不同频率血液灌流对维持性血液透析病人红细胞生成素疗效的影响
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摘要
[目的]探讨不同频率血液灌流对维持性血液透析(MHD)病人红细胞生成素(EPO)疗效的影响。[方法]选择MHD病人80例,按随机数字法分为4组,各20例;A组为常规血液透析,其余3组在此基础上联合不同频率血液灌流,B组每周1次,C组每周2次,D组每2周1次,每4周进行1次血常规测定,根据贫血纠正情况调整EPO用量,分别于治疗前和治疗24周后测定病人红细胞压积(Hct)、血红蛋白(Hb)、白蛋白(Alb)、C-反应蛋白(CRP)、白细胞介素(IL-6)和甲状旁腺激素(PTH)等指标,记录EPO用量,EPO/Hct作为EPO抵抗的指标。[结果]A组病人Hb、Hct和EPO用量均高于治疗前(P<0.05);B组和C组病人CPR、IL-6、PTH和EPO/Hct水平低于治疗前(P<0.05),Hb和Hct水平高于治疗前(P<0.05),但EPO用量与治疗前比较差异无统计学意义(P>0.05)。治疗后,与A组比较,B组、C组和D组的CPR、IL-6、PTH、EPO用量和EPO/Hct水平均明显降低(P<0.05),B组、C组和D组均能有效提高病人EPO疗效。相关性分析显示,EPO/Hct与CPR、IL-6、PTH呈正相关关系,与Alb呈负相关关系。[结论]不同频率血液灌流均能有效提高MHD病人EPO疗效,但就有效纠正MHD病人肾性贫血而言,选择常规透析联合血液灌流治疗时,需要综合病人的情况,可建议病人接受常规血液透析联合每周1次血液灌流治疗。
引文
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[16] 谢祖刚,陈安安,石相雅,等.不同频率血液灌流治疗对甲状旁腺激素和血清钙磷清除的研究[J].中国血液净化,2014,13(5):380-383.
[17] AL-HILALI N,AL-HUMOUD H,NINAN V T,et al.Does parathyroid hormone affect erythropoietin therapy in dialysis patients?[J].Med Princ Pract,2007,16(1):63-67.
[18] 张磊,崔美玉,许冬梅,等.甲状旁腺激素与血液透析患者促红细胞生成素疗效的关系[J].中国血液净化,2009,8(4):203-205.
[19] 翟红霞.不同血液净化方式对尿毒症患者促红细胞生成素疗效的影响[J].继续医学教育,2009,23(5):43-45.
[2] KANBAY M,PERAZELLA M A,KASAPOGLU B,et al.Erythropoiesis stimulatory agent-resistant anemia in dialysis patients:review of causes and management[J].Blood Purif,2010,29(1):1-12.
[3] OKAZAKI M,KOMATSU M,KAWAGUCHI H,et al.Erythropoietin resistance index and the all-cause mortality of chronic hemodialysis patients[J].Blood Purif,2014,37(2):106-112.
[4] VASLAKI L,MAJOR L,BERTA K,et al.On-line haemodiafiltration versus haemodialysis:stable haematocrit with less erythropoietin and improvement of other relevant blood parameters[J].Blood Purif,2006,24(2):163-173.
[5] BOSSOLA M,MUSCARITOLI M,TAZZA L,et al.Switch from bicarbonate hemodialysis to hemodiafiltration with online regeneration of the ultrafiltrate(HFR):effects on nutritional status,microinflammation,and beta-microglobulin[J].Artif Organs,2005,29(3):259-263.
[6] 徐鹏,陈卫东.不同血液净化方式对维持性血液透析患者红细胞生成素疗效的影响[J].中国血液净化,2014,13(6):437-440.
[7] YAMAMOTO T,MIYAZAKI M,NAKAYAMA M,et al.Impact of hemoglobin levels on renal and non-renal clinical outcomes differs by chronic kidney disease stages:the Gonryo study[J].Clin Exp Nephrol,2016,20(4):595-602.
[8] KAWAHARA K,MINAKUCHI J,YOKOTA N,et al.Treatment of renal anaemia with erythropoiesis-stimulating agents in predialysis chronic kidney disease patients:haemoglobin profile during the 6 months before initation of dialysis[J].Nephrology,2015(Suppl 4):29-32.
[9] LEE D J,FRAGATA J,PESTANA J O,et al.Erythropoietin resistance in end-stage renal disease patient with gastric antral vascular ectasia[J].J Bras Nefrol,2015,37(3):410-413.
[10] SZCZECH L A,BARNHART H X,INRIG J K,et al.Secondary analysis of the CHOIR trial epoetin–αdose and achieved hemoglobin outcomes[J].Kidney Int,2008,74(6):791-798.
[11] IBRAHIM I A,MOHAMAD U M,DARWEESH H A,et al.Impact of hepcidin,interleukin 6,and other inflammatory markers with respect to erythropoietin on anemia in chronic hemodialysis patients[J].The Egyptian Journal of Internal Medical,2014,26(1):6-14.
[12] 李聪,陈楠.炎症在维持性血液透析患者血管内皮损伤中作用及抗炎治疗[J].中国血液净化,2011,10(2):100-104.
[13] ZHANG Y,MEI C L,RONG S,et al.Effect of the combination of hemodialysis and hemoperfusion on clearing advanced glycation end products:aprospective,randomized,two-stage crossover trial in patients under maintenance hemidualysis[J].Blood Purif,2015,40(2):127-132.
[14] ZOCCALI C,TRIPEPI G,MALLAMACI F,et al.Dissecting inflammation in ESRD:do cytokines and C-reactive protein have a complementary prognostic value for mortality in dialysis patients[J].J Am Soc Nephrol,2006,17(12Suppl3):S169-173.
[15] WANG Y T,FU J J,LI X L,et al.Effects of hemodialysis and hemoperfusion on inflammatory factors and nuclear transcription factors in peripheral blood cell of multiple organ dysfunction syndrome[J].Eur Rev Med Pharmacol Sci,2016,20(4):745-750.
[16] 谢祖刚,陈安安,石相雅,等.不同频率血液灌流治疗对甲状旁腺激素和血清钙磷清除的研究[J].中国血液净化,2014,13(5):380-383.
[17] AL-HILALI N,AL-HUMOUD H,NINAN V T,et al.Does parathyroid hormone affect erythropoietin therapy in dialysis patients?[J].Med Princ Pract,2007,16(1):63-67.
[18] 张磊,崔美玉,许冬梅,等.甲状旁腺激素与血液透析患者促红细胞生成素疗效的关系[J].中国血液净化,2009,8(4):203-205.
[19] 翟红霞.不同血液净化方式对尿毒症患者促红细胞生成素疗效的影响[J].继续医学教育,2009,23(5):43-45.