摘要
目的比较3种血液净化方式对维持性血液透析(maintenance hemodialysis,MHD)患者体内炎性介质和甲状旁腺激素(PTH)的清除效果,并观察重组人红细胞生成素(r-HuEPO)的疗效。方法MHD患者54例,随机分为3组,即血液透析(HD)组、血液透析滤过(HDF)组、血液透析+血液灌流(HD+HP)组,每组18人,每4周测1次血常规,根据贫血纠正情况调整EPO用量,随访3月,检测受试前后患者C-反应蛋白(CRP)、甲状旁腺激素(PTH)、白细胞介素6(IL-6)的水平,以EPO的用量与红细胞压积(Hct)的比值(EPO/Hct)作为EPO抵抗的指标。结果治疗前后组内对比,HDF组和HD+HP组患者CRP、IL-6、PTH、EPO/Hct有所下降(HDF组t=3.642,P=0.002;t=4.019,P=0.001;t=8.724,P<0.001;t=8.386,P<0.001。HD+HP组t=5.493,P<0.001;t=8.425,P<0.001;t=12.216,P<0.001;t=5.128,P<0.001),HD组各监测指标变化无统计学意义(P>0.05);治疗后组间比较,EPO用量、EPO/Hct、CRP、IL-6、PTH有统计学差异(F=27.538,P<0.001;F=8.358,P=0.001;F=12.269,P<0.001;F=12.385,P<0.001;F=11.139,P<0.001),HDF组及HD+HP组EPO用量、EPO/Hct、CRP、IL-6、PTH均低于HD组(P<0.001,P<0.001;P=0.002,P=0.001;P=0.008,P<0.001;P=0.008,P<0.001;P<0.001,P<0.001),其中HD+HP组CRP、IL-6水平明显低于HDF组(P=0.032;P=0.032)。相关性分析提示EPO/Hct与CRP、IL-6、PTH呈正相关(r=0.33,P<0.05;r=0.28,P<0.05;r=0.42,P<0.05)。结论 HDF及HD+HP治疗能够提高尿毒症患者EPO疗效并能减少EPO用量,其机制至少部分与改善了该人群的甲状旁腺功能亢进及微炎症状态有关。
Objective To compare the three blood purification modalities for the clearance of middle molecular uremic toxins such as inflammatory mediators and parathyroid hormone （PTH）, and to evaluate the effect of recombinant human erythropoietin （r-HuEPO） in maintenance hemodialysis （MHD） patients. Methods Fifty-four MHD patients were randomly divided into three groups： hemodialysis （HD） group （n= 18）, hemodiafiltration （HDF） group （n=18）, and hemodialysis ＋ hemoperfusion （HD＋HP） group （n=18）. They were followed up for three months. Routine blood test was conducted every 4 weeks, and EPO dosage was adjusted according to its effect on anemia. Serum C-reactive protein （CRP）, PTH, interleukin-6 （IL-6）, and indicators of renal anemia were measured at the beginning and after the treatment. The ratio of EPO dosage to hematocrit （EPO/Hct） was used as the indicator of EPO resistance. Results When comparison was made before and after the treatment, CRP, IL-6, PTH, and EPO/Hct ratio decreased after the treatment in HDF and HD＋HP groups （in HDF group, t=3.642 and P=0.002 for CRP, t=4.019 and P=0.001 for IL-6, t=8.724 and P〈 0.001 for PTH, t=8.386 and P〈0.001 for EPO/Hct ratio; in HD＋HP group, t=5.493 and P〈0.001 for CRP, t= 8.425 and P〈0.001 for IL-6, t=12.216 and P〈0.001 for PTH, and t=5.128 and P〈0.001 for EPO/Hct ratio）, but not in HD group （P〉0.05）. After the treatment, EPO dosage, EPO/Hct ratio, CRP, IL-6 and PTH were significantly different among the three groups （F=27.538 and P〈0.001 for EPO dosage, F=8.358 and P= 0.001 for EPO/Hct ratio, F=12.269 and P〈0.001 for CRP, F=12.385 and P〈0.001 for IL-6, and F=11.139 and P〈0.001 for PTH）. In addition, EPO dosage, EPO/Hct ratio, CRP, IL-6 and PTH were lower in HDF and HD＋HP groups than in HD group （compared HDF group to HD group, P〈0.001 for EPO dosage, P=0.002 for EPO/Hct ratio, P=0.008 for CRP, P=0.008 for IL-6, and P〈0.001 for PTH; compared HD＋HP group to HD group, P〈0.001 for
出处
《中国血液净化》
2014年第6期437-440,共4页
Chinese Journal of Blood Purification
