维持性血液透析患者对促红细胞生成素不同反应性的研究

Investigation of the reason of different reactions to the erythropoietin in maintenance hemodialysis patients

目的 探讨血液透析患者对促红细胞生成素 (EPO)不同反应性的机理。方法 选择本院 5 2例维持性血液透析患者 ,用放射免疫法检测免疫性甲状旁腺激素 (iPTH)、EPO及中和性EPO抗体 ,并检测常规生化及血红蛋白水平。分析维持性血液透析患者EPO水平及血红蛋白 (Hb)、尿素氮 (BUN)、iPTH、碱性磷酸酶 (ALP)的关系 ,探讨透析充分性与EPO、Hb、BUN、iPTH及ALP的关系 ,并进一步研究EPO抗体和贫血的关系。结果 ①血液透析患者EPO与BUN及ALP存在显著负相关 (r分别为 - 0 .35 ,- 0 .4 1,P <0 .0 5 ) ,但EPO与Hb、Kt/V及iPTH等均无相关性。Hb与BUN、ALP、iPTH等无相关关系 (r分别为 - 0 .0 3、- 0 .0 5、0 .12 ,P均 >0 .0 5 ) ;②Kt/V大于 1.2透析较充分的一组中Hb高而iPTH较低 ,Kt/V小于 1.2的一组中Hb低而iPTH较高 ,两组之间的差异有统计学意义 ,但在两组中BUN、Alb、ALP及EPO水平无明显差别 ;③利血宝组及益比奥组抗EPO抗体的阳性例数分别为 1例 (1/ 17)、2例 (2 / 35 ) ,两例抗体滴度为 1∶8～1∶16 ,益比奥组中有 1例EPO抗体滴度为 1∶12 8,该患者骨髓活检示红系增生低下 -纯红再障。结论 维持性血液透析患者EPO与BUN及ALP存在显著负相关 ,但贫血程度与EPO、BUN、iPTH、ALP无明显直接相关 ,充分透析能较好改?

Objective To investigate the reason of erythropoietin different response in maintenanc hemodialysis patients. Methods Immunoreactive parathyroid hormone (iPTH), serum erythropoietin level and its antibody of 52 hemodialysis patients were measured by RIA, the blood biochemistry and hemoglobin concentration were determined by conventional methods at the same time. Results There was significant negative correlation between the level of erythropoietin and BUN and (ALP) alkaline phosphatase(r=-0.35,-0.41, respectively, P<0.05). There was no correlation between erythropoietin and Hb, Kt/V and iPTH. While no correlativity of Hb with BUN, ALP and iPTH as well as EPO was found(r=-0.03、-0.05、0.12, respectively, all P>0.05). The level of hemoglobin in Kt/V >1.2 group is higher than that in Kt/V <1.2 group, yet iPTH has a contrary result. The levels of Hb and iPTH were obviously different between the two groups, while there was no obvious difference of BUN, Alb, ALP and EPO between the two groups. The antibody of erythropoietin was measured in the 52 patients. The result of three patients was positive, 1(1/17) in ESPO group and the other 2(2/35) in epiao group. The titer of antibody is 1:8-1:16 in two patients, 1:128 in the other, who is diagnosed pure red-cell aplasia. Conclusion There was significantly negative correlation between erythropoietin and BUN, ALP in maintenance hemodialysis patients, but there was no correlation between Hb and erythropoietin, BUN, Kt/V and iPTH. The adeguate dialysis can improve renal anemia. The recombinant human erythropoietin can induce the antibody of erythropoietin and pure red-cell aplasia in hemodialysis patients.