The Relationship Between Iron Metabolism With NGAL Of Renal Anemia Patients And The NGAL In TCM-related Research

Objective:To explore the relationship between NGAL with Renal Anemia patients.To evaluate NAGL and Fer on regulation of iron metabolism by using ROC curves. This method is to find the best diagnostic indicator of iron deficiency in Renal Anemia patients. And to explore the relationship between TCM with Renal Anemia patients.Methods:According to the standard of NKF-K/DOQI proposed sixty patients with chronic renal disease stage3-5were randomly divided into normal control group. Serum and urine level of NGAL was determined by ELISE assay. Serum level of TIBC was determined by chemocolorimetry. Urinary contents of creatinine(UCr) by inverse HPLC; serum iron(SI),blood urea nitrogen (BUN) and creatinine (Scr) detected by Beckman automatic biochemical analyzer; hemoglobin(HGB), red blood cells(RBC) and hematocrit(Hct) content by CELL-DAY3700hemo-analysis; ferritin(Fer) determined by radioimmunoassay. Then the product of transferrin saturation(TAST) was calculated based on blood contents of TIBC and SI,and the clearance rate of endogenous creatinine (CCr) was calculated based on blood BUN and SCr. We evaluated the main factor that influenced NGAL by analyzing the correlation with the index. To evaluate sNAGL and uNAGL on regulation of iron metabolism. According to nature deficiency, we grouped five TCM, then we analyzing the correlation with the index.Results:①Compared with control group, levels of BUN and Scr in CKD3,4and5groups were higher, while levels of Ccr were lower(P<0.01); The levels of BUN and Scr were gradually increased from CKD3to CKD5, while the levels of Ccr were decreased (P<0.01).②Compared with control group, levels of RBC, Hb and Hct in CKD3,4and5groups were lower; The levels of RBC, Hb and Hct were gradually decreased from CKD3to CKD5, there were significant change (P<0.01).③Compared with control group, levels of SI and TAST in CKD3,4and5groups were lower, while levels of Fer were higher; The levels of Fer were gradually increased from CKD3to CKD5; Compared with CKD3and CKD4groups, levels of SI and TAST in CKD5group were lower. There were significant change (P<0.01). Compared with normal group, the level of TIBC showed significant changes(P<0.01).④Compared with control group, levels of sNGAL and uNGAL in CKD3,4and5groups were higher(P<0.05); The levels of sNGAL and uNGAL were gradually decreased from CKD3to CKD5(P<0.05).⑤The sNGAL is positive linear correlated to SCr, BUN, Fer and uNGAL(P<0.01); and the sNGAL is negative linear correlated to RBC, Hb, Hct, Ccr, SI and TAST(P<0.01); The uNGAL is positive linear correlated to SCr, BUN, NAG and Fer(P<0.01);and the uNGAL is negative linear correlated to RBC, Hb, Hct, Ccr, SI, NAG and TAST(P<0.01).⑥In multiple regression analysis, Hb, Ccr and TSAT are the predictors of sNGAL in Renal Anemia patients(P<0.05). The standardized coefficients of Hb and Ccr were higher than TAST. NAG, Fer and sNGAL are the predictors of uNGAL in Renal Anemia patients(P<0.05). The standardized coefficients of sNGAL was highest.⑦ROC analysis shows that sNGAL and uNGAL are better than ferritin at identifying the iron metabolism.⑧Each TCM in the CKD3-5of the distribution of differences, the five were dynamic change trend(P<0.05). Deficiency of spleen mainly distributed in the CKD stage3, Qiyinliangxu Syndrome and liver-kidney yin deficiency mainly in CKD stage4and5, yin and yang deficiency are mainly distributed in CKD stage5.⑨The level of Scr、BUN and Ccr in each TCM of the distribution of differences, the Scr、BUN level of liver-kidney yin deficiency was higher than deficiency of spleenin CKD stage3, the Scr level of yin and yang deficiency was highest in CKD stage4and5.⑩The level of Hb, uNGAL and sNGAL in each TCM of the distribution of differences, the five were dynamic change trend(P<0.05).Conclusions:1. Serum and urine levels of NGAL were increased in Renal Anemia patients, which closely related different.2. Serum NGAL may be a new therapeutic target of renal anemia.3.Serum and urine levels of NGAL are better to reflect body iron metabolism in Renal Anemia patients.4. Renal Anemia card distribution has certain regulation with the progress symptoms also showed dynamic changes.5. The level of NGAL relates with the distribution of TCM type.