvious relation with anemia,Hepc and iron metabolism factors.4.The correlation analysis on serum Hepc and mineral metabolism factors in MHD group indicates that serum Hepc level is associated with PTH,with no significant correlation with P,Ca and 1,25(OH)2D. |
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