빈혈 환자에서 철결핍의 예측인자로서 혈중 Pro-hepcidin
Seum Pro-hepcidin as an Predictor of Iron Deficiency in Anemic Patients
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Background: Hepcidin has recently been known as a negative regulatory hormone of iron. Hepcidin precursor, pro-hepcidin has been used as a surrogate and reported to be related to iron deficiency. We investigated serum pro-hepcidin levels in patients with iron deficiency anemia (IDA),anemia of chronic disorder (ACD) and ACD concomitant iron deficiency (ACD/ID) to assess its usefulness as a marker of iron deficiency and examined whether its level is associated with anemia, iron status or inflammation profiles involved in the synthesis of hepcidin. Methods: We enrolled 50 patients with IDA, 46 with ACD, 12 with ACD/ID and 60 healthy controls. Complete blood cell count, iron parameters (iron, TIBC, trasferrin saturation, ferritin), C-reactive protein (CRP) and serum pro-hepcidin were measured. Results: Patients with iron deficiency, the IDA group and ACD/ID group had lower serum pro-hepcidin levels than healthy controls and the ACD group. The cutoff value of pro-hepcidin for detecting iron deficiency was 230 ng/mL (sensitivity 88.1%, specificity 51.2%). Patients with increased CRP showed higher mean pro-hepcidin level than those with normal CRP and the difference was significant in the IDA group (P =0.02). And serum pro-hepcidin level was positively correlated with CRP level (r=0.30, P =0.04) in the IDA group but not with hemoglobin. Conclusions: In patients with anemia, pro-hepcidin measurement may be useful for differentiating anemia patients with iron deficiency, IDA and ACD/ID from those with ACD. Serum pro-hepcidin levels may be more affected by inflammation than by the degree of anemia.
Abstract
Background: Hepcidin has recently been known as a negative regulatory hormone of iron. Hepcidin precursor, pro-hepcidin has been used as a surrogate and reported to be related to iron deficiency. We investigated serum pro-hepcidin levels in patients with iron deficiency anemia (IDA),anemia of chronic disorder (ACD) and ACD concomitant iron deficiency (ACD/ID) to assess its usefulness as a marker of iron deficiency and examined whether its level is associated with anemia, iron status or inflammation profiles involved in the synthesis of hepcidin. Methods: We enrolled 50 patients with IDA, 46 with ACD, 12 with ACD/ID and 60 healthy controls. Complete blood cell count, iron parameters (iron, TIBC, trasferrin saturation, ferritin), C-reactive protein (CRP) and serum pro-hepcidin were measured. Results: Patients with iron deficiency, the IDA group and ACD/ID group had lower serum pro-hepcidin levels than healthy controls and the ACD group. The cutoff value of pro-hepcidin for detecting iron deficiency was 230 ng/mL (sensitivity 88.1%, specificity 51.2%). Patients with increased CRP showed higher mean pro-hepcidin level than those with normal CRP and the difference was significant in the IDA group (P =0.02). And serum pro-hepcidin level was positively correlated with CRP level (r=0.30, P =0.04) in the IDA group but not with hemoglobin. Conclusions: In patients with anemia, pro-hepcidin measurement may be useful for differentiating anemia patients with iron deficiency, IDA and ACD/ID from those with ACD. Serum pro-hepcidin levels may be more affected by inflammation than by the degree of anemia.
참고문헌 (28)
- Wish JB, "Assessing iron status: beyond serum ferritin and transferrin saturation", Clin J Am Soc Nephrol, 1, pp.4~8 (2006)
- Fleming RE, "Hepcidin: a putative iron-regulatory hormone relevant to hereditary hemochromatosis and the anemia of chronic disease", Proc Natl Acad Sci USA, 98, pp.8160~8162 (2001)
- Theurl I, "chronic disorder and iron deficiency anemia: diagnostic and therapeutic implications", Blood, 113, pp.5277~5285 (2009)
- Nicolas G, "Hepcidin, a new iron regulatory peptide", Blood Cells Mol Dis, 29, pp.327~335 (2002)
- Nemeth E, "Hepcidin, a putative mediator of anemia of inflammation, is a type II acute-phase protein", Blood, 101, pp.2461~2463 (2003)
- Nicolas G, "The gene encoding the iron regulatory peptide hepcidin is regulated by anemia, hypoxia, and inflammation", J Clin Invest, 110, pp.1037~1044 (2002)
- Grebenchtchikov N, "High-sensitive radioimmunoassay for human serum hepcidin", Br J Haematol, 146, pp.317~325 (2009)
- Kulaksiz H, "Pro-hepcidin: expression and cell specific localisation in the liver and its regulation in hereditary haemochromatosis, chronic renal insufficiency, and renal anaemia", Gut, 53, pp.735~743 (2004)
- Tsuchihashi D, "Serum pro-hepcidin as an indicator of iron status in dialysis patients", Ther Apher Dial, 12, pp.226~231 (2008)
- Orhon FS, "Serum pro-hepcidin levels in infant with iron deficiency anaemia", Int J Lab Hematol, 30, pp.546~547 (2008)
- Sasu BJ, "Serum hepcidin but not prohepcidin may be an effective marker for anemia of inflammation (AI)", Blood Cells Mol Dis, 45, pp.238~245 (2010)
- Kato A, "Association of prohepcidin and hepcidin-25 with erythropoietin response and ferritin in hemodialysis patients", Am J Nephrol, 28, pp.115~121 (2008)
- Ryu EY, "Correlation between pro-hepcidin level and iron parameter in infant patients with iron deficiency anemia and anemia-free infants", Clin Pediatr Hematol Oncol, 14, pp.145~150 (2007)
- Paesano R, "Lactoferrin efficacy versus ferrous sulfate in curing iron deficiency and iron deficiency anemia in pregnant women", Biometals, 23, pp.411~417 (2010)
- Theurl I, "Dysregulated monocyte iron homeostasis and erythropoietin formation in patients with anemia of chronic disease", Blood, 107, pp.4142~4148 (2006)
- Cook DJ, "Iron deficiency: definition and diagnosis", J Intern Med, 226, pp.349~355 (1989)
- Looker AC, "Prevalence of iron deficiency in the United States", JAMA, 277, pp.973~976 (1997)
- Ganz T, "Immunoassay for human serum hepcidin", Blood, 112, pp.4292~4297 (2008)
- Kemna EH, "Mass spectrometrybased hepcidin measurement in serum and urine: analytical aspects and clinical implication", Clin Chem, 53, pp.620~628 (2007)
- Lasocki S, "Diagnostic accuracy of serum hepcidin for iron deficiency in critically ill patients with anemia", Intensive Care Med, 36, pp.1044~1048 (2010)
- Cheng PP, "Hepcidin expression in anemia of chronic disease and concomitant iron-deficiency anemia", Clin Exp Med, 11, pp.33~42 (2011)
- Means RT Jr, "Hepcidin and anaemia", Blood Rev, 18, pp.219~225 (2004)
- Punnonen K, "Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency", Blood, 89, pp.1052~1057 (1997)
- Dallalio G, "Serum hepcidin in clinical specimens", Br J Haematol, 122, pp.996~1000 (2003)
- Malyszko J, "Is hepcidin a link between anemia, inflammation and liver function in hemodialyzed patients", Am J Nephrol, 25, pp.586~590 (2005)
- Ulukol B, "Serum pro-hepcidin levels and relationship with ferritin in healthy non-anaemic infants", Acta Haematol, 118, pp.70~72 (2007)
- 김해림, "Serum Pro-hepcidin Could Reflect Disease Activity in Patients with Rheumatoid Arthritis", Journal of Korean Medical Science, 25(3), pp.348~352 (2010), 대한의학회
- 정자용, "여대생에서 혈청 pro-hepcidin 농도와 철분 영양 상태와의 관계", 한국영양학회지, 38(9), pp.750~755 (2005), 한국영양학회