不同血液净化方式对尿毒症患者促红细胞生成素疗效的影响

The Application of "Case Methods of Teaching" to the Teaching of Pathophysiology

目的:研究不同血液净化方式对尿毒症患者促红细胞生成素疗效的影响。方法:选择维持性血液透析患者50例,随机分为血液透析(HD)组、血液透析滤过(HDF)组和血液透析联合血液灌流(HD+HP)组,记录治疗前和治疗6个月后患者每周促红细胞生成素用量与红细胞压积的比值(EPO/Hct)、C-反应蛋白(CRP)和甲状旁腺素(PTH)的变化。结果:治疗后与治疗前各组内对比,HDF组和HD+HP组患者EPO/Hct、CRP、PTH有所下降,HD组患者各指标无变化。治疗后3组间对比,HDF组及HD+HP组EPO/Hct、CRP、PTH低于HD组,HDF组PTH水平高于HD+HP组,HDF和HD+HP组间EPO/Hct及CRP对比无差异。单因素分析提示EPO/Hct与CRP及PTH呈正相关。结论:HDF及HD+HP治疗能够提高尿毒症患者促红细胞生成素疗效。其机制至少部分与改善了该人群的甲状旁腺功能亢进及微炎症状态有关。

Objective： To investigate the effect of different blood purification methods on responsiveness to erythropoietin （EPO） in uremia patients. Methods： 50 patients on maintenance hemodialysis were randomly divided into HD group, HDF group and HD＋HP group. The ratio of weekly EPO dosage to Hct （EPO/Hct） was regarded as responsiveness to EPO. EPO/Hct, serum PTH and serum CRP levels were observed before and after 6 months treatment. Results： EPO/Hct, PTH, CRP were decreased significantly after treatment in HDF group and HD＋HP group while no significant difference was found in HD group. After 6 months treatment, the levels of EPO/Hct, PTH, CRP in HDF group and HD＋HP group were lower than in HD group. The level of PTH was lower in HD＋HP group than in HDF group and no difference was observed in EPO, CRP between the two groups. Univariate analysis showed that EPO/Hct was positively correlated with PTH and CRP. Conclusion： HDF and HD＋HP may improve the responsiveness to EPO in uremia patients. The reason was considered at least in part with the relief of hyperparathyroidism and microinfiammation.