Повышенный гепцидин может быть использован как индикатор плохого ответа на лечение ЖДА пероральными препаратами железа; в/в введение железа в такой ситуации помогает в 2/3 случаев, тогда как продолжение приема перорального железа только в 20% дает ответ на лечение:
Am J Hematol. 2012 Nov 17.
Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia.
Bregman DB, Morris D, Koch TA, He A, Goodnough LT.
SourceLuitpold Pharmaceuticals, Inc., Valley Forge, Pennsylvania; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York.
Levels of hepcidin, a major regulator of iron homeostasis, may identify patients with iron deficiency anemia (IDA) who will not respond to oral iron therapy. In this study, IDA patients underwent a 14-day trial (run-in) course of ferrous sulfate therapy. Nonresponders (Hgb increase <1 g/dL with 67% compliance rate) were randomized to IV ferric carboxymaltose (FCM; two injections of 750 mg) or further oral iron for 14 days. Screening hepcidin levels were 38.4 versus 11.3 ng/mL, P = 0.0002 in nonresponders versus responders to a trial of oral iron. Hepcidin of > 20 ng/mL, showed sensitivity of 41.3%, specificity of 84.4%, and positive predictive value of 81.6% for predicting nonresponsiveness to oral iron. PPVs for ferritin> 30 ng/mL or transferrin saturation (TSAT)>15% were 59.2 and 55%, respectively. Negative predictive values for hepcidin, ferritin, and TSAT were 46.3, 22.7, and 19.7, respectively. FCM versus oral iron showed Hgb increases of ≥1 gm/dL in 65.3% versus 20.8% (P < 0.0001) and Hgb increases of 1.7 ± 1.3 versus 0.6 ± 0.9 g/dL (P = 0.0025), respectively. We conclude that hepcidin predicts nonresponsiveness to oral iron in patients with IDA and is superior to TSAT or ferritin for this purpose. Nonresponse to oral iron therapy does not rule out IDA, since two-thirds of patients subsequently responded to intravenous iron.
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