한국산업보건학회지 (Journal of Korean Society of Occupational and Environmental Hygiene)

  • 제29권1호
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  • Pages.42-49
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  • 2019
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  • 2384-132X(pISSN)
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  • 2289-0564(eISSN)
한국산업보건학회 (Korean Industrial Hygiene Association)
권호 표지
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만성폐쇄성폐질환을 동반한 광물성분진 노출 이직근로자의 철 결핍

Iron deficiency in Retired Workers exposed to Mineral dust with Chronic Obstructive Pulmonary Disease

  • 이종성 (근로복지공단 직업환경연구원) ;
  • 신재훈 (근로복지공단 직업환경연구원) ;
  • 백진이 (근로복지공단 직업환경연구원) ;
  • 정지영 (근로복지공단 직업환경연구원) ;
  • 김형근 (근로복지공단 인천병원) ;
  • 최병순 (근로복지공단 직업환경연구원)
  • Lee, Jong Seong (Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service) ;
  • Shin, Jae Hoon (Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service) ;
  • Baek, Jin Ee (Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service) ;
  • Jeong, Ji Yeong (Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service) ;
  • Kim, Hyeong Geun (Incheon Hospital, Korea Workers' Compensation & Welfare Service) ;
  • Choi, Byung-Soon (Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service)
  • 투고 : 2019.02.21
  • 심사 : 2019.03.18
  • 발행 : 2019.03.31
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초록

Objective: Chronic obstructive pulmonary disease(COPD) is characterized by persistent airflow limitations associated with chronic inflammatory response due to noxious particles or gases in the lung. Iron deficiency is associated with chronic inflammation, such as COPD. The aim of this study was to evaluate the relationship among iron deficiency, iron homeostasis, and inflammation in retired miners with COPD. Methods: The serum levels of ferritin, soluble transferrin receptor(sTfR), and transferrin saturation(TSat) as biomarkers for iron deficiency and high-sensitivity C-reactive protein(hsCRP) as a biomarker for inflammation and hepcidin as a biomarker for iron homeostasis were measured in 93 male subjects. Iron deficiency was defined as any one or more of (1) sTfR>28.1 nmol/L, (2) TSat<16%, and (3) ferritin< $12{\mu}g/L$. Results: Iron deficiency was found 28% of the study subjects. Median levels of serum hsCRP was significantly increased related to airflow limitation of COPD(GOLD 1, $0.09{\mu}g/dL$ vs. GOLD 2, $0.17{\mu}g/dL$ vs. GOLD $3{\leq}$, $0.30{\mu}g/dL$, p=0.010), and was positively correlated with hepcidin(p=0.009). Mean level of serum hepcidin was lower in COPD subjects with iron deficiency(p=0.004) and serum levels of hepcidin was negatively correlated with %$FEV_1$ predicted(p=0.030). Conclusions: These results suggest that high serum levels of hepcidin are related to severe airflow limitation or inflammation and can decrease iron availability, regardless of iron status.

키워드

SOOSB1_2019_v29n1_42_f0001.png 이미지

Figure 1. Scatter plot showing relationship between hepcidin and %FEV1 predicted in the COPD subjects

SOOSB1_2019_v29n1_42_f0002.png 이미지

Figure 2. Scatter plot showing relationship between hepcidin and hsCRP in the COPD subjects

Table 1. General characteristics of study subjects(N=93)

SOOSB1_2019_v29n1_42_t0001.png 이미지

Table 2. Levels of hepcidin and hsCRP in serum according to general characteristics

SOOSB1_2019_v29n1_42_t0002.png 이미지

참고문헌

  1. Agusti A. Thomas a. Neff lecture. Chronic obstructive pulmonary disease-a systemic disease. Proc Am Thorac Soc 2006;3:478-481. https://doi.org/10.1513/pats.200603-058MS
  2. Ahn J & Johnstone RM. Origin of a soluble truncated transferrin receptor. Blood 1993;81(9):2442-2451(PMID:8481524) https://doi.org/10.1182/blood.v81.9.2442.2442
  3. Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K et al. American Thoracic Society Statement: Occupational contribution to the burden of airway disease. Am J Respir Crit Care Med 2003;167(5):787-797. https://doi.org/10.1164/rccm.167.5.787
  4. Beguin Y. Soluble transferrin receptor for the evaluation of erythropoiesis and iron status. Clinica Chimica Acta 2003;329:9-22. https://doi.org/10.1016/S0009-8981(03)00005-6
  5. Bergdahl IA, Tore'n K, Eriksson K, Hedlund U, Nilsson T et al. Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J 2004;23: 402-406. https://doi.org/10.1183/09031936.04.00034304
  6. Choi JK, Paek DM, Lee JO. Normal predictive values of spirometry in Korean population. Tuberc Respir Dis 2005;58:230-242. https://doi.org/10.4046/trd.2005.58.3.230
  7. Chen YW, Leung JM, Sin DD. A Systematic Review of Diagnostic Biomarkers of COPD Exacerbation. PLoS One 2016;11(7):e0158843. https://doi.org/10.1371/journal.pone.0158843
  8. Cloonan SM, Mumby S, Adcock IM, Choi AMK, Chung KF et al. The "Irony" of Iron Over load and Iron Deficiency in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017;196(9):1103-1112. https://doi.org/10.1164/rccm.201702-0311PP
  9. Coggon D & Anthony Newman TA. Coal mining and chronic obstructive pulmonary disease: a review of the evidence. Thorax 1998;53:398-407(PMID:9708233) https://doi.org/10.1136/thx.53.5.398
  10. Cohen RAC, Patel A, Green FHY. Lung disease caused by exposure to coal mine and silica dust. Semin Respir Crit Care Med 2008;29:651-661. https://doi.org/10.1055/s-0028-1101275
  11. Cook JD, Skikne BS, Baynes RD. Serum transferrin receptor. Annu Rev Med 1993;44:63-74. https://doi.org/10.1146/annurev.me.44.020193.000431
  12. Drakesmith H & Prentice AM. Hepcidin and the iron-infection axis. Science 2012;338(6108):768-772. https://doi.org/10.1126/science.1224577
  13. Duru S, Bilgin E, Ardic S. Hepcidin: A useful marker in chronic obstructive pulmonary disease. Ann Thorac Med 2012;7(1):31-35. https://doi.org/10.4103/1817-1737.91562
  14. Fogarty AW, Jones S, Britton JR, Lewis SA, McKeever TM. Systemic inflammation and decline in lung function in a general population: a prospective study. Thorax 2007;62(6):515-520. https://doi.org/10.1136/thx.2006.066969
  15. Gan WQ, Man SFP, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis. Thorax 2004;59:574-580. https://doi.org/10.1136/thx.2003.019588
  16. Ganz T & Nemeth E. Hepcidin and disorders of iron metabolism. Annu Rev Med 2011;62:347-360. https://doi.org/10.1146/annurev-med-050109-142444
  17. Halpern MT, Zilberberg MD, Schmier JK, Lau EC, Shorr AF. Anemia, costs and mortality in chronic obstructive pulmonary disease. Cost Eff Resour Alloc 2006;4:17. https://doi.org/10.1186/1478-7547-4-17
  18. Hnizdo E, Sullivan PA, Bang KM, Wagner G. Association between Chronic Obstructive Pulmonary Disease and Employment by Industry and Occupation in the US Population: A Study of Data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2002;156(8):738-746(PMID:12370162) https://doi.org/10.1093/aje/kwf105
  19. Jayaranee S & Sthaneshwar P. Serum soluble transferrin receptor in hypochromic microcytic anaemia. Singapore Med J 2006;47(2):138-142(PMID:16435056)
  20. Joo H, Park J, Lee SD, Oh YM. Comorbidities of chronic obstructive pulmonary disease in Koreans: a populationbased study. J Korean Med Sci 2012;27(8):901-906. https://doi.org/10.3346/jkms.2012.27.8.901
  21. Karadag F, Kirdar S, Karul AB, Ceylan E. The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med 2008;19(2):104-108. https://doi.org/10.1016/j.ejim.2007.04.026
  22. Korean academy of tuberculosis and respiratory diseases (KATRD). Guideline for COPD and asthma. Seoul: Seoul Medcus.; 2005. p. 26-27
  23. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012;380(9859):2095-2128. https://doi.org/10.1016/S0140-6736(12)61728-0
  24. Meijers JM, Swaen GM, Slangen JJ.Mortality of Dutch coal miners in relation to pneumoconiosis, chronic obstructive pulmonary disease, and lung function. Occup Environ Med. 1997;54(10):708-713(PMID:9404317) https://doi.org/10.1136/oem.54.10.708
  25. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R et al. Standardisation of spirometry. Eur Respir J 2005;26:319-338. https://doi.org/10.1183/09031936.05.00034805
  26. Nemeth E, Valore EV, Territo M, Schiller G, Lichtenstein A, Ganz T. Hepcidin, a putative mediator of anemia of inflammation, is a type II acute-phase protein. Blood 2003;101(7):2461-2463. https://doi.org/:10.1182/blood-2002-10-3235
  27. Nickol AH, Frise MC, Cheng HY, McGahey A, McFadyen BM et al. A cross-sectional study of the prevalence and associations of iron deficiency in a cohort of patients with chronic obstructive pulmonary disease. BMJ Open 2015;5(7):e007911. https://doi.org/10.1136/bmjopen-2015-007911
  28. Pantopoulos K, Porwal SK, Tartakoff A, Devireddy L. Mechanisms of mammalian iron homeostasis. Biochemistry 2012;51(29):5705-5724. https://doi.org/10.1021/bi300752r
  29. Pepys MB & Hirschfield GM. "C-reactive protein: a critical update". J Clin Invest 2003;111(12):1805-1812. https://doi.org/10.1172/JCI18921
  30. Portillo K, Martinez-Rivera C, Ruiz-Manzano J. Anaemia in chronic obstructive pulmonary disease. Does it really matter? Int J Clin Pract 2013;67(6):558-565. https://doi.org/10.1111/ijcp.12125
  31. Punnonen K, Irjala K, Rajamaki A. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 1997;89(3):1052-1057(PMID:9028338) https://doi.org/10.1182/blood.v89.3.1052
  32. Sarkar M, Rajta PN, Khatana J. Anemia in Chronic obstructive pulmonary disease: Prevalence, pathogenesis, and potential impact. Lung India 2015; 32(2):142-151. https://doi.org/10.4103/0970-2113.152626
  33. Silverberg DS, Mor R, Weu MT, Schwartz D, Schwartz IF, Chernin G. Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron. BMC Pulm Med 2014;14:24. https://doi.org/10.1186/1471-2466-14-24
  34. Strassmann R, Bausch B, Spaar A, Kleijnen J, Braendli O et al. Smoking cessation interventions in COPD: a network meta-analysis of randomised trials. Eur Respir J 2009;34:634-640. https://doi.org/10.1183/09031936.00167708
  35. Su B, Liu T, Fan H, Chen F, Ding H, et al.. Inflammatory Markers and the Risk of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. PLoS One 2016;11(4):e0150586. https://doi.org/10.1371/journal.pone.0150586
  36. Tandara L, Grubisic TZ, Ivan G, Jurisic Z, Tandara M et al. Systemic inflammation up-regulates serum hepcidin in exacerbations and stabile chronic obstructive pulmonary disease. Clin Biochem 2015;48(18):1252-1257. https://doi.org/10.1016/j.clinbiochem.2015.07.010
  37. Tkacova R, Kluchova Z, Joppa P, Petrasova D, Molcanyiova A. Systemic inflammation and systemic oxidative stress in patients with acute exacerbations of COPD. Respir Med 2007;101(8):1670-1676. https://doi.org/10.1016/j.rmed.2007.03.005
  38. Wang J, Dong A, Liu G, Anderson GJ, Hu TY et al. Correlation of serum hepcidin levels with disease progression in hepatitis B virus-related disease assessed by nanopore film based assay. Sci Rep 2016;6:34252. https://doi.org/10.1038/srep34252
  39. World Health Organization(WHO). Assessing the iron status of populations: report of a joint World Health Organization/ Centers for Disease Control and Prevention technical consultation on the assessment of iron status at the population level, 2nd ed., Geneva, World Health Organization, 2007. Available from: URL:http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/9789241596107.pdf(download 2018.10.1.)
  40. Worwood M. Serum ferritin. CRC Crit Rev Clin Lab Sci 1979;10(2):171-204(PMID:378539) https://doi.org/10.3109/10408367909147133