重组人促红细胞生成素治疗肾性贫血的疗效分析

To evaluate the therapeutic effect of recombinant human erythropoietin on renal anemia

目的观察重组人促红细胞生成素（rHuEPO）治疗慢性。肾衰竭患者贫血的疗效。方法选择我院慢性肾衰竭患者42例，分为2组，其中慢性肾衰竭维持性血液透析患者21例为血液透析组（HD组），慢性肾衰竭维持性腹膜透析患者21例为腹膜透析组（PD组）。所有慢性肾衰竭患者分别于入组后的第1天、3个月、6个月测定血红蛋白（Hb）、红细胞计数（RBC）、血细胞比容（Hct）、网织红细胞计数（Ret）、全段甲状旁腺素（iPTH）和促红细胞生成素（EPO）水平。结果①治疗前，2组间Hb、RBC、Hct、Ret、iPTH和EPO无统计学差异（P〉0．05）。②治疗后第3个月，HD组Hb、Hct低于PD组（P〈0．05），iPTH高于PD组（P〈0．05）。③治疗后第6个月，HD组Hb、Hct、iPTH与PD组相比无显著性差异（P〉0．05）。④相关分析表明，慢性肾衰竭患者Hb与iPTH呈负相关（r=-0．81，P〈0．05），与RBC、Hct和Ret呈正相关（r分别为0．79、0．91、0．59，P〈0．05），与EPO水平无相关性（P〉0．05）。结论慢性肾衰竭患者的贫血程度与甲状旁腺功能有关。rHuEPO治疗早期，腹膜透析较血液透析更容易改善患者的贫血状况，可能与前者较好的清除血iPTH有关，但随着治疗时间的延长，腹膜透析此方面的优势不再明显。

Objective To evaluate the therapeutic effect of recombinant human erythropoietin （rHuEPO） on chronic renal failure patients with anemia. Methods Forty-two chronic renal failure patients were divided into two groups,group HD was composed of 21 patients with hemodialysis,group PD was composed of 21 patients with peritoneal dialysis. The parameters including hemoglobin（ Hb）, red blood cell（RBC） ,hematocrit（Hct） ,reticulocyte（Ret）,estimated glomerular filtration rate （eGFR）, erythropoietin （EPO） and intact parathyroid hormone （iPTH） were analyzed at the first day, the third month,the sixth momth. Results Before treatment, there were no difference with the level of Hb, RBC, Hct, Ret, iPTH and EPO between two groups （P〉0. 05）. （2）After treatment for three months, Hb and Hct in group HD was lower than that of group PD（P〈0. 05） ,but the level of iPTH in group HD was higher than that in group PD（P〈0. 05）. （3）After treatment for six months, Hb, Hct and iPTH in group HD and group PD had no difference（P〉0. 05）. （4）The level of Hb in patients with chronic renal failure was negative correlation with level of iPTH （r = - 0. 81, P〈0. 05）, was positive correlation with level of RBC, Hct and Ret（r = 0. 79,0. 91,0. 59,P〈0. 05）, and had no correlation with level of EPO（P〉0. 05）. Conclusions The degree of anemia in patients with chronic renal failure is correlation with level of iPTH. The advantage of peritoneal dialysis on improving the degree of anemia is obvious at the early time, but the advantage gradually disappear.