2025 年第 5 期 第 20 卷

血清核因子E2相关因子2和铁调素25及胰岛素样生长因子1水平与肿瘤化疗患者发生贫血的关系

The relationship between serum levels of nuclear factor erythroid 2-related factor 2, hepcidin 25 and insulin-like growth factor 1 and anemia in cancer patients undergoing chemotherapy

作者：冯恒荣丁昌平许蕾刘付弟

英文作者：Feng Hengrong Ding Changping Xu Lei Liu Fudi

单位：扬州大学附属医院检验科，扬州225000

英文单位：Department of Laboratory Medicine Affiliated Hospital of Yangzhou University Yangzhou 225000 China

关键词：肿瘤；化疗；贫血；核因子E2相关因子2；铁调素25；胰岛素样生长因子1

英文关键词：Tumor;Chemotherapy;Anemia;Nuclearfactorerythroid2-relatedfactor2;Hepcidin25;Insulin-likegrowthfactor1

• 摘要：

• 目的 探讨血清核因子E2相关因子2（Nrf2）、铁调素25（Hepc-25）和胰岛素样生长因子1（IGF-1）水平与肿瘤化疗患者发生贫血的关系。方法 选取扬州大学附属医院2022年1月至2024年1月收治的142例肿瘤患者，根据其化疗后是否发生贫血分为观察组（发生贫血，89例）和对照组（未发生贫血，53例）；根据贫血严重程度，将观察组患者分为轻度组（23例）、中度组（44例）和重度组（22例）。采用酶联免疫吸附试验法检测Nrf2、Hepc-25、IGF-1水平；多因素Logistic回归方法分析影响肿瘤化疗患者发生贫血的因素；受试者工作特征（ROC）曲线分析Nrf2、Hepc-25、IGF-1对肿瘤化疗患者发生贫血的预测价值。结果 观察组血红蛋白、红细胞计数明显低于对照组，女性以及胃癌患者比例明显高于对照组（均P＜0.05）。观察组血清Nrf2、IGF-1水平低于对照组［（1.36±0.24）μg/L比（2.98±0.53）μg/L、（166±20）μg/L比（192±27）μg/L］，血清Hepc-25水平高于对照组［（49±6）μg/L比（23±4）μg/L］（均P＜0.05）。轻度组、中度组、重度组患者血清Nrf2、IGF-1水平依次下降，Hepc-25水平依次上升（均P＜0.05）。多因素Logistic回归分析结果显示，Hepc-25、女性、胃癌是肿瘤化疗患者发生贫血的危险因素（均P＜0.05），Nrf2、IGF-1、血红蛋白、红细胞计数是肿瘤化疗患者发生贫血的保护因素（均P＜0.05）。ROC曲线分析结果显示，单独使用血清Nrf2水平对肿瘤化疗患者发生贫血进行预测的曲线下面积（AUC）为0.867，血清Hepc-25水平预测的AUC为0.841，IGF-1水平预测的AUC为0.797，当三者联合使用时，预测AUC提高到0.954。结论 肿瘤化疗后发生贫血的患者血清Nrf2、IGF-1水平下降，Hepc-25水平升高，三者水平与肿瘤化疗患者发生贫血有关，且三者联合使用能够有效预测肿瘤化疗患者发生贫血的风险。

• Objective To investigate the relationship between the levels of serum nuclear factor erythroid 2-related factor 2 (Nrf2), hepcidin 25 (Hepc-25) and insulin-like growth factor 1 (IGF-1) and anemia in cancer patients undergoing chemotherapy. Methods A total of 142 tumor patients admitted to the Affiliated Hospital of Yangzhou University from January 2022 to January 2024 were selected. According to whether anemia occurred after chemotherapy, they were divided into observation group (anemia occurred, 89 cases) and control group (no anemia occurred, 53 cases). According to the severity of anemia, the patients in the observation group were divided into mild group (23 cases), moderate group (44 cases) and severe group (22 cases).The levels of Nrf2, Hepc-25 and IGF-1 were detected by enzyme-linked immunosorbent assay. Multivariate Logistic regression was used to analyze the influencing factors of anemia in patients during tumor chemotherapy. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of Nrf2, Hepc-25 and IGF-1 in anemia. Results The hemoglobin and red blood cell count of the observation group were significantly lower than those of the control group, and the proportions of female and gastric cancer patients were significantly higher than those of the control group (all P＜0.05). The serum levels of Nrf2 and IGF-1 in the observation group were lower than those in the control group［（1.36±0.24）μg/L vs （2.98±0.53）μg/L, （166±20）μg/L vs （192±27）μg/L］, and the serum levels of Hepc-25 were higher than those in the control group［（49±6）μg/L vs （23±4）μg/L］(all P＜0.05). The serum levels of Nrf2 and IGF-1 in the mild group, the moderate group and the severe group decreased in turn, and the serum levels of Hepc-25 increased in turn(all P＜0.05). The results of multivariate Logistic regression analysis showed that Hepc-25, female, gastric cancer were the risk factors for anemia (all P＜0.05), while Nrf2, IGF-1, hemoglobin and red blood cell count were protective factors for anemia induced by tumor chemotherapy (all P＜0.05). ROC curve analysis showed that the area under the curve (AUC) of Nrf2, Hepc-25 and IGF-1 in predicting anemia was 0.867, 0.841 and 0.797, respectively. When combined, the AUC increased to 0.954. Conclusion The serum levels of Nrf2 and IGF-1 are decreased and Hepc-25 is increased in the cancer patients with anemia after chemotherapy. The serum levels of Nrf2 and IGF-1 are related to the occurrence of anemia in the cancer patients with anemia after chemotherapy, and the combined use of the three factors can effectively predict the occurrence of anemia in the cancer patients with anemia after chemotherapy.