促红细胞生成素改善慢性肾功能衰竭血透患者红细胞质量

THE EFFECTS OF ERYTHROPOIETIN ON THE QUALITY OF ERYTHROCYTE IN MAINTAIN HEMODIALYSIS PATIENTS

目的：探讨重组促红细胞生成素（ｒＨｕＥＰＯ）替代治疗慢性肾功能衰竭（ＣＲＦ）贫血患者的红细胞质量改变。方法：选择４３例ＣＲＦ维持性血透贫血患者，２４例应用ｒＨｕＥＰＯ治疗，１９例应用输血治疗，分别观察两组治疗前、后，血红蛋白（Ｈｂ）、血球压积（Ｈｃｔ）、脂质过氧化物（ＬＰＯ）、超氧化物岐化酶（ＳＯＤ）和Ｎａ＋－Ｋ＋ＡＴＰａｓｅ活性变化以及分析Ｎａ＋－Ｋ＋ＡＴＰａｓｅ活性与ＬＰＯ，ＳＯＤ之间相关性。结果：治疗后两组Ｈｂ、Ｈｃｔ均显著升高，ｒＨｕＥＰＯ组ＬＰＯ显著下降（Ｐ＜０．０５），ＳＯＤ和Ｎａ＋－Ｋ＋ＡＴＰａｓｅ活性显著升高（Ｐ＜０．０５）。输血组ＬＰＯ，ＳＯＤ和Ｎａ＋－Ｋ＋ＡＴ－Ｐａｓｅ活性差异不显著，并且Ｎａ＋－Ｋ＋ＡＴＰａｓｅ与ＬＰＯ水平呈显著负相关（ｒ＝－０．４９１，Ｐ＜０．０５），ＳＯＤ活性呈正相关（ｒ＝０．４１３，Ｐ＜０．０５）。结论：ｒＨｕＥＰＯ、输血均能纠正ＣＲＦ患者贫血，增加红细胞数量，前者并能改善红细胞质量，但后者不能。

OBJECTIVE To investigate the effects of recombinant human erythropoietin (rHuEPO)on the quality of erythrocyte in maintenance hemodialysis patients. METHODOLOGY Forty three patients on maintenance hemodialysis for an sverage time of 9±3 months were enrolled into this study.Anemia was corrected by rHuEPO in 24 patients and by flesh blood transfusion in the other 19 patients.The targeted hematocrits(Hct)in both groups of patients were 30%.Hct,hemoglobin(Hb),plasma lipid peroxides(LPO) concentration,plasma superoxide dismutase (SOD) and erythrocyte memtrane Na + K +ATPase activity were examined before and after the Hct correction. RESULTS No difference was found between the pre rHuEPO Hct(18 61±0 52 %)and the pre transfusion Hct(19 33±0 72 g/L),or between the post rHuEPO Hct(30 52±0 63 %)and the post transfusion Hct(29 80±0 82 %)。In rHuEPO treated patients,the mean plasma LPO concentration was significantly reduced(from 5 72±1 43 nmol/ml to 4 08±1 02 nmol/ml, P <0 05)and the average erythrocyte SOD activity was significantly increased (from 903 92±73 21 u/gHb to 1309 24±92 80 u/gHb, P <0 05)after the rHuEPO treatment.Activity of erythrocyte membrane Na + K +ATPase Was markedly elevated after rHuEPO treatment [from 13.41±0 53 μmol pi/(g Hb·2h) to 16.72±1 98 μmol pi/(g Hb·2h), P <0 05].While in transfused patients,no significant changes were detected in serum LPO concentration,SOD and Na + K + ATPase activity.The Na + K + ATPase activity was negatively correlated with the serum LPO concentration( r = 0 491, P <0 05)and positively correlated with the SOD activity( r =0 413, P <0 05). CONCLUSION Treatment with rHuEPO does correct hemoglobin concentration and hematocrit in anemic patients on maintenance hemodialysis,and also improve the quality of erythrocyte,whereas transfusion does not improve the quality of erythrocyte.