红细胞生成素纠正贫血后血液透析患者心脏功能的变化

Changes of cardiac function in hemodialysis patients after anemia correction by erythropoietin

目的:通过重组人红细胞生成素(rHuEPO)纠正贫血,阻断心衰、肾衰和贫血形成的恶性循环,提高血液透析患者生存质量及存活率。方法:血红蛋白(Hgb)≤85g·L-1、红细胞压积(Hct)≤25%的患者,接受rHuEPO治疗,起始剂量每周100U·kg-1,分2次皮下注射,疗程为12周,预期目标值为Hgb100～110g·L-1、Hct30%～33%;有76例患者完成12周治疗后未被剔除,将Hgb≥100g·L-1、Hct≥30%的患者30例列入观察组,Hgb<100g·L-1、Hct<30%的患者46例列入对照组。结果:显效27例、有效39例,总有效率86.84%(66/76);2组患者治疗后Hgb均显著升高(P<0.01),但观察组患者Hgb升高较对照组更显著(P<0.01)。经治疗改善贫血后,可使所有患者重度心功能不全(Ⅲ级/Ⅳ级)构成比及心率显著下降(P<0.01,P<0.05),EF、SV显著增高(P<0.01);并使观察组患者LVDd明显缩小(P<0.05)。治疗12周后,观察组与对照组的EF、SV、LVDd改变差异有显著性(P<0.05)。结论:及早应用rHuEPO纠正贫血达目标值能使血液透析患者的心脏功能和结构好转。

OBJECTIVE To improve survival quality and survival rate of hemodialysis（HD） patient by blocking infernal circle of congestive heart failure, chronic renal failure, and correcting anaemia. METHODS The patients presented heamoglobin （Hgb）≤85 g·L^-1,hematocrit （Hct）≤25 % accepted twice a week hypodermic injection rHuEPO therapy for 12 weeks, initial dose 100 U·kg^-1 per week, target was Hgb 100 - 110 g·L^-1 , Hct30%-33%. There were 76 patients be selected after 12 weeks, 30 （Hgb≥100g·L^-1 , Hct≥30% ） be classified into observation group（OG）, 46（ Hgb〈100 g·L^-1 , Hct〈30%） be classified into control group（CG）. RESULTS The 27 patients excellence, 39 patients in effect, total effective rate 86. 84G （66/76）. Hgb higher in all patients（P〈0. 01）, but more obviously in OCT than CG（P〈0. 01）. Improved anaemia made constituent ratio of severe cardia insufficiency（grade Ⅲ/grade IV）and heart rate significant descent （P〈0. 01, P〈0. 05）, ejection fraction （EF）, stroke volume （SV） significant increase （P〈0. 01）. Left ventricular end-diastole diameter （LVEDd） grew downwards very significance in OG patients. There were significant difference（P〈0.05） in EF, SV, and LVDd between OG and CG after 12 weeks rHuEPO therapy. CONCLUSION Anaemia correction to reach target by rHuEPO therapy at an early date, can make cardiac function and structure improved in HD patients.