C-反应蛋白水平与血液透析患者贫血和促红细胞生成素抵抗的关系

Serum C-reactive protein predicts erythropoietin resistance in hemodialysis patients

目的 探讨维持性血液透析患者C -反应蛋白 (CRP)与贫血和促红细胞生成素 (EPO)疗效的关系。方法 96例维持性血液透析患者于透析日空腹采血测定血红蛋白 (Hb)、红细胞比积 (Hct)、血清铁蛋白 (SF)、转铁蛋白饱和度 (TSAT)以及血浆白蛋白 (Alb)、血脂、纤维蛋白原 (Fib)和CRP ,记录重组人红细胞生成素 (rHuEPO)用量 ,以rHuEPO用量 /Hct比值 (EPO/Hct)作为EPO抵抗指标。结果 96例患者中 5 7例(占 5 9.4 % )CRP升高 (CRP增高组 ) ,39例 (占 4 0 .6 % )正常 (CRP正常组 ) ,CRP增高组rHuEPO用量、EPO/Hct比值、Fib和CRP水平均高于CRP正常组 ,Hct、Hb、血浆白蛋白 (Alb)低于CRP正常组 ;多因素逐步回归分析表明 ,影响EPO/Hct比值的因素有CRP、Alb和透析疗程 (R2 =0 .388,P =0 .0 39)。结论 微炎症反应在维持性血液透析患者中较为常见 ,C -反应蛋白升高是促红细胞生成素抵抗的独立影响因素。

Objective To investigate serum C-reactive protein (CRP) level and its correlation with erythropoietin (EPO) resistance. Methods Ninety-six maintenance hemodialysis patients (including 56 men and 40 women), aged (50.6±14.9) years were studied. Blood samples were collected at the day on hemodialysis for the determination of serum albumin, iron indicts, fibrinogen, CRP, hemoglobin (Hb) and hematocrit (Hct). The EPO resistance was defined according to the recombinant human erythropoietin (rHuEPO) dosage to Hct (EPO/Hct) ratio. Results Patients in elevated serum-CRP group (57 cases,59.4%) had higher dosage of rHuEPO, EPO/Hct ratio, and fibrinogen level, but lower levels of serum albumin, Hb and Hct, as compared with the patients in normal serum-CRP group (39 cases, 40.6%). Multiple stepwise regression analysis showed that the levels of serum albumin, serum-CRP and the duration of hemodialysis were the best predictors of EPO/Hct (R_2=0.338, P=0.039).Conclusions There is a prevalence of microinflammatory state in the maintenance hemodialysis patients. The microinflammatory state is the most important predictor of the EPO resistance.