摘要
目的评估脓毒症患者铁代谢紊乱并探讨缺铁对病死率的影响。方法纳入2016年9月至2018年7月入住大连医科大学附属第一医院急诊ICU且符合脓毒症3.0诊断标准的患者(n=130),另选性别、年龄均匹配的健康志愿者为对照组(n=20)。入院后第1天(对照组为入组后)、3 d和7 d抽取外周静脉血检测铁代谢相关指标和白介素-6(interleukin-6,IL-6);进行SOFA评分。比较各组间铁代谢相关指标的差异,分析血浆铁与血红蛋白、铁调素、铁蛋白、IL-6、可溶性转铁蛋白受体(soluble transferrin receptor,sTFR)/log铁蛋白的相关性以及血浆铁水平降低对脓毒症患者28 d死亡的预测能力。结果在入院3 d后脓毒症患者即出现显著贫血;入院第1周的血浆铁、转铁蛋白、铁饱和度、总铁结合力及未饱和铁结合力均显著低于对照组;红细胞分布宽度、铁蛋白、IL-6、铁调素和sTFR水平显著高于对照组。入院第3和7天的红细胞分布宽度、铁蛋白和铁调素,以及第7天的血浆铁和铁饱和度均显著高于第1天;而第7天的总铁结合力和未饱和铁结合力,以及第3天的sTFR/log铁蛋白显著低于第1天。入院第1周存活和死亡组患者在第3天和第7天均出现显著贫血,但死亡组贫血更严重;入院第1周死亡组的转铁蛋白、总铁结合力和未饱和铁结合力,以及第3和7天死亡组的血浆铁均显著低于存活组;而入院第1周死亡组的铁蛋白、IL-6和铁调素,以及第7天铁饱和度均显著高于存活组。Spearman相关性分析表明血浆铁与IL-6(r=-0.391,P<0.01)、铁蛋白(r=-0.293,P=0.001)、铁调素(r=-0.209,P=0.017)均呈负相关,而与血红蛋白不相关(r=0.005,P=0.958)。血浆铁预测脓毒症患者28 d死亡的工作曲线下面积(AUC)为0.524(95%CI:0.416~0.631,P=0.656)。结论脓毒症患者早期即存在显著的贫血和铁代谢紊乱,而死亡组患者铁代谢紊乱更严重。血浆铁水平降低不能预测脓毒症患者28 d病死率。血浆铁水平降低与血红蛋白降低不相关,补铁治疗要慎重。
Objective To evaluate iron metabolism disorders in sepsis patients and explore the effect of iron deficiency on mortality.Methods Patients(n=130)who were admitted to the emergency intensive care unit(ICU)of the First Affiliated Hospital of Dalian Medical University from September 2016 to July 2018 and met the diagnostic criteria of Sepsis 3.0 were selected,and sex-and age-matched healthy volunteers(n=20)were enrolled as a control group.Peripheral venous blood samples were collected in sepsis patients on day 1,3 and 7 after admission,or in the healthy volunteers upon enrollment,to detect iron metabolism-related indicators and interleukin-6(IL-6);the Sequential Organ Failure Assessment(SOFA)score was calculated upon hospital admission.Iron metabolism-related indicators were compared between the groups;the correlation of plasma iron with hemoglobin,hepcidin,ferritin,IL-6,sTFR/log ferritin and the ability of plasma iron to predict 28-day death of sepsis patients were analyzed.Results Sepsis patients developed significant anemia on day 3 after admission;plasma iron,transferrin,iron saturation,total iron binding capacity and unsaturated iron binding capacity in the first week of admission were significantly lower than those in the control group;distribution width of red blood cells,ferritin,IL-6,hepcidin and soluble transferrin receptor were significantly higher than those in the control group.Distribution width of red blood cells,ferritin and hepcidin on day 3 and 7 after admission,and plasma iron and iron saturation on day 7 after admission were significantly higher than those on day 1.However,total iron binding capacity and unsaturated iron binding power on day 7,and sTFR/log ferritin on day 3 were significantly lower than those on day 1.Patients in the survival and non-survivor groups in the first week of admission had significant anemia on day 3 and 7,but the anemia was worse in the nonsurvivor group.Transferrin,total iron binding capacity,and unsaturated iron binding capacity in the nonsurvivor group in the first week of admission,and plasma iron in the non-survivor group on day 3 and 7,were significantly lower than those in the survival group.Ferritin,IL-6 and hepcidin in the non-survivor group in the first week of admission,and iron saturation on day 7 were significantly higher than those in the survival group.Spearman correlation analysis showed that plasma iron was negatively correlated with IL-6(r=-0.391,P<0.01),ferritin(r=-0.293,P=0.001)and hepcidin(r=-0.209,P=0.017),but not with hemoglobin(r=0.005,P=0.958).The area under the operation curve(AUC)for plasma iron for predicting 28-day mortality in sepsis patients was 0.524(95%CI:0.416-0.631,P=0.656).Conclusions Sepsis patients have significant anemia and iron metabolism disorders in the early stage,while non-survival patients are more severe.Reduced plasma iron level has no capacity to predict 28-day mortality of sepsis patients.In addition,decreased plasma iron level is not related to decreased hemoglobin,and thus iron supplementation should be cautious in sepsis patients.
作者
姜毅
安萌萌
龚平
Jiang Yi;An Mengmeng;Gong Ping(Department of Emergency Medicine,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Emergency Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Critical Care Medicine,Dalian Friendship Hospital,Dalian 116100,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2021年第5期562-568,共7页
Chinese Journal of Emergency Medicine
关键词
脓毒症
铁代谢
贫血
补铁
Sepsis
Iron metabolism
Anemia
Iron supplement
