促红细胞生成素治疗肾性贫血的红细胞抵抗血管紧张素转化酶抑制剂合用的影响

The observation on the erythrocyte resistance during the erythropoiesis treating the anemia of chronic renal failure and the effect using angiotensin-converting enzyme inhibitor

目的研究血管紧张素转化酶抑制剂应用剂量及时间对促红细胞生成素治疗肾性贫血的影响。方法对66例肾性贫血实行个体化血液透析。将入选病例分成仅应用促红细胞生成素组、仅应用血管紧张素转化酶抑制剂组,两者均应用组和两者均未应用的对照组四组。主要观察指标为四组患者在治疗前和治疗2周、4周、8周、12周时空腹抽血检测Hb、Hct。结果ACEI+EPO组组内相比较,Hb、Hct无显著性差异,P>0.05。与对照组相比较,ΔHb、ΔHct4周时较对照组存在显著性差异P<0.05。EPO组与EPO+ACEI组组间ΔHb比较,仅在12周时有显著性差异,P<0.05。两组间ΔHct组间比较与ΔHb相同,仅在12周时存在显著性差异,P<0.05。结论许多因素可导致EPO治疗肾性贫血的抵抗,ACEI亦为其中之一;ACEI对慢性肾功能不全患者可加重贫血或造成EPO抵抗。

Objective To assess the effect of angiotensin-converting enzyme inhibitors(ACEI) in the procedure of EPO treating the anemia of chronic renal failure patients receiving blood dialysis and observe the change of the hemoglobin(Hb) when the treatment plan is the respective application with EPO,EPO+ACEI at different time. Method This study included 66 maintenance hemodialysis patients who were divided into EPO treatment without ACEI(EPO group, n=25), EPO treatment plus ACEI (EPO+ACEI group n=16), ACEI treatment without EPO (ACEI group, n=13), and neither EPO nor ACEI treatment (control group,n=12). Hemoglobin level (Hb) and hematocrit (Hct) were observed at pretreatment, two-weeks, four-weeks, eight-weeks, and twelve-weeks' treatment. Results In the ACEI+EPO group, the Hb and Hct hadn't significally different. However, when compared with the control group, the ΔHb and ΔHct appeared significally different from four-weeks. When the comparison between EPO group and EPO+ACEI group, only when the twelve-weeks ΔHb and ΔHet had significally difference, P<0.05. Conclusion The resistance agents during the EPO treating renal anemia include hyperparathy roidism, aluminium over loading, angiotensin-converting enzyme inhibitor's appliance, and dialysis unsufficient malnutrition, hemolysis malignant tumor, myelofibrosis, hemoglobinopathy etc. ACEI influences on the erythropoietin action effect.